Repair Of Zone Research Articles

PRIMARY REPAIR OF ZONE I FLEXOR TENDON INJURIES

Eighty-two patients who were treated by suture repair for zone I flexor tendon injuries over a ten-year period were identified, to determine the incidence of post-operative surgical complications and subsequent re-operations. Eighty-five percent of patients completed 12 weeks follow-up post-surgery. Of these patients almost all had good to excellent outcome in terms of total active movement (TAM). However when assessing the range of motion at the distal interphalangeal joint (DIPJ), only 23% could be classified as having good or excellent results at final follow-up. A total of six patients (7.32%) required surgery for tendon repair complications. This study illustrates that DIPJ ROM is more indicative of functional recovery after tendon repair in flexor zone I. Given the DIPJ is important in providing a fine pinch and a span pinch grip movements, patients should be counselled for inability to perform these functions post-tendon repair.

Functional evaluation and influencing factor analysis after repair of zone V flexor tendon injury

Objective To evaluate the functional outcome after repair of zone V flexor tendon and to identify the relevant factors affecting the outcome. Methods A total of 52 patients ( 163 fingers) with wrist lacerations involving zone V flexor tendon from September 2003 to July 2009 were retrospectively studied.The average follow-up period was 32 months.The lacerated tendons were repaired by using three suture methods of different strands.Functional outcome was assessed by determining the active range of motion (AROM),and grip and pinch strength of the injured fingers,testing the independent flexor digitorum superficialis (FDS) action and employing the disability of arm,shoulder,and hand (DASH) questionnaire.Influencing factors for function of the repaired tendon including laceration section levels,repair methods,surgeons' experience,and injury severity were analyzed statistically. Results Functionally,146 out of 163 fingers (89.6％) achieved excellent or good range of motion and 103 out of 147 fingers with FDS injury (70.1％ ) obtained independent FDS action.Grip and pinch strength recovered to about two-thirds of the uninjured level.The mean DASH score was 11.9.Patients had adverse functional outcorme in tendons repaired with the 2-strand Kessler,in the tendons repaired by the surgeons with low level of expertise,or in the wrists with Spaghetti injuries,but levels of laceration section had no significant influence on the outcomes. Conclusions Functional recovery of zone V flexor tendon injuries is generally good,but repair methods,levels of expertise of surgeons,and injury severity have significant influences on the outcome.Thereby,advanced levels of expertise of surgeons can effectively improve the postoperative function. Key words: Finger injuries; Tendons; Flexor tendon

Readmission audit in a single plastic surgery unit in light of recent department of health policy on non-payment for emergency readmissions

s / International Journal of Surgery 10 (2012) S53–S109 S68 ABSTRACTS pain (associated with removal of non-absorbable sutures) favours the use of absorbable sutures in the elective-hand-surgery. Further RCTs are required. 0687: READMISSION AUDIT IN A SINGLE PLASTIC SURGERY UNIT IN LIGHT OF RECENT DEPARTMENT OF HEALTH POLICY ON NONPAYMENT FOR EMERGENCY READMISSIONS John Martin, Adnan Tahir, Haroon Siddiqui. Department of Plastic Surgery, Jame's Cook University Hospital, Middlesbrough, UK Introduction: In April 2011 a Department of Health policy came into effect stating that no tariffs would be paid for readmission of patients to hospital within 30 days of discharge. The purpose of this audit was to determine the reasons behind readmissions in our unit. Methods:We evaluated readmissions over a one-year period fromOctober 2009 to October 2010. A total of 140 patients were identified. 50 patients were randomly selected to conduct this audit. We also compared the readmission rate in plastic surgery to other specialties in our hospital. Results: Readmission to plastic surgery made up one per cent of the total readmissions in our hospital over a one-year period. Of the patients readmitted in plastic surgery, 34/50 (68 per cent) were emergencies and 16/50 (32 per cent) were elective. 18 per cent of readmissions were planned as part of ongoing treatment, for example delayed grafting of a wound bed, but were wrongly coded as readmissions. 8 per cent of readmissions were unrelated to the original admission. Conclusions: This audit has shown that this rule is difficult to apply in surgical practice and coding entries for planned or unplanned admissions are complex and inaccurate in the NHS. 0744: RE-RUPTURE RATE FOLLOWING PRIMARY FLEXOR TENDON REPAIR OF THE HAND WITH POTENTIAL CONTRIBUTING RISK FACTORS: CASE SERIES Mazin Ibrahim, Mai Rostom, Mohamed Asim Khan, Alastair James Platt. Castle hill hospital, Cottingham, UK Aim: Flexor tendon injuries of the hand are common with over 3,105 per annum in the UK. This study was aimed to investigate re-rupture rate following primary flexor tendon repair at our institution and to identify potential risk factors. Method: 51 patients with 101 flexor tendons' injuries who underwent primary repair over one year period were reviewed. Data was collected on age, gender, occupation, co morbidities, injured fingers, hand dominance, smoking status, time to surgery, surgeon grade, type of repair and suture, and antibiotic use. Causes of re-rupture were examined. Results: Re-rupture rate was 10.9%. Mean age was 35.8. Primary tendon repairs with re-rupture were compared to those without re-rupture. Univariate and multivariate analysis was undertaken to identify significant risk factors. Significantly higher rate was noted when the repair was performed on the dominant hand (p-value 1⁄4 0.009), in zone 2 (0.001), and when a delay more than 72 hours occurred (0.01). Multivariate regression analysis identified repair in zone 2 injuries to be the most significant predictor of re-rupture. Conclusions: Re-rupture rate of 10.9% was associated with delay in surgery, repair on dominant hand, and zone 2 repairs. Careful consideration for these factors is crucial to reduce this rate. 0803: PLASTIC SURGERY TOURISM COMPLICATIONS PRESENTING TO AN NHS HOSPITAL – A ONE YEAR RETROSPECTIVE STUDY Nicholas Segaren , Kumaran Shanmugarajah , Sheraz Markar , Neil Segaren , Onur Gilleard , Kalpesh Vaghela . Chelsea and Westminster Hospital, London, UK; Queen Victoria Hospital, East Grinstead, UK; Royal Derby Hospital, Derby, UK; Kingston General Hospital, London, UK Aim: The advent of cosmetic surgery tourism packages has led to an increase in the number of people from the UK flying to foreign destinations to undertake procedures by plastic surgeons that may not have any affiliation to a regulatory body. Any complications from these operations are dealt with in NHS funded units back in the United Kingdom. We wanted to investigate the potential impact that these presentations had on our department. Method: We conducted a retrospective study examining all presentations to Chelsea and Westminster Hospital for complications following plastic surgery procedures undertaken abroad. The data was collected from January 2011 to the end of December 2011. Results: There were 21 patients in total, nineteen females and two males, the mean age was 38.6. Fourteen patients presented with complications from craniofacial procedures, and six following breast augmentation procedures. One patient was admitted with an infected buttock implant. The average in-patient stay was 2.6 days. Conclusions: The popularity of cosmetic surgery abroad is increasing and therefore the complication rates will rise in the future. The recent scandal regarding the PIP breast implants has further highlighted the potential dangers of cut price cosmetic surgery abroad. 0825: AN AUDIT EXPLORING THE ADEQUACY OF CONSENT FORMS IN PATIENTS RECEIVING EMERGENCY BURNS TREATMENT Samim Ghorbanian , Nicki Bystrzonowski , Pundrique Sharma , B Philips . 1 Lister Hospital, Stevenage, UK; Broomfield Hospital,

Prospective Morphologic and Dynamic Assessment of Deep Flexor Tendon Healing in Zone II by High-Frequency Ultrasound: Preliminary Experience

The purpose of this article is to prospectively evaluate early postoperative morphologic and functional changes after deep flexor tendon repair in zone II using ultrasound and to correlate findings from ultrasound with the clinical outcome. Ten patients (mean age, 34 years; range, 19-55 years) with 11 injured deep flexor tendons of the hand underwent surgical tendon repair. Postoperative tendon morphology was assessed with gray-scale and power Doppler ultrasound over a period of 3 months. Tendon excursion over the proximal interphalangeal joint was assessed by sonographic scar tracking. Correlation of ultrasound findings with clinical outcome was performed. Almost all repaired tendons exhibited a spindlelike shape after 1 week, of which 50% developed a normal shape after 12 weeks. A persisting spindlelike shape over 3 months was associated with a significantly increased tendon excursion (p < 0.05) and a trend toward better active motion of the fingers (p = 0.056). Tendons with increased power Doppler signal showed a significantly better tendon excursion and active motion after 12 weeks (all p < 0.05). Tendon excursion measurements obtained by scar tracking showed excellent correlation (r = 0.84; p < 0.05) with total active finger motion. Preliminary data of this study indicate a better clinical outcome if a sutured tendon maintains a spindlelike shape and increased power Doppler signal. This might indicate a predominantly intrinsic healing pattern with reduced adhesion formation. Ultrasound morphology, power Doppler signal, and tendon excursion may be helpful tools to rate tendon healing and to establish individually modified rehabilitation protocols.

Systematic review of flexor tendon rehabilitation protocols in zone II of the hand.

Restoration of function following flexor tendon repair in zone II represents a difficult clinical problem. Despite many publications on rehabilitation methods, there exists no consensus as to which method is superior. This study was undertaken to determine which flexor tendon rehabilitation protocol provides the best outcome after surgical repair in zone II. Electronic databases were searched for articles published between 1970 and 2009. The population included patients aged 5 years and older who sustained a flexor tendon laceration in zone II. The primary outcome was rupture rate. Secondary outcomes were range of motion and quality of life. The following protocols and their variations were considered: passive flexion and active extension protocols (Kleinert type protocols), controlled passive motion protocols (Duran type protocols), combination of the Kleinert and Duran protocols, and early active motion protocols. Seventy-nine articles were identified. Fifteen studies met the inclusion criteria. The mean rate of rupture was lowest in the combined Kleinert and Duran protocols (2.3 percent) and highest in the Kleinert protocols (7.1 percent). No statistically significant differences were found. The combined Kleinert and Duran protocols and the early active motion protocols exhibited the highest proportion of digits with excellent or good results using the Strickland and Buck-Gramcko systems. One study included a quality-of-life assessment-meaningful comparison was not possible. Both early active motion protocols and combined Kleinert and Duran protocols result in low rates of tendon rupture and acceptable range of motion following flexor tendon repair in zone II. Future studies should include quality-of-life measurements using validated scales.

A biomechanical study of flexor tendon repair in zone II: Comparing a combined grasping and locking core suture technique to its grasping and locking components

All previous experimental and clinical repairs of flexor tendons in zone II have used either a grasping or a locking technique. In this article, a combined (grasping and locking) repair was compared biomechanically to its grasping and locking components. Using fresh flexor profundus adult sheep tendons, three techniques of tendon repair were tested biomechanically: the 'three figure-of-eight sutures' (a six-strand grasping technique), the 'locked cruciate repair' (a four-strand locked technique) and the 'combined technique' (a 10-strand repair using both the figure-of-eight and cruciate sutures). All repairs were tested to single-cycle tensile failure using a computerised tensometer. For each repair, the 2-mm gap force and the ultimate breaking (failure) force were recorded. Biomechanically, the combined repair was found to be the strongest regarding both gap and failure (P<0.025; two-tailed by the Mann-Whitney test). The combined 10-strand repair is stronger biomechanically than its grasping and locking components.

A six-strand technique for zone II flexor-tendon repair in children younger than 2 years of age

Introduction A six-strand repair for zone II flexor-tendon repair in children younger than 2 years of age has not been reported in the literature because of the small size of the flexor tendon in this very young age group. Purpose The aim is to introduce the use of a six-strand repair in zone II flexor-tendon repair in children younger than 2 years of age. Methods A total of 12 children younger than 2 years, with 12 injured fingers, were treated over a 10-year period. A ‘profundus only’ repair was done using three separate ‘figure of eight’ core sutures and a continuous epitendinous suture. The repair site was bulky and ‘venting’ of the pulley system proximal to the repair site was done. The hand was immobilised for 3.5 weeks after surgery and then physiotherapy exercises were started. The final net range of motion at the interphalangeal joints was measured and the outcome was assessed as per the Strickland–Glogovac criteria. Results There were no ruptures. The final outcome in range of motion was excellent in nine children and good in the remaining three children. None of the children required tenolysis. Conclusion Our six-strand technique is an alternative technique for zone II flexor-tendon repair in children younger than 2 years of age, but the bulky repair site requires a ‘profundus only’ repair and ‘venting’ of the pulley system.

Flexor tendon repair in zone III

There is a paucity of the literature on the outcome of zone III flexor tendon injuries. In this paper, we report on the results of zone III flexor tendon repair in 35 consecutive adult patients with clean cut lacerations of both flexor tendons in 42 fingers. There were 25 men and 10 women with an average age of 32 years. Repair of both flexor tendons was performed using 'figure of eight' core sutures and a continuous epitendinous suture. Postoperatively, an immediate active range of motion protocol was applied to ensure full active extension of the interphalangeal joints. The results were assessed using the Strickland-Glogovac grading system. There were no ruptures. One patient with two injured fingers developed complex regional pain syndrome and the final outcome was fair in both fingers. In the remaining 34 patients (40 fingers), 33 patients (38 fingers) had an excellent outcome and the remaining patient (two fingers) had a good outcome.

The Effects of Core Suture Purchase on the Biomechanical Characteristics of a Multistrand Locking Flexor Tendon Repair: A Cadaveric Study

To determine the effects of suture purchase on work of flexion (WOF), 2-mm gap force, and load to failure on the combination cross-locked cruciate-interlocking horizontal mattress (CLC-IHM) flexor tendon repair in zone II. A total of 33 fresh-frozen cadaveric fingers were mounted in a custom jig, and the flexor digitorum profundus of each finger was fixed to the mobile arm of a tensile strength machine. Initial measurements of WOF were obtained. Each tendon was repaired with the CLC core suture, randomly assigned to placement of 3, 5, 7 or 10 mm from the cut edge of the tendon, and completed with the IHM circumferential suture. After the repair was completed, measurements of WOF were repeated. Each finger was cycled 1000 times. After each 250 cycles, gapping was recorded, and WOF was measured again. Change in WOF (WOF after repair - WOF of intact tendon) was calculated. Tendons were then dissected from the fingers and linearly tested for 2-mm gap force and ultimate load to failure. The group repaired at 10 mm had the lowest percent increase in WOF (5.2%), the highest 2-mm gap force (89.8 N), and the highest ultimate load to failure (111.5 N). The group repaired at 3 mm had the highest percent increase in WOF (22.1%), the lowest 2-mm gap force (54.6 N), and the lowest ultimate load to failure (84.6 N). A 10-mm suture purchase is the recommended distance for optimal performance for the CLC-IHM combination repair method. This method with a 10-mm suture purchase has a low increase in WOF, high strength, and high resistance to gapping, and it should be strong enough to tolerate early motion.

Reconstruction of Circulation in the Fingertip Without Vein Repair in Zone I Replantation

In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery. We present a new technique for reconstructing circulation without vein anastomosis in zone I replantation and analyze the outcomes of this technique in terms of eliminating external bleeding and of a high survival rate of the replanted digits. Between 1997 and 2007, we performed 120 replantations in 112 patients (83 male and 29 female; mean age, 33 years; range, 3-54 years). All were zone I amputations, based on the Tamai classification. We surgically repaired both proper digital arteries, excluded the vein, and then ligated 1 of the arteries. Using this technique, circulation was restored. Included in the outcome evaluation were 91 digits in the 87 patients (mean age, 35 years; range, 14-54) who returned for outcome assessments 12 months after surgery. Of 120 digits replanted, 115 digits survived, corresponding to an overall success rate of 96%. No patients received alternative means to alleviate venous congestion, such as leeches or other means of external bleeding. Nearly all of the 87 patients (91 digits) were satisfied with the results of the replantations. Our technique reconstructs circulation without vein anastomosis in zone I replantation. This alternative to venous congestion involves a simple surgical procedure and straightforward postoperative care. Follow-up assessments of a series of 120 replantations show that the majority of zone I replantations led to satisfactory function. We therefore propose this technique as an effective method for zone I replantation. Therapeutic IV.

Clinical Results of Flexor Tendon Repair in Zone II Using a Six-Strand Double-Loop Technique Compared with a Two-Strand Technique

The clinical and functional results of 46 patients who underwent zone II flexor tendon repair using the Lim/Tsai technique combined with the Kleinert/Duran early active mobilisation regime and place and hold exercises were assessed. The results were compared with 25 patients who were treated by the modified Kessler technique and the Kleinert/Duran regime alone. After a follow-up of 8 to 17 weeks, the Lim/Tsai group had a better grip strength and a significantly better total active motion of 141 degrees compared with 123 degrees . The rupture rates (Lim/Tsai: 1/51; Kessler: 3/26) and the extension deficits were not statistically different in the two groups. However, the complication rate was significantly lower and the average time of treatment was significantly shorter in the Lim/Tsai group. These results support the use of the Lim/Tsai six-strand repair technique in zone II flexor tendon injuries and early active mobilisation without rubber-band traction.

Comparison of Arthroscopic Meniscal Repair Results Using 3 Different Meniscal Repair Devices in Anterior Cruciate Ligament Reconstruction Patients

The goal of this study was the clinical evaluation of arthroscopic meniscal repair results with the use of 3 different repair devices. From 2001 to 2006, 265 patients underwent 280 meniscal repairs (RapidLoc [DePuy Mitek, Raynham, MA] in 88 patients, T-Fix [Acufex Microsurgical, Mansfield, MA] in 85 patients, and FasT-Fix [Smith & Nephew Endoscopy, Andover, MA] in 92 patients). There were 181 medial and 99 lateral tears; 174 tears were located in Cooper radial zone 1, and 106 tears were in Cooper radial zone 2. All patients had associated anterior cruciate ligament reconstructions. Follow-up assessment included clinical examination, arthrometry (KT-1000; MEDmetric, San Diego, CA), International Knee Documentation Committee scores, and scores on Lysholm functional questionnaires. Clinical criteria for a successful result included the absence of joint line tenderness, swelling, and blocking and the presence of a negative McMurray test. The mean follow-up was 24.5 months (range, 20 to 26 months). Tear length averaged 3.17 cm (range, 1.4 to 4 cm). A mean of 2.4 suture devices was used. On the basis of our criteria, 28 meniscus repairs were considered to be failures (success rates of 92.4% for FasT-Fix, 87% for T-Fix, and 86.5% for RapidLoc). There were 16 relook arthroscopies for device removal and partial meniscectomy, with 11 patients (68.7%) having failure of the meniscal repair in zone 2. Both the Lysholm and International Knee Documentation Committee scores were significantly improved. Chronicity or location of the tear, length of the tear, and patient age did not affect the clinical outcome. The compared meniscal repair systems showed comparable clinical results. These meniscal repair systems appeared to be safe and effective, providing a high rate of meniscal healing both in patients with complex tears and in patients with tears located in Cooper radial zone 2. Level III, therapeutic retrospective comparative study.

Early Results of Flexor Tendon Repair in Zone II With Modified, Four-Strand Strickland Technique

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Primary Repair of Zone II Flexor Tendon Lacerations at 5 Weeks and 5 Days after Injury

Primary Repair of Zone II Flexor Tendon Lacerations at 5 Weeks and 5 Days after Injury

Flexor Tendon Repair in Zone II With 6-Strand Techniques and Early Active Mobilization

Flexor Tendon Repair in Zone II With 6-Strand Techniques and Early Active Mobilization

Factors That Influence the Outcome of Zone I and Zone II Flexor Tendon Repairs in Children

To evaluate the factors that influenced the clinical results of zone I and II flexor tendon repairs in children at a single institution. Forty-one fingers (35 patients) in patients ages 2 to 14 years with zone I or II flexor tendon injuries were identified. There was a zone I tendon injury in 16 fingers and a zone II tendon injury in 25 fingers. Concomitant injuries to the digital nerves were seen in 18 fingers. Primary repair was performed within 1 week in 35 fingers and delayed repair (2-9 wk) was performed in 6 fingers. After surgery 22 fingers (21 patients) were treated with early controlled mobilization and 19 fingers (14 patients) were treated with plaster immobilization. All patients were available for evaluation at a mean follow-up period of 42 months. Patients were subdivided into 2 age groups: (1) 0 to 7 years and (2) 8 to 15 years. Digital performance was evaluated by determining the percentage return of normal finger function according to a total active motion formula. Functional evaluation of all digits in both groups showed excellent or good results. Zone I repairs had better results than zone II repairs and isolated tendon repairs had better results than those with associated nerve repairs. The age of the patients nor postoperative protocol did not influence the final digital motion. A good outcome can be expected after repair of zone I or II flexor tendon injuries in children. Prognostic III.

Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation

The outcome of primary extensor repair in hand surgery has been widely explored, but little systematic effort has been made to investigate the influence of the anatomical zone of tendon injury. Therefore, the aim of our study was to assess the outcome of primary extensor tendon repair with a special focus on the pre-operative state and Verdan's anatomical zones. Our hypothesis being tested was that the outcome after primary extensor repair depends on the complexity of trauma and the site of lesion. One hundred and seventy seven patients with 203 extensor tendon repairs were studied. After tendon repair and a 6-week protective immobilization, physiotherapy was carried out. A score proposed by Geldmacher and Schwarzbach was applied to estimate the outcome pre-operatively and to assess the results in a follow-up after a mean of 13 months. Correlations were tested between the anatomical zone of tendon injury, the pre-operative expectation and the results as considered both by the patient and the physician. In Verdan's zones 1, 2, 4 and 5, excellent or good results were obtained in the vast majority of patients. Due to a higher frequency of complex injuries with concomitant soft tissue and bony injuries, the outcome was significantly worse after tendon repair in zones 3 and 6, as expected after the pre-operative estimation. In addition, a strong correlation was found for all anatomical zones between the pre-operative estimation and the outcome as judged both by the physician and the patient. Recovery of finger function after primary extensor tendon repair depends on the complexity of trauma and the anatomical zone of tendon injury. Static splinting is an appropriate tool after primary extensor tendon repair in Verdan's zone 1, 2, 4 and 5, whereas injuries in zones 3 and 6 may demand for a different treatment regimen.

Flexor Tendon Repair in Zone II With 6-Strand Techniques and Early Active Mobilization

There are many biomechanic studies of 6-strand suture techniques for active mobilization, but few reports have described the clinical outcome in zone II flexor tendon lacerations. We discuss the clinical results of zone II flexor tendon repair using 2 of these techniques followed by controlled early active mobilization. Six-strand sutures using the number 1 technique by Yoshizu or a triple-looped suture technique were used to repair flexor tendons in 27 fingers from 21 consecutive patients. Fingers were mobilized by combining active extension and passive or active flexion in a protective splint for the first 3 weeks after surgery. The follow-up period averaged 13 months. Based on the original Strickland criteria, the results were excellent in 17 fingers, good in 9, and fair in 1. The average flexion was 62 degrees for distal interphalangeal joints and 91 degrees for proximal interphalangeal joints. None of the repaired tendons ruptured. The 6-strand flexor tendon suture technique followed by controlled active mobilization protected with a dorsal splint is safe, produces no ruptures, and achieves very good results in zone II flexor tendon laceration repair. Therapeutic, Level II.

Comparison of Pullout Button Versus Suture Anchor for Zone I Flexor Tendon Repair

To evaluate the clinical outcome after repair of zone I flexor tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx. Between 1998 and 2002 we treated 26 consecutive zone I flexor tendon injuries. Thirteen patients had repairs from 1998 to 2000 using a modified pullout button technique (group A) and 13 patients had repair using suture anchors placed in the distal phalanx (group B). Patient characteristics were similar for both groups. The same postoperative flexor tendon rehabilitation protocol and follow-up schedule were used for both groups. Evaluation included range of motion, sensibility and grip strength, failure, complications, and return to work. The Student t test was used to determine significant differences. All patients completed 1 year of follow-up evaluation. There were 2 infections in group A that resolved with oral antibiotics and no infections in group B. There were no tendon repair failures and no repeat surgeries in either group. At final follow-up evaluation there were no statistically significant differences for the following end points: sensibility (Semmes-Weinstein monofilament testing and 2-point discrimination), active range of motion (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined motion), flexion contracture (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined contracture), and grip strength (injured tendon as a percent of the contralateral uninjured tendon). The suture anchor group had a statistically significant improvement for time to return to work. There was no significant difference in the clinical outcome after flexor tendon repair using either suture anchors or the pullout button technique. A significant improvement was found for time to return to work for repairs using the suture anchor technique. Flexor tendon repair can be achieved using suture anchors placed in the distal phalanx, thereby avoiding the potential morbidity associated with the pullout button technique. Therapeutic, Level III.

Early active mobilization after flexor tendon repairs in zone two

This study aims to evaluate an early mobilization regimen after 136 flexor tendon repairs in zone two in 82 patients. Postoperatively patients were managed by an early mobilization program, which incorporated immediate active flexion and extension. Results are based on both the International Federation of Societies for Surgery of the Hand (IFSSH) and the Strickland systems of evaluation. The results of long fingers and thumbs were analyzed separately. The results of the long fingers group were excellent (72.2%), good (26.0%) and fair (1.9%) according to Strickland's standards and were good (81.5%), fair (16.6%) and poor (1.9%) according to the IFSSH standards. The results of the thumbs group were excellent (96.4%) and fair (3.6%) according to Strickland's standards and were excellent (82.1%), good (14.3%) and poor (3.6%) according to the IFSSH standards. This study corroborates evidence that postoperative programs that incorporate early active flexion can produce good results after flexor tendon repair in zone two.