Background: Because the FDP (flexor digitorum profundus)
and the two slips of the FDS (flexor digitorum superficialis)
are crowded within a tight fibro-osseous tunnel, it has
never been easy to have good functional results after flexor
tendon restoration in zone II, elevating the possibility of
postoperative adhesions and a decrease in post-operative range
of motion and power. Main aims of tendon repair are improved
tendon healing and adhesion reduction. Primary flexor tendon
healing methods are still being refined to this day.
Aim of the Work: The goal is to assess the outcomes of
heparin injection into cut ends of flexor tendon zone II injuries
both clinically and radiologically using musculoskeletal
ultrasound.
Patients and Methods: This is an interventional clinical
trial including forty individuals with flexor tendon injuries
zone II. The Patients were sampled randomly into two groups,
group I twenty patients (study group) with heparin injection
and group II twenty patients (control group) without heparin
injection.
Results: Forty cases were included in our study which
had zone II flexor tendon injury repaired using four strand
techniques. Both groups had the same protocol of physiotherapy
and follow-up. Results were measured as regards the total
range of motion according to Strickland criteria showing no
significant change between the two groups. Heparin injection
shows a higher rupture rate of flexor tendons which were
injected also showing gap formation in MSK US. Also, heparin
injection increases the formation of granulation tissue which
negatively affects the gliding of tendon. So, heparin injection
is not recommended in flexor tendon repair zone II.
Conclusion: Heparin injection shows a higher rupture
rate of flexor tendons which were injected also which reflect
gap formation in MSK US. Also, heparin injection increases
the formation of adhesive granulation tissue which negatively
affects the gliding of tendon.
So, heparin injection is not recommended in flexor tendon
repair zone II. However, there were a few limitations to our
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study such as poor compliance of some patients which is
considered one of the major problems that affect the postoperative
outcomes.