Flexor Zone 5 Cut Injuries: Emergency Management and Outcome

Objective: To determine the outcome and devise a protocol for emergency management of cut injuries in Flexor Zone 5 of hands. Study Design: Descriptive study. Place and Duration of Study: Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2009 to March 2013. Methodology: All patients above 12 years of age with single sharp cut injuries in Flexor Zone 5, with no skeletal injuries, presenting within 12 hours in emergency were included with follow-up of 6 months, with active range of motion evaluated by Strickland's adjusted formula. Power of opponens pollicis and adductor muscles was evaluated from P0-4. Nerve repair results were evaluated serially by advancing Tinnel's sign, electrophysiological studies and sensory perception scored from S0-4 compared to the normal opposite upper limb. Results: The study group comprised of 31 patients (M : F = 2.4: 1). Average age was 27 years ranging from 17 - 53 years. In 25 (80%) cases, injury was accidental, in 3 (10%) homicidal and in 3 (10%) injury was suicidal. Four most commonly involved structures included Flexor carpi ulnaris, ulnar artery, ulnar nerve and Flexor digitorum superficialis. Median nerve and radial artery were involved in 10 cases each, while ulnar artery and ulnar nerve were involved in 14 cases each. Long-tendons were involved in most cases with greater involvement of medial tendons. None of the patients required re-exploration for ischaemia of distal limb while doppler showed 22 out of 24 vascular anastomosis remained patent. Recovery of long-tendons was good and recovery after nerve repair was comparable in both median and ulnar nerves. Conclusion: Early and technically proper evaluation, exploration and repair of Zone 5 Flexor tendon injuries results in good functional and technical outcome.