Comparison of Six-Strand and Four-Strand Techniques for the Repair of Injured Zone II Flexor Tendons of the Hand: A Randomized Controlled Trial

Abstract

 Objective: To compare the functional outcomes of six-strand and four-strand techniques for repair of injured flexor tendons of zone II of the hand.

Study Design and Setting: Randomized controlled trial—Department of Plastic Surgery, Allied Hospital, Faisalabad, from 27th January 2026 to 26th April 2026.

Methodology: A total of 136 patients with clean, sharp zone II flexor tendon injuries presenting within one week of trauma were randomized into two equal groups (n = 68 each). Group A received four-strand repair, and Group B received six-strand repair. All patients were managed with dorsal blocking splintage and early mobilization using the modified Kleinert protocol. Functional outcomes were assessed at three months using Tang criteria. This study analysed data using IBM SPSS version 25, with p < 0.05 considered significant.

Results: Group B had a statistically significantly higher mean overall active movement than Group A (218.46 ± 25.31 degrees vs 190.85 ± 28.72 degrees; p<0.001). The mean extension deficit was lower in Group B than in Group A (12.41 ± 6.78 degrees vs 18.94 ± 8.36 degrees; p<0.001). There was an excellent functional outcome in the six-strand group (52 (76.5)) versus the four-strand group (36 (52.9)) cases. In Group B, the final desirable outcome (excellent and good results) was observed in 94.1% of patients, compared with 79.4% in Group A (p=0.023).

Conclusion: Six-strand flexor tendon repair demonstrated superior functional outcomes compared with four-strand repair in zone II hand injuries, with a higher rate of excellent results, greater total active movement, and reduced extension deficit