Up to five-week delay in primary repair of Zone 2 flexor tendon injuries: outcomes and complications

J Hand Surg Eur Vol. 2021 Oct;46(8):818-824. doi: 10.1177/17531934211024435. Epub 2021 Jun 18.


We report the outcomes of delayed primary repair of flexor tendons in Zone 2 in 31 fingers and thumb (28 patients) averaging 15 days (range 4-37) after injury in 2020. The delay was longer than usual due to the COVID-19 pandemic. The tendons were repaired with a 6-strand core suture (M-Tang method) or a double Tsuge suture and a peripheral suture. This was followed by an early, partial-range, active flexion exercise programme. Adhesions in four digits required tenolysis. These patients were not with longest delay. Outcomes of two improved after tenolysis. The other two patients declined further surgery. One finger flexor tendon ruptured in early active motion. This was re-repaired, and final outcome was good. Overall excellent and good results using the Tang criteria were in 27 out of 31 fingers and thumbs (87%). The time elapsed between the injury and surgery is not an important risk factor for a good outcome, rather it depends on proper surgical methods, the surgeon's experience and early mobilization, properly applied. Adhesions may occur, but they can be managed with tenolysis.Level of evidence: IV.

Keywords: Flexor tendon; complication; delayed primary repair; outcomes; tendon repair.

MeSH terms

  • COVID-19*
  • Finger Injuries* / surgery
  • Humans
  • Pandemics
  • Range of Motion, Articular
  • SARS-CoV-2
  • Suture Techniques
  • Tendon Injuries* / surgery
  • Tendons / surgery