Efficacy of Pull-In Suture for Tendon Avulsion Injury Associated With Severe Forearm Open Fracture, Forearm Amputation, and Hand Amputation

BACKGROUND: The pull-in suture technique is a method of primary tendon repair that involves pulling the distal stump of the ruptured tendon into the proximal muscle belly and suturing it to the intact muscle fascia for avulsion injuries at the musculotendinous junctions associated with severe open forearm trauma. The aim of this study is to report the clinical outcomes of the pull-in suture technique for musculotendinous avulsion injuries associated with severe open forearm trauma and to evaluate its effectiveness. METHODS: This study included patients who underwent pull-in suture repair for musculotendinous avulsion injuries associated with severe open forearm fractures, traumatic forearm amputation, or traumatic hand amputation. Patient demographics, characteristics of injury, functional outcomes at the final follow-up were investigated. Functional outcomes included total active motion (TAM) of the thumb and fingers, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and HAND20 score. RESULTS: Ten patients (mean age, 52 years; 1 female) were included 4 severe open fractures, 4 incomplete amputations, and 2 complete amputations. All injuries resulted from industrial machinery. All patients underwent free flap reconstruction (anterolateral thigh, latissimus dorsi, or radial forearm flap). Mean TAM at the final follow-up was 52.4° for the thumb, and the mean summed TAM of the 4 fingers was 637.2°. Mean DASH and HAND20 scores were 28.7 and 39.8, respectively. CONCLUSION: Pull-in suture offers a viable option for preserving tendon function in severe forearm trauma with multiple musculotendinous avulsions, including amputations, when other primary repair methods are not feasible.