الفهرس 
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Abstract
The study was conducted on twenty patients with acute flexor tendon injury recruited from the emergency department. The study was conducted in Reconstructive Surgery Unit; Menoufia University Hospital, El Helmeyah Military Hospital and El Menshawy General Hospital.
Methods:
All patients were subjected to the following:
I. Pre-operative:
1- History taking
2- Clinical examination
3- Investigations:
4- Photography: Standardized color digital photography of the site of injury.
II. Operative techniques:
The patients were divided into 2 groups:
group A: Two-strand; modified Kessler core suture.
group B: Four strand; double modified Kessler core suture.
In all cases in both group’s peripheral epitendinous tendon suture was done.
III. Post-operative care and follow-up:
Splints: All patients were put in dorsal blocking splint for 6 weeks.
Post-repair: Early passive mobilization was started until skin wound is healed; using the Kleinert protocol, then we start supervised active mobilization.
All patients were followed up and evaluated as regards:
a) Range of motion (ROM) using a Geniometer, performed at 3, 6 and 12 weeks following surgery.
b) Endurance muscle power using a custom made pulley system performed at 3, 6 & 12 weeks following surgery.
Results:
Age: All of the patients with age range (15-34) years old.
Sex: Most cases were males.
There was an insignificant statistical difference between both groups regarding to age, sex, and cause of injury
The mean Operative time for group A was 28.0 ± 8.56 while the mean Operative time for group B was 38.20 ± 11.01 with p value = 0.033 which was Statistically significant that Operative time for group A was shorter than Operative time for group B.
There was an insignificant statistical difference between both groups regarding to the endurance muscle power after 3 weeks post-operatively
There was a significant statistical difference between both groups regarding to the endurance muscle power after 6, 12 weeks post-operatively with a higher achievement in group B.
There was an insignificant statistical difference between both groups as regarding the angle of flexion after 3 weeks of follow up.
There was a significant statistical difference between both groups as regarding the angle of flexion after 6, 12 weeks of follow up.
Conclusion
In our study, we found that the four strand double modified Kessler repair is superior to the two strands modified Kessler repair regarding the regain of the endurance muscle power and gives a better range of flexion and extension through different inter-phalangeal joints.
However the two strand technique has a short operative time.
It was found that using 3/0 for the core suture followed by 6/0 prolene for epitenon suture was ideal for the repair and decreases the repair site bulk.