Cutting or Round-Bodied Needles for Tendon Repair

2003 ◽  
Vol 28 (5) ◽  
pp. 475-477 ◽  
Author(s):  
W. L. LAM ◽  
A. GARRIDO ◽  
J. VANDERMEULEN ◽  
M. J. FAGAN ◽  
P. R. W. STANLEY
Keyword(s):  
Tensile Strength ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Suture Repair ◽  
Longitudinal Stress ◽  
The Core ◽  
Group 3 ◽  
Group 2 ◽  
Repair Group ◽  
Group 1

We carried out a biomechanical study comparing tensile strength after using round-bodied or cutting needles for tendon repair. Swine tendons were repaired in three groups: Group 1 core suture repair only; group 2 core and circumferential suture repair; and group 3 isolated circumferential suture repair. The tendons were tested at longitudinal stress to failure at 5 mm/minute. No significant differences were found between the round-bodied and cutting needles in any group. Equal numbers in the core suture repair group failed by suture pullout when comparing cutting and round-bodied needles. We conclude that the choice of needle has no effect on the outcome of tendon repair if there is consistency of surgeon’s skill and experience.

Vein grafts to augment flexor tendon repairs: a biomechanical study on strength and gap resistance

2014 ◽  
Vol 40 (7) ◽  
pp. 695-699 ◽  
Author(s):  
M. P. Rodger ◽  
P. Theobald ◽  
G. Giddins
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tendon Repair ◽  
Biomechanical Study ◽  
Suture Repair ◽  
Gap Formation ◽  
Vein Grafts ◽  
Video Images ◽  
A New Technique ◽  
Repair Group

The ultimate tensile repair strength and gap formation of the pig extensor tendons repaired with a standard 4-strand Savage with epitendinous suture repair, was compared with a new technique of adding a vein sleeve. Force and displacement data were recorded, and video images during linear cyclic loading up to failure. At 35 N, video-graphic observation detected significantly smaller gap lengths in the standard and vein repair specimens compared with standard repair specimens ( p = 0.047). The incidence of 3 mm gaps between the repaired tendon ends in the standard repair group was 20 %, but no 3 mm gaps were seen in the standard and vein specimens. The addition of a vein sleeve increased the ultimate tensile strength of the standard repair from 50.4 N (4.5) to 55.4 N (4.5); this was statistically significant ( p = 0.03). This study demonstrated that the addition of a vein graft prevented gap formation and increased ultimate tensile strength of tendon repair.

scholarly journals Patterns of core and penumbra in acute MI occlusion and their clinical correlates

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 348-348
Author(s):  
Tudor G Jovin ◽  
Steven Goldstein ◽  
Gebel M James ◽  
Wechsler R Lawrence ◽  
Margareth-Beth Ott ◽  
...  
Keyword(s):  
Ischemic Penumbra ◽  
The Core ◽  
Functionally Impaired ◽  
Acute Mi ◽  
Group 3 ◽  
Group 2 ◽  
Core Volume ◽  
Selection Of Patients ◽  
Selection Of ◽  
Group 1

P51 Background and Purpose: The ischemic penumbra is composed of neurons that are functionally impaired but structurally intact, and thus potentially salvageable. Identifying the penumbra and its relationship with the ischemic core may lead to a more physiologic selection of patients who might benefit from recanalization therapy. We sought to explore the core/penumbra relationship by quantitatively measuring cerebral blood flow (CBF) in patients with acute M1 occlusion. Methods: 19 patients with M1 occlusion proven by CT angiography or conventional cerebral angiography underwent a Xe-CT/CBF study within 6 hours of symptoms onset. Mean CBF values were measured in the ipsilateral cortical MCA territory. The core was defined as areas with CBF< 8 ml/100g/min and the penumbra was defined as areas with CBF 9–20 ml/100g/min. Findings were correlated with the admission NIH stroke scale (NIHSS). Results: In 6/19 patients (31.5%)(group 1), the size of the penumbra was greater than twice the size of the core. In 8/19 patients (42.1%) (group 2), the size of the penumbra was approximately equal the size of the core. In 5/19 patients (26.8%)(group 3) the size of the penumbra was less than half the size of the core. The median core volumes for each of the three groups, expressed as percentage of core relative to ipsilateral cortical MCA territory, increased from group 1 to group 3. While there was a trend towards a correlation between the admission NIHSS and the combined core and penumbral volumes, no such correlation could be established between admission NIHSS and core or penumbral volumes alone. Conclusions: In the first 6 hours after M1 occlusion, penumbral volumes that are larger than or equal to core volumes are present in 14 out of 19 patients. A smaller core volume is associated with an increased penumbra to core ratio. The admission NIHSS in patients with M1 occlusion correlates with the combined volumes of core and penumbra.

scholarly journals Characterization and outcomes of urethroplasty for hypospadias-associated urethral strictures in adults

2019 ◽  
Vol 13 (12) ◽  
Author(s):  
Alvaro A. Saavedra ◽  
Keith F. Rourke
Keyword(s):  
Urethral Stricture ◽  
Significant Risk ◽  
Hypospadias Repair ◽  
Urethrocutaneous Fistula ◽  
Urethral Strictures ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Repair Group ◽  
Group 1

Introduction: Urethral stricture is one of the most commonly encountered complications after hypospadias repair but remains poorly described. The aim of this study is to better characterize hypospadias-associated urethral strictures (HAUS) and treatment outcomes. Methods: We conducted a retrospective analysis of 84 patients who underwent urethroplasty (UP) for HAUS from 2003–2017. Patients were characterized with regard to demographics, stricture length, location, concurrent pathology, previous surgery, type of urethroplasty, 90-day complications, and surgical success defined as the absence of stricture on cystoscopy. Univariate and survival multivariate analysis was performed. Results: Overall success was 88.1% at a mean followup of 19 months, with a 90-day complication rate of 9.5%, a 21.4% rate of urethrocutaneous fistula requiring a mean of 1.4 surgeries. Patients were categorized into one of four groups based on stricture length, location, and number of previous procedures: group 1 (66.7%) – previous failed hypospadias repair (HR) with stricture involving the entire repair; group 2 (7.1%) – “junctional stricture” at the junction of the “neourethra” and native urethra; group 3 (11.9%) – isolated bulbar stricture outside the repaired urethra; group 4 (14.3%) – urethral stricture in untreated hypospadias. Despite differing by technique (p<0.0001), stricture length (p=0.02), location (p<0.001), and number of previous repairs (p<0.001), groups did not significantly differ by success (p=0.82), complications (p=0.16), or urethrocutaneous fistula (p=0.19), whereas individual techniques did. Conclusions: UP for HAUS is often successful but patients frequently require more than one operation and have a significant risk of associated complications. Despite a broad spectrum of presentation, patients can often be categorized into one of four groups, which can help direct decision-making and obtain similar outcomes regardless of baseline differences.

scholarly journals Biomechanical Comparison of Flexor Digitorum Profundus Avulsion Repair

2019 ◽  
Vol 08 (04) ◽  
pp. 312-316 ◽  
Author(s):  
Jill G. Putnam ◽  
Damon Adamany
Keyword(s):  
Suture Anchor ◽  
Tendon Repair ◽  
Maximum Load ◽  
Flexor Digitorum Profundus ◽  
Anchor Group ◽  
Load To Failure ◽  
Group 3 ◽  
Group 2 ◽  
Flexor Digitorum ◽  
Group 1

Purpose Multiple repair techniques have been investigated for flexor digitorum profundus (FDP) tendon avulsions. The purpose of this study is to compare the biomechanical characteristics of a new fully threaded titanium suture anchor with previously examined fixation techniques. Methods Repair of FDP tendon avulsions was performed in 18 fresh-frozen cadavers using one of three implants: Nano Corkscrew FT 1.7 mm suture anchor (Group 1; Arthrex, Inc., Naples, FL; n = 6), Mitek Micro 1.3 mm suture anchor (Group 2; Mitek Surgical Products, Westwood, MA; n = 6), or pullout suture button fixation (Group 3; n = 6). Constructs were preloaded before testing load to failure. For each trial, elongation at 20 N and maximum load, mean load to failure, stiffness, and failure mechanism were recorded. Results Load to failure occurred in all trials. Mean load to failure was significantly greater for Group 1 (61.6 ± 18.9 N) compared to Group 2 (42.5 ± 4.2 N; p < 0.05) and Group 3 (41.6 N ± 8.0 N; p < 0.05). Stiffness was significantly greater in Groups 1 and 2 compared to Group 3 (6.9 ± 2.2 N/mm vs. 6.1 ± 0.8 N/mm vs. 3.1 N/mm ± 0.5 N/mm, respectively, p < 0.01). Mechanism of failure differed between the groups: Group 1 broke at the anchor in two trials and tore through the tendon in three trials, Group 2's suture universally broke at the anchor, and Group 3's trials mainly failed at the button. Conclusions The Nano Corkscrew anchor (Group 1) has a significantly higher load to failure when compared with the other techniques. The higher load to failure of the corkscrew anchor provides a secure method for flexor tendon repair in zone I. Clinical Relevance A fully threaded titanium suture anchor used for FDP tendon avulsion injuries is likely to withstand early active range of motion protocols.

scholarly journals Volar versus combined dorsal and volar plate fixation of complex intraarticular distal radius fractures with small dorsoulnar fragment – a biomechanical study

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Mariya Hadzhinikolova ◽  
Ivan Zderic ◽  
Daniel Ciric ◽  
Jan P. Barcik ◽  
Dian Enchev ◽  
...  
Keyword(s):  
Distal Radius ◽  
Biomechanical Study ◽  
Neutral Position ◽  
Volar Plating ◽  
Radius Fractures ◽  
Group 3 ◽  
Group 2 ◽  
Dorsal Plating ◽  
Double Plating ◽  
Group 1

AbstractComplex intraarticular distal radius fractures (DRFs), commonly managed with volar locking plates, are challenging. Combined volar and dorsal plating is frequently applied for treatment, however, biomechanical investigations are scant. The aim of this biomechanical study was to investigate volar plating versus double plating in DRFs with different degrees of lunate facet comminution.Thirty artificial radii with simulated AO/OTA 23-C2.1 and C3.1 DRFs, including dorsal defect and lunate facet comminution, were assigned to 3 groups: Group 1 with two equally-sized lunate facet fragments; Group 2 with small dorsal and large volar fragment; Group 3 with three equally-sized fragments. The specimens underwent volar and double locked plating and non-destructive ramped loading in 0° neutral position, 40° flexion and 40° extension.In each tested position, stiffness: (1) did not significantly differ among groups with same fixation method (p ≥ 0.15); (2) increased significantly after supplemental dorsal plating in Group 2 and Group 3 (p ≤ 0.02).Interfragmentary displacements between styloid process and lunate facet in neutral position were below 0.5 mm, being not significantly different among groups and plating techniques (p ≥ 0.63).Following volar plating, angular displacement of the lunate facet to radius shaft was significantly lower in Group 1 versus both Group 2 and Group 3 (p < 0.01). It decreased significantly after supplemental dorsal plating in Group 2 and Group 3 (p < 0.01), but not in Group 1 (p ≥ 0.13), and did not differ significantly among the three groups after double plating (p ≥ 0.74).Comminution of the lunate facet within its dorsal third significantly affected the biomechanical outcomes related to complex intraarticular DRFs treated with volar and double locked plates.Double plating demonstrates superior stability versus volar plating only for lunate facet comminution within its dorsal third. In contrast, volar plating could achieve stability comparable with double plating when the dorsal third of the lunate facet is not separated by the fracture pattern. Both fixation methods indicated achievable absolute stability between the articular fragments.

scholarly journals Which mesh should be used to repair abdominal wall defect in peritonitis? An experimental study

2020 ◽  
Vol 7 (2) ◽  
pp. 353
Author(s):  
Hüseyin Alakuş ◽  
Mustafa Göksu
Keyword(s):  
Tensile Strength ◽  
Abdominal Wall ◽  
Abdominal Wall Defect ◽  
Abdominal Wall Defects ◽  
Mesh Group ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Ptfe Mesh ◽  
Group 1

Background: In this study, following the Bogota bag closure of abdominal wall defects created in a rat peritonitis model, the short-term efficacy of polypropylene (PP) mesh (Prolene®, Ethicon), PP Mesh+Seprafilm®, polytetrafluoroethylene (PTFE) mesh [Infinit® Mesh (Gore)] and expanded PTFE (ePTFE) [Dualmesh®plus(Gore)] in the permanent repair of the defects was investigated.Methods: 64 rats were used. The rats were randomized into four groups, each consisting of 16 subjects: PP mesh (Group 1), PP mesh+Seprafilm (Group 2), PTFE mesh (Group 3), and ePTFE mesh (Group 4). Laparotomy was performed and abdominal wall defects were created. Contamination of the peritoneal cavity was induced, and closure was undertaken using a Bogota bag. After three days, the Bogota bag was removed, and materials were placed. At the end of the follow-up period, the rats were sacrificed. Mortality, grade of adhesion, surgical site infection (SSI), and tensile strength were evaluated.Results: Mortality was calculated as 6.3%, 50%, 25%, and 0% for Groups 1, 2, 3, and 4, respectively (p=0.002). Adhesion was observed at a rate of 61.1% in Group 1 and 38.9% in Group 2 (p=0.621). There was no adhesion in Groups 3 and 4 (p=0.001). The rate of SSI was 68.8% in Group 1, %75% in Group 2, and 100% in Groups 3 and 4 (p=0.022). Tensile strength was 2196±193.6 g/cm in Group 1 and 1906±142.1 g/cm in Group 2 (p=0.258).Conclusions: We argue that PP mesh is a suitable prosthesis for the permanent repair of contaminated abdominal wall defects despite the increased adhesion risk.

scholarly journals FiberWire vs FiberTape: Comparison of Bacterial Adherence in a Murine Air Pouch Wound Model

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096448
Author(s):  
Allison M. Blumenthal ◽  
Therese Bou-akl ◽  
Mario D. Rossi ◽  
Bin Wu ◽  
Wei-Ping Ren ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Optical Density ◽  
Bacterial Adherence ◽  
High Tensile Strength ◽  
Histological Assessment ◽  
Wound Model ◽  
Group 3 ◽  
Group 2 ◽  
Time Point ◽  
Group 1

Background: For high–tensile strength sutures, past research has largely focused on mechanical properties or bacterial adherence across various manufacturers. Purpose: This study investigated high-tensile strength sutures with different shapes but otherwise identical composition. The purpose was to evaluate the differences between high–tensile strength suture wire and suture tape relative to bacterial adherence and bacterial retention after washout. Study Design: Controlled laboratory study. Methods: Sutures were implanted in dorsal air pouches of 72 BALB/cJ mice. Experimental pouches were inoculated with Staphylococcus aureus; no bacteria were used in the control conditions. The mice were randomized into 3 groups: group 1 underwent suture extraction 7 days after implantation; group 2 underwent an irrigation procedure, followed by immediate suture extraction on day 7; and group 3 underwent an irrigation procedure on day 7, with delayed suture extraction on day 14 after implantation. The sutures were evaluated using confocal microscopy; electron microscopy; and spectrophotometry, through which optical density, as measured by the amount of scattered light, is directly correlated with the number of bacteria. Histological assessment was performed on the pouches. Results: Optical density (mean ± SD) was significantly higher for FiberTape sutures than for FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.0550 ± 0.0081 vs 0.0162 ± 0.006 [ P = .0054]; group 2, 0.0225 ± 0.0049 vs 0.0056 ± 0.0006 [ P = .0045]; group 3, 0.055 ± 0.0222 vs 0.0043 ± 0.0005 [ P = .0103]). Additionally, groups 2 and 3 showed statistically significant results at the 4-hour time points (group 2, 0.0384 ± 0.0087 vs 0.0145 ± 0.0042 [ P = .0280]; group 3, 0.0532 ± 0.0159 vs 0.0101 ± 0.0025 [ P = .0058]). The wash fluid also demonstrated significantly greater optical density for the FiberTape than the FiberWire sutures, respectively, at the 2-hour time point for all groups (group 1, 0.1657 ± 0.0319 vs 0.0317 ± 0.008 [ P = .0063]; group 2, 0.0522 ± 0.0156 vs 0.0127 ± 0.0022 [ P = .0219]; group 3, 0.1707 ± 0.0205 vs 0.0191 ± 0.0053 [ P < .0001]). No bacterial growth occurred in the control conditions. Histological assessment revealed only mild inflammation in the control groups as compared with more severe responses in the experimental groups at all time points. Conclusion: FiberTape was associated with increased bacterial adhesion as well as retention as compared with FiberWire in an in vivo murine wound model. Clinical Relevance: This study demonstrates that suture design influences the occurrence of and ability to clear surgical infection and must be considered when selecting high-tensile strength sutures in a clinical setting.

scholarly journals Tendon-Holding Capacities of Two Newly Designed Implants for Tendon Repair: An Experimental Study on the Flexor Digitorum Profundus Tendon of Sheep

2014 ◽  
Vol 8 (1) ◽  
pp. 135-139
Author(s):  
İsmail Ağır ◽  
Mahmut Nedim Aytekin ◽  
Onur Başçı ◽  
Barış Çaypınar ◽  
Bülent Erol
Keyword(s):  
Tensile Strength ◽  
Tendon Repair ◽  
Longitudinal Axis ◽  
Study Groups ◽  
Flexor Digitorum Profundus ◽  
Suture Materials ◽  
Safety Margins ◽  
Group 3 ◽  
Flexor Digitorum ◽  
Group 1

Background: Two main factors determine the strength of tendon repair; the tensile strength of material and the gripping capacity of a suture configuration. Different repair techniques and suture materials were developed to increase the strength of repairs but none of techniques and suture materials seem to provide enough tensile strength with safety margins for early active mobilization. In order to overcome this problem tendon suturing implants are being developed. We designed two different suturing implants. The aim of this study was to measure tendon-holding capacities of these implants biomechanically and to compare them with frequently used suture techniques Materials and Methods: In this study we used 64 sheep flexor digitorum profundus tendons. Four study groups were formed and each group had 16 tendons. We applied model 1 and model 2 implant to the first 2 groups and Bunnell and locking-loop techniques to the 3rd and 4th groups respectively by using 5 Ticron sutures. Results: In 13 tendons in group 1 and 15 tendons in group 2 and in all tendons in group 3 and 4, implants and sutures pulled out of the tendon in longitudinal axis at the point of maximum load. The mean tensile strengths were the largest in group 1 and smallest in group 3. Conclusion: In conclusion, the new stainless steel tendon suturing implants applied from outside the tendons using steel wires enable a biomechanically stronger repair with less tendon trauma when compared to previously developed tendon repair implants and the traditional suturing techniques.

scholarly journals Adhesion Assessment Between Composites Using Three Different Protocols

2020 ◽  
Vol 57 (1) ◽  
pp. 236-243
Author(s):  
Raul Ghiurca ◽  
Smaranda Buduru ◽  
Marius Bud ◽  
Rares Buduru ◽  
Cristian Culcitchi ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Testing Machine ◽  
Surface Preparation ◽  
Test Group ◽  
Diamond Bur ◽  
Universal Testing ◽  
Etch And Rinse ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The main purpose of this study is to evaluate three different adhesiveprotocols between two composites. We used 60 composite specimens (Kerr�s Herculite XRV Ultra), randomly divided into 3 equal experimental groups, in which adhesion was performed using different protocols: Group 1 (n= 20) surface preparation with a 1.4 mm cylindrical diamond bur (Kerr Dental, FG503C-5) + etch and rinse technique in 2 steps; Group 2 (n= 20) surface preparation with a 1.4 mm cylindrical diamond bur (Kerr Dental, FG503C-5) + Al2O3 (Zhermack Dental) sandblasting + etch and rinse technique in 2 steps; Group 3 (n= 20) surface preparation with a 1.4 mm cylindrical diamond bur (Kerr Dental, FG503C-5) + glycine (EMS) sandblasting + etch and rinse technique in 2 steps. Adhesion assessment was made by measuring tensile strength with a universal testing machine, the INSTRON 3343 (Instron�, USA). At the end, the results were statistically compared using the ANOVA test. Group 3 (glycine protocol) had the greatest values in terms of tensile strength.

The Transosseous Internal Four Strand Technique: A New All-Inside Technique for Zone 1 Flexor Tendon Repairs

Hand ◽  
2021 ◽  
pp. 155894472110604
Author(s):  
Patrick S. Harenberg ◽  
Jörg G. Grünert ◽  
Samuel M. Christen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Suture Technique ◽  
Suture Techniques ◽  
Suture Repair ◽  
Active Motion ◽  
Pull Out ◽  
Group 2 ◽  
Pull Out Suture ◽  
Group 1

Background: Multiple techniques for the repair of flexor tendon injuries in zone 1 have been proposed over time. While pull-out suture techniques and bone anchor seem to be stronger than internal suture techniques, they are associated with a higher complication rate. We therefore developed an alternative internal suture repair with similar biomechanical stability to those of pull-out sutures and bone anchors. Methods: Twenty porcine distal phalanges and deep flexor tendons were randomized to 2 groups of 10 each. The tendons were transsected at the level of the distal interphalangeal joint. In group 1, repairs were performed with a well-established intraosseous suture repair and in group 2 with our new multistrand technique. The repairs were biomechanically tested with linear distraction until failure. Results: We recorded a significantly higher 2-mm gap force (2GF)—and thus higher stability—of the repairs in group 1 in comparison to group 2. With a 2GF of more than 50 N, our suture technique allows for a modern early active motion rehabilitation protocol. Breakage of the suture construct occurred at random places in the repair in both groups. No pull-outs were noted. Conclusions: This study presents a strong transosseous multistrand repair technique for flexor tendon repair in zone 1 that is simple and fast to perform and should have enough strength to withstand early active motion rehabilitation.

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