Zone II Acute Injury Primary Repair

ZONE II INJURY

ZONE II INJURY

This is called as "No Man's Land".

This is because of the tight Fibroosseus canal.Basics

Not to injure the fibroosseous canal. Do a meticulous repair.Good core suturing.Early mobilozation.

Planning of incision

PROCEDURE

This case had a cut injury transversly in the little finger.

Both proximal and Distal window is created to expose the zone II injured zone.

Zig zag incision are made to avoid scar contracture.

Assesment

Retrieve the cut ends of the tendon by flexing the finger.

Proximal end will not go beyond zone III level because of attachment of lumbricals.

SUTURING

By railroad technique using an scalp vein set to retreive and suture the tendons.

Mod.kessler mason stitches are made .

Epitendinuous suturing with 5-0 prolene done core stitch with 3-0 prolene.

Distal end is sutured first.Then tension adjustment is done to suture the proximal end.

DIGITAL NERVE

Digital nerve

This case had digital nerve cut so primary repaired with 7-0 prolene.

Closure 

Wound is closed with 3-0 ethilon.

POST OP FOLLOW UP

Note the important Finger are in cascade.

Meaning to say they are in progressive grade of decreasing flexion from little to index.

Simple technique is used as  its difficult to close wound at the finger level so stay sutures are taken before closing each stitches distal to proximal and closed one by one.

Dorsal blocking splint is given.

After 21 days to start on mobilization or any of the early mobilization protocol can be used depending on the core stitches made.