Gulzar Saeed Ahmed, Syed Muhammad Ali, Mohammad Arif, Muhammad Inam.
Delayed primary repair of flexor tendon injury in distal forearm.
J Med Sci May ;21(4):183-6.

Objective: To analyze the results of delayed primary tendon repair using modified Kessler technique in patients with flexor tendon injury in distal forearm (hand zone V). Material and Methods: The study was conducted at Liaquat University Hospital and a private practice setup at Jamshoro from January 2010 to December 2011. A total of 50 adult patients were included in the study. The inclusion criteria were adult patients having injury with sharp objects in zone five of hand, presenting between 24 hours to 10 ten days after injury. The exclusion criteria were associated vascular injury requiring repair, nerve injury, diabetes mellitus, infection, and segmental loss in tendons. The primary outcome measures were, painless movement of tendon, full range of movement of finger or wrist joint associated with the repaired tendon. Secondary outcome measures were infection, limitation or painful movement of tendons, adhesions, dehiscence of repair leading to tendon rupture at the repair site. Surgery was performed under general anesthesia and tourniquet. The tendons were repaired with 3/0 proline, using modified Kessler technique. Results: Out of 50 patients, 38 (76%) were male and 12 (24%) were female. The age range was between 20 to 65 years. Mean age was 34.40 years + 12.49 SD. The injury was caused by knife in 18(36%), glass in 16(32%), hatchet in 13(26%) and machine in 3 (6%) patients. Total number of tendon repaired was 115. (2.3 per patient). Tendon repair was performed within 24 hours of admission in all patients. Modified Kessler technique was performed in all tendons repairs. Thirty eight out of 50(76%) patients recovered fully and regained full range of pain free movement at wrist and fingers in 8 to 12 weeks time. Mean time of recovery was 8.8 days + 1.319 SD. Six patients (12%) developed early post operative superficial infection. These patients responded well to treatment and recovered normally in 8 to 12 weeks time. Four (8%) patients develop adhesions resulting in limitation of movement at fingers, and two (4%) patients develop rupture of tendon at the suture site, requiring second surgery. Conclusion: Modified Kesslers suture technique of tendon repair is effective for delayed primary repair of flexor tendon injury in distal forearm (zone V).

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