Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II
Halahal, M., Abdelshaheed, M., Elnahas, W., Khalil, A., Zeid, T. (2024). Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II. EKB Journal Management System, 48(2), 163-170. doi: 10.21608/ejprs.2024.352140
Mohamed Ibrahim Halahal; Mohamed Abdelshaheed; Waleed Elnahas; Ahmed Khalil; Tamer Zeid. "Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II". EKB Journal Management System, 48, 2, 2024, 163-170. doi: 10.21608/ejprs.2024.352140
Halahal, M., Abdelshaheed, M., Elnahas, W., Khalil, A., Zeid, T. (2024). 'Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II', EKB Journal Management System, 48(2), pp. 163-170. doi: 10.21608/ejprs.2024.352140
Halahal, M., Abdelshaheed, M., Elnahas, W., Khalil, A., Zeid, T. Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II. EKB Journal Management System, 2024; 48(2): 163-170. doi: 10.21608/ejprs.2024.352140

Intratendinious Versus Extracorporeal Knot Four Strand Core Suture Repair of Flexor Tendon Injuries of the Hand Zone II

The Egyptian Journal of Plastic and Reconstructive Surgery
Article 11, Volume 48, Issue 2, April 2024, Pages 163-170    PDF (992.1 K)
Document Type: Original Article
DOI: 10.21608/ejprs.2024.352140
Authors
Mohamed Ibrahim Halahal* 1; Mohamed Abdelshaheed* 2; Waleed Elnahas3; Ahmed Khalil1; Tamer Zeid1
1The Department of Plastic Surgery, Faculty of Medicine, Mansoura University
2The Departments of Plastic Surgery, Faculty of Medicine, Mansoura University
3The Departments of Oncology Surgery, Faculty of Medicine, Mansoura University
Abstract
Background: Over the past few years, there has been a
shift in how flexor tendons are repaired. Because of adhesions
or ruptures that occurred when early active motion was attempted,
flexor tendon repairs in the digit have a long history
of producing disappointing outcomes.
Objectives: To make an evaluation to the outcomes of
flexor tendon repair using ordinary 4 strands suture with intratendinous
knot technique and comparing it with four strands
suture with extracorporeal knot. And comparing it with our innovation
technique; The four-strand suture with extracorporeal
knot.
Subjects and Methods: This interventional prospective trial
was performed on persons admitted to our emergency hospital
and Burn and Plastic Surgery Center, Mansoura University
with flexor tendon injuries zone II from February 2020 to February
2023. Patients were classified into two groups; group A
treated with the 4-strand suture with extra corporeal knot, and
group B treated with the 4-strand suture with intra tendinous
knot.
Results: Statistical analysis revealed a statistically significant
distinction among the groups according to outcome, total
active flexion (TAF) and total active range of motion (TARM)
for group A, and operation time for group B. No statistically
significant variations were observed amongst the groups
as regard socio-demographic characteristics, injury location
& dominant hand distribution among the study populations,
anesthesia WALAIAT or General, follow up period, patient or
parent’s satisfaction, age and outcome of treatment.
Conclusion: We noticed that the four strands suture with
extracorporeal knot technique for flexor tendons repair zone II
was easy to accomplish, had a lower volume and no bulk at the
site of repair, with no suture knot inside tendon at site of repair,
besides a more regular suture, that offer less interfering with
tendon gliding, less adhesion formation, adequate strong repair
for an early active post-operative mobilization protocol, good
results, good total active range of motion and good patients
satisfaction.
Keywords
ntratendinious; Extracorporeal knot; Strand core suture
References
1- Kozono N., Okada T., Takeuchi N., Hanada M., Shimoto
T. and Iwamoto Y.: Asymmetric six-strand core sutures enhance
tendon fatigue strength and the optimal asymmetry.
Journal of Hand Surgery (European Volume), Oct. 41 (8):
802-8, 2016.
2- Chang M.K., Wong Y.R. and Tay S.C.: Biomechanical
comparison of modified Lim/Tsai tendon repairs with intra-
and extra-tendinous knots. Journal of Hand Surgery
(European Volume), Nov. 43 (9): 919-24, 2018.
3- Fang Wu Y., Feng Mao W. and Bo Tang J.: The impact of
transverse components on 4-strand tendon repairs. Journal
of Hand Surgery, (17531934). Oct. 1; 46 (8), 2021.
4- Llorente V., Velarde P., Desco M. and Gómez-Gaviro
M.V.: Current Understanding of the Neural Stem Cell
Niches. Cells, 11: 3002, 2022.
5- Lilly, Soma I. and Messer, Terry M.: Journal of the American
Academy of Orthopaedic Surgeons, 14 (7): 387-396,
July 2006.
6- Han J., Wang Z., Wei G., Zhai Z., Ma L., Yi B. and Zhao
B.: Application of modified purse-string closure in the
wound following loop stoma reversal. Zhonghua wei
Chang wai ke za zhi= Chinese Journal of Gastrointestinal
Surgery, Dec. 1; 21 (12): 1403-7, 2018.
7- Jo S. and Calfee R.P.: General Principles of Current Concepts
in Flexor Tendon Repair and Rehabilitation, An Issue
of Hand Clinics, E-Book, Apr. 19; 39 (2): 131, 2023.
8- Tang J.B., Lalonde D., Harhaus L., Sadek A.F., Moriya K.
and Pan Z.J.: Flexor tendon repair: Recent changes and
current methods. Journal of Hand Surgery (European Volume),
Jan. 47 (1): 31-9, 2022.
9- Santhosh Kumar G.: A Double-Blind randomized control
study to analyze the clinical outcomes between the twostrand
modified Kessler repair and the four-strand cruciate
McLarney repair techniques following passive motion
protocol in adults (Doctoral dissertation, Christian Medical
College, Vellore).
10- Wu Y.F. and Tang J.B.: Recent developments in flexor
tendon repair techniques and factors influencing strength
of the tendon repair. Journal of Hand Surgery (European
Volume), Jan. 39 (1): 6-19, 2014.
11- Rigo I.Z. and Røkkum M.: Predictors of outcome after
primary flexor tendon repair in zone 1, 2 and 3. Journal of
Hand Surgery (European Volume), Oct. 41 (8): 793-801,
2016.
12- Lalonde D.H.: Conceptual origins, current practice, and
views of wide-awake hand surgery. Journal of Hand Surgery
(European Volume), Nov. 42 (9): 886-95, 2017.
Vol. 48, No. 2 / Intratendinious Versus Extracorporeal Knot Four S 170 trand Core Suture Repair
13- Pan Z.J., Pan L., Xu Y.F., Ma T. and Yao L.H.: Outcomes
of 200 digital flexor tendon repairs using updated protocols
and 30 repairs using an old protocol: Experience over
7 years. Journal of Hand Surgery (European Volume), Jan.
45 (1): 56-63, 2020.
14- Marume M., De Klerk S. and Khuabi L.A.: Rehabilitation
following flexor tendon injury to the hand in African countries:
A study protocol for a scoping review. BMJ Open,
Apr. 1; 11 (4): e045260, 2021.
15- Güntürk Ö.B., Kayalar M., Kaplan I., Uludağ A., Özaksar
K. and Keleşoğlu B.: Results of 4-strand modified Kessler
core suture and epitendinous interlocking suture followed
by modified Kleinert protocol for flexor tendon repairs in
Zone 2. Acta orthopaedica et traumatologica turcica, Sep.
1; 52 (5): 382-6, 2018.
16- Sadek A.F.: Flexor digitorum profundus with or without
flexor digitorum superficialis tendon repair in acute Zone
2B injuries. Journal of Hand Surgery (European Volume),
Dec. 45 (10): 1034-44, 2020.
17- Saunois M., Stavert A.R., Poulter B., Bousquet P.,
Canadell J.G., Jackson R.B., Raymond P.A., Dlugokencky
E.J., Houweling S., Patra P.K. and Ciais P.: The global
methane budget 2000–2017. Earth system science data,
Jul. 15; 12 (3): 1561-623, 2020.
18- Singh M.S., Park S.S., Albini T.A., Canto-Soler M.V.,
Klassen H., MacLaren R.E., Takahashi M., Nagiel A.,
Schwartz S.D. and Bharti K.: Retinal stem cell transplantation:
Balancing safety and potential. Progress in retinal
and eye research, Mar. 1; 75: 100779, 2020

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