Deep Fascial Grafts Compared to a Porcine Acellular Dermal Matrix in Zone II Flexor Tendon Repair:A Randomized Controlled Trial on Adhesion Prevention.

Abstract

Flexor tendon injury repair, especially in Zone II, presents significant challenges due to the high risk of adhesion formation, which can compromise functional outcomes. This study evaluates the effectiveness of an innovative approach that uses a deep fascial graft conduit compared to a porcine acellular dermal matrix (ADM)(Pelnac®) conduit in reducing adhesion formation and improving functional recovery after flexor tendon repair. Forty-five patients with Zone II flexor tendon injuries were randomly assigned into three groups using computer-generated block randomization: Group A (control, classic repair), Group B (deep fascial graft-wrapped repair), and Group C (ADM-wrapped repair). Functional outcomes were assessed using the Buck-Gramcko II criteria and ultrasound (US) imaging six months postoperatively. The modified total active motion scores were significantly higher in the fascia group (8, IQR:7 -8) compared to the control (6, IQR: 5 -7) and ADM groups (5,IQR: 4 - 6) (P<0.001). The deep fascial graft group achieved superior functional outcomes, with 73.3 % of cases classified as "excellent" and no evidence of adhesion on US imaging. In contrast, the control and ADM groups showed significantly lower rates of excellent outcomes (6.7% and 0%, respectively) and higher rates of adhesion formation. Postoperative complications, including tendon rupture and infection, were comparable across all groups. The promising results of this study suggest that deep fascial grafts could significantly reduce adhesion formation and enhance functional recovery in Zone II flexor tendon repairs, surpassing both traditional repair methods and ADM.