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Document Type

Original Article

Abstract

Background: Anatomical complexity and postoperative adhesions make zone II flexor tendon repair difficult to achieve good functional outcomes. Tendon surgery aims to heal and limit adhesions, so primary flexor tendon repair methods are constantly being modified. Aim of the study: The purpose of this work is to assess the wide-awake approach's efficacy in treating zone II flexor-tendon injuries. Methods: A prospective study was done at Al-Azhar University Hospitals from February 2022 to August 2023, 22 participants (32 digits) with zone II flexor-tendon injuries received primary tendon repairing with4-strand core sutures utilizing local infiltration anaesthesia with the wide-awake technique. The repairwas evaluated and gapping or triggering corrected using intraoperative total active movement (ITAM)assessment. The Strickland evaluation system assessed range of motion (ROM) for 12 weeks postoperatively after early active motion rehabilitation. Results: The results indicated a 93.7% recovery of motion, with 61.3% of patients reporting good to excellent outcomes at 6 weeks, and 70.9% at 12 weeks postoperatively, demonstrating further improvement over time. Statistical analysis revealed several influencing factors, including the method of repair, rehabilitation program, gender, occupation, etiology of injury, and number of affected fingers. At 12 weeks postoperatively, 18.8% of cases had complications, including rupture of tendons (6.3%), superficially wound infections (9.4%), and poorly ROM (6.3%). Conclusions: This preliminary study demonstrates encouraging outcomes for wide-awake primary tendon repair in zone II flexor tendon injuries. This new method under conventional anesthesia is satisfactory for surgeons and patients. The technique has promise despite a small sample size, patient compliance issues, and lower-level evidence.

Keywords

Flexor tendon repair, Zone II, Wide-awake technique, Functional outcomes, Postoperative adhesions

Subject Area

Orthopedics

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