Publication:

Functional outcomes of two-stage flexor tendon reconstruction in zone 2 of the hand

Zone II flexor tendon injuries with delayed presentation or failed primary repair remain among the most challenging conditions in hand surgery due to adhesion formation and compromised pulley systems. Two-stage reconstruction using the Paneva-Holevich technique has demonstrated favorable outcomes internationally; however, data from the Middle Eastern region are scarce. We present a retrospective case series of 21 patients who underwent two-stage flexor tendon reconstruction in zone II at a tertiary referral center in Oman between 2012 and 2020. Functional outcomes were assessed using total active motion (TAM), Adjusted Strickland score, Buck-Gramko rating system, and QuickDASH questionnaire. The mean TAM was 85.4% of the contralateral digit, and the mean Adjusted Strickland score was 82.2%. According to Buck-Gramko criteria, 90.5% achieved excellent outcomes. The mean QuickDASH score was 8.5, indicating minimal disability. Patient satisfaction was 95%, and 85% returned to their previous occupation. Complications requiring reoperation occurred in 28.6% of patients. This case series demonstrates that the Paneva-Holevich technique provides reliable functional restoration in complex Zone II injuries within our population.