Flexor tendon injuries secondary to blade assaults are complex and challenging, often involving multiple zones and levels of injury. These injuries can result in poor outcomes, including reduced range of motion, impaired grip strength, and pain. The literature on the management of these injuries is limited, and there is a lack of standardized criteria and guidelines for their treatment.

This retrospective study reviewed 25 cases of severely complex multiple zones flexor tendon injuries secondary to blade assaults treated at the University Hospital of Marrakesh over a 5-year period. The study aimed to describe injury patterns, surgical management, and outcomes, and to identify factors associated with outcomes. Data collected included demographic information, injury details, surgical techniques, and postoperative outcomes. Outcome measures included range of motion, grip strength, pain, sensibility, and functional scores.

The mean age of the patients was 28.4±9.7 years. The majority of patients were male (88%) and manual workers (68%). The most common mechanism of injury was knife attack (68%). The mean number of injured zones per patient was 3.2±0.9, and the mean number of injured tendons per patient was 6.4±2.1. Nerve injuries were present in 80% of patients, and vascular injuries in 64%. Postoperative complications included tendon rupture (16%), infection (12%), and adhesions (24%). The mean range of motion of the injured fingers was 54.8±15.6° for the DIP joint, 67.2±18.4° for the PIP joint, and 19.6±8.2° for the MCP joint. The mean grip strength of the injured hand was 68.4±15.2% of the uninjured hand.

The findings of this study highlight the severity and complexity of flexor tendon injuries secondary to blade assaults. The study emphasizes the need for a meticulous surgical technique and comprehensive postoperative rehabilitation to optimize outcomes. The identified factors associated with poorer outcomes can help guide surgical decision-making and inform patients about potential complications.

This study provides valuable insights into the management and outcomes of severely complex multiple zones flexor tendon injuries secondary to blade assaults. The proposed management decision tree flowchart, based on the study's findings, can serve as a practical guide for surgeons treating these challenging injuries. Further research is needed to investigate the effectiveness of different surgical techniques and rehabilitation protocols to improve outcomes for these patients.