Comparison of Postoperative Complications in Zone 2 Flexor Tendon Injuries Repaired in the Emergency Department and Operating Room

Objective: This study aimed to comparatively evaluate the impact of the surgical setting (emergency department vs. operating room) on postoperative complication rates in isolated Zone 2 flexor tendon injuries. Methods:Seventy patients who presented with isolated Zone 2 flexor tendon injuries and underwent primary surgical repair between January 2023 and December 2023 were retrospectively reviewed.Patients were divided into two groups according to the surgical setting: emergency department (Group 1, n=35) and operating room (Group 2, n=35).All patients underwent repair using a modified Kessler core suture technique combined with an epitendinous running suture, followed by rehabilitation with a modified Kleinert protocol.Patients were systematically evaluated over a 3-month postoperative period for tendon rupture, adhesion, flexion contracture, and infection.Results: There was no statistically significant difference between the groups regarding demographic characteristics (p>0.05).The tendon rupture rate in Group 1 (37.1%) was significantly higher compared to Group 2 (11.4%) (p<0.01).No statistically significant differences were observed between the groups regarding adhesion, flexion contracture, or infection rates (p>0.05).Additionally, no significant correlation was found between patient age and the development of complications. Conclusion:The findings suggest that the surgical environment plays a critical role in postoperative outcomes following isolated Zone 2 flexor tendon repairs.Tendon rupture risk is significantly higher when repairs are performed under emergency department conditions.Therefore, performing flexor tendon repairs under sterile conditions with appropriate surgical equipment and experienced surgical teams in the operating room is strongly recommended.