Evaluation of factors affecting the strength of hand flexor tendon repair with emphasis on anatomical zone classification

Introduction: The human hand with ۱۲ flexor tendons in the forearm and wrist enables grasping function. FDP tendons start from the medial epicondyle of the humerus and attach to the base of the distal phalanx. Damage to these tendons, especially in zone ۲, is one of the serious challenges in orthopedic surgery. The aim of this review is to examine the evidence related to the effect of different suture methods on durable repair and reducing complications such as re-rupture.Methods: The present study was a systematic review using the PRISMA ۲۰۲۰ principles. An electronic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar databases on articles from ۲۰۱۰ to ۲۰۲۵. The inclusion criteria were to investigate the outcomes of primary repair of flexor tendons in zones ۲ and ۳ using at least two different suture methods. The outcome variables included: final strength of the repaired tendon (by tensile test), the degree of diastasis (gapping) in initial active movements, and the rate of re-rupture within ۳ months after surgery. Finally, ۱۸ studies were selected after full-text evaluation.Findings: Based on ۱۸ studies, suture methods with ۶ or more strands reduce the end gap to less than ۳ mm and are stronger, but due to occupying more space, they reduce blood supply and are associated with greater adhesion and movement limitation. In contrast, simpler methods, although they increase the risk of rupture (۹-۱۱%), have shown better functional outcomes with appropriate physiotherapy. The success of the treatment seems to depend more on the accuracy of the tendon end alignment, preservation of the peritendon, and proper rehabilitation than with the suture method.Conclusion: It seems that no single suture method meets all clinical needs and its selection should be based on the affected area, patient age, expected functional activity level, and surgeon experience. Given the lack of clinical trials with a similar control group, prospective studies with a follow-up of at least one year are necessary to develop practical guidelines.

کلیدواژه ها:

Tandon ، Hand Flexor ، Anatomic