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Background <p>The time frame for delayed primary repair (DPR) of flexor tendon injuries remains debatable, and the focus has been on repair timing within three to six weeks of injury. This study aimed to determine the association between the ultrasonographically measured flexor tendon gap and DPR.</p> Methods <p>This non-randomized clinical study was conducted on 40 patients presenting to the Plastic and Reconstructive Surgery Department of a tertiary university-based hospital with delayed flexor tendon injury who underwent DPR or two-stage reconstruction. Patients were classified into four groups based on ultrasound-measured tendon gap: group I: tendon gap is 0–2&#xa0;cm, group II: tendon gap is 2.1–3&#xa0;cm, group III: tendon gap is 3.1–4&#xa0;cm, and group IV: tendon gap &gt; 4&#xa0;cm.</p> Results <p>DPR was performed in 100% of Group I and 87.5% of Group II patients, whereas two-stage reconstruction was required in 81.8% of Group III and 100% of Group IV patients (<i>p</i> &lt; 0.001). Patients treated with DPR showed better functional outcomes, with good Tang and ASSH scores predominating in Groups I–II (62.5–100%), shorter return-to-work time, and fewer complications (64.7% complication-free vs. 16%). ROC analysis identified an ultrasound-measured tendon gap cut-off of 2.95&#xa0;cm for predicting the need for two-stage reconstruction (AUC = 0.939), with 100% specificity when the gap exceeded 3.6&#xa0;cm.</p> Conclusions <p>DPR for ultrasound-measured small gaps leads to faster recovery and better hand function. DPR provides better functional outcomes with fewer complications compared to two-stage reconstruction.</p> Level of evidence <p>Level II, therapeutic study.</p>

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The correlation between tendon gap measurement by ultrasound and management of flexor tendon injury zone 1, 2, and 3

  • 期刊论文

  • 发表日期：

    2026年5月13日

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  • Omar Mohamed Nouh,
  • Hatem Mohamed El-Azizy,
  • Mohamed Magdy Mowafy,
  • Ahmed Samy Saad,
  • Hamed Mohamed Kadry

摘要

Background

The time frame for delayed primary repair (DPR) of flexor tendon injuries remains debatable, and the focus has been on repair timing within three to six weeks of injury. This study aimed to determine the association between the ultrasonographically measured flexor tendon gap and DPR.

Methods

This non-randomized clinical study was conducted on 40 patients presenting to the Plastic and Reconstructive Surgery Department of a tertiary university-based hospital with delayed flexor tendon injury who underwent DPR or two-stage reconstruction. Patients were classified into four groups based on ultrasound-measured tendon gap: group I: tendon gap is 0–2 cm, group II: tendon gap is 2.1–3 cm, group III: tendon gap is 3.1–4 cm, and group IV: tendon gap > 4 cm.

Results

DPR was performed in 100% of Group I and 87.5% of Group II patients, whereas two-stage reconstruction was required in 81.8% of Group III and 100% of Group IV patients (p < 0.001). Patients treated with DPR showed better functional outcomes, with good Tang and ASSH scores predominating in Groups I–II (62.5–100%), shorter return-to-work time, and fewer complications (64.7% complication-free vs. 16%). ROC analysis identified an ultrasound-measured tendon gap cut-off of 2.95 cm for predicting the need for two-stage reconstruction (AUC = 0.939), with 100% specificity when the gap exceeded 3.6 cm.

Conclusions

DPR for ultrasound-measured small gaps leads to faster recovery and better hand function. DPR provides better functional outcomes with fewer complications compared to two-stage reconstruction.

Level of evidence

Level II, therapeutic study.