Background: The reconstruction of tendon continuity, particularly in zone II, of the fingers is one of the most challenging aspects of hand surgery. The present work aimed to compare the results of two techniques: modified Brunelli technique and Modified Kessler sutures techniques regarding operative time, suture strength, gap formation, and efficiency of two strand suture repair.

Methods: This prospective randomized clinical trial as was carried out on 42 patients with acute flexor tendon injuries, smooth tendon suture was used for restoring a gliding surface, patients were allocated into two equal groups (21patients in each group): Group I were managed by modified Brunelli pull out technique, and Group II were managed by modified Kessler suture technique. The patients were followed for 6 months to assess grip strength, active range of motion, active mobilization against resistance, and rupture rates.

Results: A high statistically significant (p-value < 0.001) increased operative time was revealed in group I (74.7 ± 13.5 min) when compared with group II (45.9 ± 15.2 min). A Statistically significant (p-value = 0.04) increased percentage of extension deficit of IP joint was found in group II (9 patients, 42.9%) when compared with group I (3 patients, 14.3%). Statistically significant differences was revealed between both studied groups as regard pinch strength, and satisfaction (p-value = 0.04).

Conclusion: Active mobilization against resistance can begin at the very first stage by shifting strain away from the healing site and onto the pulp of the finger.