Use of porcine trotters as models for flexor tendon repair—the pulley system

The direct midlateral approach and the lateral enlarging procedure of the pulley system have been utilized in our service since 1972. The incision runs directly behind the neurovascular pedicle, which is left in the palmar skin flap of the anterior compartment of the finger, in order to ensure its blood supply and sensibility. The transverse digital lamina of Landsmeer’s skin anchoring system and Cleland’s ligament are preserved and are used to perform a lateral enlargement of the pulleys after tendon repair. The technique allows wide surgical exposure of the digital fibro-osseous tunnel, enlargement and reconstruction of the pulley system and tendon sheath, flexor tendon repair (using the technique of choice) and reduces postoperative impingement in zone 2.

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Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413487470 ◽

2013 ◽

Vol 39 (1) ◽

pp. 40-45 ◽

Cited By ~ 28

Author(s):

C. W. Joyce ◽

K. E. Whately ◽

J. C. Chan ◽

M. Murphy ◽

F. J. O’Brien ◽

...

Keyword(s):

Flexor Tendon ◽

Biomechanical Testing ◽

Tendon Repair ◽

Barbed Suture ◽

Suture Repair ◽

Flexor Tendon Repair ◽

Cross Sectional ◽

Pulley System ◽

Suture Group

We compared the tensile strength of a novel knotless barbed suture method with a traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine flexor tendons were transected and randomly assigned to one of the repair groups before repair. Biomechanical testing demonstrated that the tensile strengths between both tendon groups were very similar. However, less force was required to create a 2 mm gap in the four-strand repair method compared with the knotless barbed technique. There was a significant reduction in the cross-sectional area in the barbed suture group after repair compared with the Adelaide group. This would create better gliding within the pulley system in vivo and could decrease gapping and tendon rupture.

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Early Results of Flexor Tendon Repair in Zone II With Modified, Four-Strand Strickland Technique

Polish Journal of Surgery ◽

10.2478/v10035-008-0100-8 ◽

2008 ◽

Vol 80 (12) ◽

Author(s):

Ireneusz Walaszek ◽

Andrzej Żyluk ◽

Bernard Piotuch

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Early Results ◽

Zone Ii

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Ischaemic contracture of the hand

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699134 ◽

2006 ◽

Vol 39 (01) ◽

pp. 94-102

Author(s):

G. Balakrishnan

Keyword(s):

Suture Material ◽

Flexor Tendon ◽

Tendon Repair ◽

Hypodermic Needle ◽

Flexor Tendon Repair ◽

Active Motion ◽

Custom Made

ABSTRACTStronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

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Comparison of the Outcomes of 2 Rehabilitation Protocols After Flexor Tendon Repair of the Hand at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

Hand ◽

10.1177/1558944716660555js ◽

2016 ◽

Vol 11 (1_suppl) ◽

pp. 139S-139S

Author(s):

Roxanne Wentzel ◽

Corrianne van Velze ◽

Elsje Rudman

Keyword(s):

South Africa ◽

Flexor Tendon ◽

Tendon Repair ◽

Academic Hospital ◽

Flexor Tendon Repair ◽

Rehabilitation Protocols

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Methods of Evaluation of the Functional Results of Flexor Tendon Repair of the Fingers

Journal of Hand Surgery (European Volume) ◽

10.1016/s0266-7681(85)80018-8 ◽

1985 ◽

Vol 10 (1) ◽

pp. 60-61 ◽

Cited By ~ 11

Author(s):

A. B. NIELSEN ◽

P. Ø. JENSEN

Keyword(s):

Functional Outcome ◽

Standard Method ◽

Flexor Tendon ◽

Tendon Repair ◽

Functional Results ◽

Functional Evaluation ◽

Flexor Tendon Repair ◽

Methods Of Evaluation ◽

Method Of Measurement ◽

No Man's Land

The methods used by Buck-Gramcko, Kleinert and Tsuge in evaluating the functional results of flexor tendon repair were each applied to assess the functional outcome in sixty-seven fingers where both tendons had been severed in “no man's land”. The method of Buck-Gramcko gave the highest rating, and the three methods showed evident differences in the results of evaluation after surgery. The study suggests a need for one standard method of measurement and recording, if a comparison of results after flexor tendon repair is to be of value. We found that the method of Buck-Gramcko incorporated the most essential features in the functional evaluation.

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Looped suture properties: implications for multistranded flexor tendon repair

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413516245 ◽

2015 ◽

Vol 40 (3) ◽

pp. 234-238 ◽

Cited By ~ 6

Author(s):

R. Haddad ◽

T. Peltz ◽

N. Bertollo ◽

W. R. Walsh ◽

S. Nicklin

Keyword(s):

Mechanical Properties ◽

Flexor Tendon ◽

Tendon Repair ◽

Relative Effect ◽

Flexor Tendon Repair ◽

Polypropylene Monofilament ◽

Single Suture ◽

Biomechanical Strength ◽

Standard Techniques ◽

Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

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