TITLE:
Zone II Flexor Tendon Repair in a 13-Month-Old: Report of a Complication
AUTHORS:
Joao B. Panattoni, Mohammed M. Ahmed
KEYWORDS:
Flexor Tendon Repair; Pediatrics; Complications
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.4 No.1,
January
14,
2014
ABSTRACT: Despite early cautions against the primary repair
of zone II flexor tendon injuries, recent advances in surgical technique and suture materials have allowed such
repairs to become commonplace. The 6-strand repair technique is rarely applied
to the young pediatric population, however, to our
knowledge, no English-language articles have described this method of primary
repair in zone II of children less than 2 years old. A 13-month-old male presented flexor digitorum
profundus repair after lacerating it in zone II on a sharp aluminum can. The
tendon was repaired with a 6-strand technique, using a 4.0 Fiberloop for the
core suture and 6.0 Prolene for the epitendinous suture. Approximately four
months after surgery, the patient developed a palmar collection at the level of
his middle phalanx and a serosanguinous sinus tract at the distal
interphalangeal crease. During the revision surgery, the inspection of the repaired tendon revealed a small
gap filled with scar tissue. There was no evidence of new fistula formation at
his final visit one month after the second procedure. After the revision, the
patient could move his digit with minimal loss of range of motion at the distal
interphalangeal joints. Unfortunately, he was subsequently lost to follow up.
This surgical technique was selected to provide a strong repair that would
allow the early postoperative
movement. In retrospect, a 6-strand repair with braided suture is not ideal in
young children as the bulky suture can cause a foreign-body reaction and
possibly extrude through the skin. Additionally, the immobilization with a long-arm cast remains a
valuable tool after tendon repair in infants who cannot voluntarily restrict
their movements.