title: Flexor Zone 5 cut injuries: emergency management and outcome.
abstract: OBJECTIVE
  To determine the outcome and devise a protocol for emergency management of cut injuries in Flexor Zone 5 of hands.
  
  
  METHODS
  Descriptive study.
  
  
  METHODS
  Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2009 to March 2013.
  
  
  METHODS
  All patients above 12 years of age with single sharp cut injuries in Flexor Zone 5, with no skeletal injuries, presenting within 12 hours in emergency were included with follow-up of 6 months, with active range of motion evaluated by Strickland's adjusted formula. Power of opponens pollicis and adductor muscles was evaluated from P0-4. Nerve repair results were evaluated serially by advancing Tinnel's sign, electrophysiological studies and sensory perception scored from S0-4 compared to the normal opposite upper limb.
  
  
  RESULTS
  The study group comprised of 31 patients (M : F = 2.4 : 1). Average age was 27 years ranging from 17 - 53 years. In 25 (80%) cases, injury was accidental, in 3 (10%) homicidal and in 3 (10%) injury was suicidal. Four most commonly involved structures included Flexor carpi ulnaris, ulnar artery, ulnar nerve and Flexor digitorum superficialis. Median nerve and radial artery were involved in 10 cases each, while ulnar artery and ulnar nerve were involved in 14 cases each. Longtendons were involved in most cases with greater involvement of medial tendons. None of the patients required re-exploration for ischaemia of distal limb while doppler showed 22 out of 24 vascular anastomosis remained patent. Recovery of long-tendons was good and recovery after nerve repair was comparable in both median and ulnar nerves.
  
  
  CONCLUSIONS
  Early and technically proper evaluation, exploration and repair of Zone 5 Flexor tendon injuries results in good functional and technical outcome.
authors.affiliation: Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore.
authors.forename: Muhammad Sheraz
authors.initials: MS
authors.lastname: Raza
authors.affiliation: Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore.
authors.forename: Syed Ammar Yasir
authors.initials: SA
authors.lastname: Jaffery
authors.affiliation: Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore.
authors.forename: Farid Ahmad
authors.initials: FA
authors.lastname: Khan
mesh_terms: D000293:Adolescent; D000328:Adult; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D022125:Lacerations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010154:Pakistan; D011826:Radial Nerve / Q000293:injuries* / Q000502:physiology; D020127:Recovery of Function; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome; D017535:Ulnar Artery / Q000293:injuries / Q000601:surgery; D014459:Ulnar Nerve / Q000293:injuries* / Q000502:physiology / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery*; D014953:Wrist / Q000098:blood supply / Q000294:innervation; D014954:Wrist Injuries / Q000601:surgery*; D055815:Young Adult