Prevention of peritendinious adhesions in zone II primary flexor tendon repair using a vein patch graft: A comparative study

  • Khazbak Ahmed M. 
  • Shaker Ayman Abu Elmakarem 
  • El Shishtawy Nihal Ibrahim 
  • Basim Mohamed Zaki
  • Nada Abdel Sattar Mahmoud
Original Paper



Adhesion after intrasynovial tendon injury is a major clinical problem. Here we assess autogenous vein graft over the primary flexor tendon repair to prevent postoperative peritendinious adhesions.


Twenty-six patients (30 digits) had an acute flexor tendon injury in zone II. Primary tenorrhaphy was done using the traditional Kessler repair technique. Patients were divided into two groups according to the management of tendon sheath defects. In group I (n = 15 digits), a patch of a marked forearm vein was harvested, divided and sutured to the tendon sheath window. In group II (n = 15 digits), the tendon sheath was left untreated. Patients were evaluated using the second Buck-Gramcko scale at 8 weeks and 6 months.


We detected no statistically significant difference between the groups. For the vein graft group, excellent results were achieved in four digits, five digits with very good results, five digits with good results and one digit with fair results. Using the traditional technique, excellent results were achieved in three digits, very good results were achieved in four digits, good results were achieved in six digits and fair results were achieved in two digits.


The use of autologous vein graft has many advantages; it is inexpensive, autologous and will not affect tendon healing. Comparing autologous vein graft to the conventional tendon repair technique, we detected no statistically significant difference. Clinically, less adhesion formation and fewer joint contractures were noted when using the autologous vein graft.

Level of Evidence: Level I, therapeutic study.


Hand Flexor tendon Finger Plastic surgery Trauma 


Compliance with ethical standards

Conflict of interest

Ahmed M. Khazbak and Ayman Abu Elmakarem Shaker declare that they have no conflict of interest.


No funding was received regarding this work.

Informed consent

A written informed consent for participation was obtained from all participants who had also provided informed consent for approval of publication of photographs.

Ethical approval

This research has been reviewed and approved by the Ethical Committee of Scientific Research MASU 1555/2011.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The Department of Plastic & Reconstructive SurgeryAl Mataria Teaching HospitalCairoEgypt
  2. 2.The Department of Plastic, Reconstructive & Craniofacial SurgeryAin Shams University HospitalsCairoEgypt
  3. 3.The Department of Physical medicine, Rheumatism & RehabilitationAin Shams University HospitalsCairoEgypt

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