Article
Outcomes of release of the entire A4 and partial A2 pulleys for distal zone 2 primary flexor tendon repair in 27 fingers
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Authors
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Xiang Zhou
- People's Hospital of Jiangyin, Wuxi, China
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Jun Qin
- People's Hospital of Jiangyin, Wuxi, China
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Jing Chen
- Affiliated Hospital of Nantong University, Nantong, China
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: We report the outcomes of using 6-strand M-Tang repair method in 27 flexor digitorum profundus (FDP) tendons in distal zone 2 of 23 patients followed by postoperative early active motion.
Methods: We used the 6-strand repair in repairing 27 FDP tendons of 23 patients in the past 4 years. The patients aged 17 to 63 years old, average 34 years. There are 18 men and 5 women. Twelve tendons were in zone 2A, fifteen in zone 2B. All patients were repaired primarily in the day of injury or within the first or second days after injury. The FDP tendon was repaired with a 6-strand M-Tang repair using 4-0 looped suture and sparsely placed simple running peripheral suture with 6-0 or 5-0 nylon. The C1, C2, A3, A4 pulley was completely released and A2 pulley was partial released in all fingers. After surgery, the fingers were immobilized for 3-4 days and active motion was initiated after that. The patient was encouraged to move the fingers interphalangeal joints and metacarpophalangeal joint to about ½ of the total motion range in the first 1-3 weeks after repair. Then the patient proceeded to full range of active motion around the end of week 3. The active motion was performed mostly out of splint and splint was used at the intervals not performing any motion exercise and during night.
Results and Conclusions: We tested the gliding of the repaired tendon during surgery through passive full extension and flexion of the repaired fingers immediately after repair and all repairs passed the test. There was no repair rupture in this case series. The functional outcomes were evaluated with Strickland criteria. The mean total active motion of fingers was 158°at 5 to 27 months of follow-up. The recovery of function was excellent in 17 (63%), good in 8 (30%), fair in 0 (0%) and poor in 2 (7%) fingers. No bowstringing was found in the fingers after venting of partial A2 pulley and entire A4 pulley during follow-up.
Releasing of entire A4 pulley and partial A2 pulley does not cause tendon bowstringing and achieve high excellent and good rate. We conclude that a strong repair method, such as the method used in this report, should be used and pulley should be vented properly to allow smooth tendon gliding, and early out-of-splint active motion is safe.
