scholarly journals The Effect of Gelatin Molecular Weight on Tendon Lubrication Utilizing an Extrasynovialized Turkey Flexor Tendon Model

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 729-736
Author(s):  
Michael J Forthofer, BS ◽  
Katherine M Arnold, MS ◽  
Ramona L Reisdorf, BS ◽  
Peter C Amadio, MD ◽  
Chunfeng Zhao, MD
Keyword(s):  
Molecular Weight ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Flexor Digitorum Profundus ◽  
Saline Control ◽  
Control Group ◽  
Saline Control Group ◽  
Military Population ◽  
Significant Difference ◽  
Flexor Digitorum

ABSTRACT Introduction Flexor tendon injuries are common hand injuries among the military population often resulting in functional impairment. Flexor tendon gliding friction has been linked to adhesion formation, especially with the use of extrasynovial grafts. Carbodiimide-derivatized hyaluronic acid with gelatin (cd-HA-gelatin) can reduce gliding friction of the tendon graft; however, the effects of gelatin molecular weight (MW) have not been studied. The turkey model has been shown to better match humans, but extrasynovial tendons are unavailable. The purpose of this study was to (1) manually roughen turkey flexor digitorum profundus (FDP) tendons to simulate extrasynovial tendons and (2) investigate the effects of gelatin MW on tendon friction. Materials and Methods The third digit of (n = 48) turkeys were dissected with the proximal pulley, and FDP tendon and the flexor superficialis tendon were preserved. Digits were randomly assigned into four groups: one saline control and three cd-HA-gelatin-treated groups of varying gelatin MW. Flexor digitorum profundus tendon friction was measured at its original condition, serving as a baseline. Tendons were roughened using a custom rig, and tendon friction was measured again. All four groups received treatment and gliding friction was measured every 100 cycles to a total of 1,000 cycles. Results Tendon friction significantly increased (P < 0.05) after roughening. Friction in the saline control group increased steadily over repeated cycles, whereas friction of all gelatin-treated tendons decreased significantly compared with the saline control group (P < 0.05), maintaining low friction to 1,000 cycles representing human tendons. There was no significant difference found between gelatin-treated groups. Conclusions We have developed a method to roughen synovial FDP tendons to create extrasynovial-like tendons for lubrication material evaluations. Cd-HA-gelatin effectively reduces tendon friction in this model. Our data suggest medium or low MW gelatin may provide a better reduction in friction compared with high MW gelatin.

Simplifying four-strand flexor tendon repair using double-stranded suture: a comparative ex vivo study on tensile strength and bulking

2012 ◽  
Vol 37 (2) ◽  
pp. 101-108 ◽  
Author(s):  
T. H. Low ◽  
T. S. Ahmad ◽  
E. S. Ng
Keyword(s):  
Tensile Strength ◽  
Flexor Tendon ◽  
Ex Vivo ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Significant Difference ◽  
Load To Failure ◽  
Fresh Frozen ◽  
Flexor Digitorum

We have compared a simple four-strand flexor tendon repair, the single cross-stitch locked repair using a double-stranded suture (dsSCL) against two other four-strand repairs: the Pennington modified Kessler with double-stranded suture (dsPMK); and the cruciate cross-stitch locked repair with single-stranded suture (Modified Sandow). Thirty fresh frozen cadaveric flexor digitorum profundus tendons were transected and repaired with one of the core repair techniques using identical suture material and reinforced with identical peripheral sutures. Bulking at the repair site and tendon–suture junctions was measured. The tendons were subjected to linear load-to-failure testing. Results showed no significant difference in ultimate tensile strength between the Modified Sandow (36.8 N) and dsSCL (32.6 N) whereas the dsPMK was significantly weaker (26.8 N). There were no significant differences in 2 mm gap force, stiffness or bulk between the three repairs. We concluded that the simpler dsSCL repair is comparable to the modified Sandow repair in tensile strength, stiffness and bulking.

ADHESION FORMATION AFTER FLEXOR TENDON REPAIR: COMPARISON OF TWO- AND FOUR-STRAND REPAIR WITHOUT EPITENDINOUS SUTURE

Hand Surgery ◽  
2005 ◽  
Vol 10 (02n03) ◽  
pp. 193-197 ◽  
Author(s):  
Margaret J. Strick ◽  
Susan L. Filan ◽  
Mark Hile ◽  
Catriona McKenzie ◽  
William R. Walsh ◽  
...  
Keyword(s):  
Broiler Chickens ◽  
Adhesion Formation ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Significant Difference ◽  
Histological Data ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Chicken Model

Increased handling, increased bulk at the repair site and an increase in external suture material may affect adhesion formation and gliding after tendon repair. A previous study1 showed no significant difference in biomechanical or histopathological measurement of adhesion formation in two- and four-strand repairs combined with an epitendinous suture in the chicken model. In the present study, the flexor digitorum profundus tendon of the middle toe of 47 broiler chickens was cut and repaired with either a single (two-strand) or double (four-strand) modified Kessler core suture without epitendinous suture and immobilised for four weeks. Adhesion formation was measured by biomechanical testing or quantitative and qualitative histopathology. Biomechanical and histological data showed no differences between two- and four-strand repairs. Results did not differ from the previous study which used an epitendinous suture. Adhesion formation is not necessarily increased when multi-strand techniques are used, nor by the placement of an epitendinous suture if care is taken with surgical technique. Individual healing response introduces more variability than an increase in tendon handling by an experienced surgeon.

Photochemical Tissue Bonding Technique for Improving Healing of Hand Tendon Injury

2019 ◽  
Vol 26 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Baozhi Ding ◽  
Xin Wang ◽  
Min Yao
Keyword(s):  
Adhesion Formation ◽  
Tendon Repair ◽  
Inflammatory Cells ◽  
Tendon Injury ◽  
Biochemical Properties ◽  
Flexor Digitorum Profundus ◽  
Human Amniotic Membrane ◽  
Active Motion ◽  
Significant Difference ◽  
Flexor Digitorum

Purpose. We utilized a novel approach of combined photochemical tissue bonding (PTB) and human amniotic membrane (HAM) to improve hand tendon repair and also evaluated its efficacy. Methods. Subei chickens underwent surgical transection of the flexor digitorum profundus tendons and repair by (1) SR (standard Kessler suture; n = 24; 6-0 prolene) and (2) HAM/PTB (n = 24), where a section of HAM was stained with 0.1% Rose Bengal, wrapped around the ruptured tendon and bonded with 532 nm light (0.5 W/cm2, 200 J/cm2). Total active motion, gross appearance, extent of adhesion formation, biochemical properties, and inflammatory cells of the repaired tendon were evaluated on days 3, 7, 14, and 28 postoperatively. Results. PTB strongly bonded HAM with flexor digitorum profundus tendon surface. No significant difference was observed between the tensile properties of either group on all postoperative time points. The joint activities and the adhesion formation levels were significantly better in the HAM/PTB group compared with those in the SR group on day 14. Histological examination revealed drastically reduced number of inflammatory cells in the HAM/PTB group than in the SR group on days 7 and 14 after surgery. Conclusions. These findings revealed that PTB sealing of HAM around the tendon repair site provided considerable benefits for hand tendon repair by eliminating technical difficulties and obvious contraindications. Thus, this novel procedure has considerable benefits in repairing hand tendon damage.

Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs — an in vitro biomechanical study

2012 ◽  
Vol 38 (4) ◽  
pp. 418-423 ◽  
Author(s):  
E. McDonald ◽  
J. A. Gordon ◽  
J. M. Buckley ◽  
L. Gordon
Keyword(s):  
Mechanical Properties ◽  
Stainless Steel ◽  
Ultimate Load ◽  
Flexor Tendon ◽  
Biomechanical Study ◽  
Flexor Digitorum Profundus ◽  
Human Cadaver ◽  
Mode Of Failure ◽  
Flexor Digitorum

Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength.

Addition of Epinephrine to Intrathecal Bupivacaine and Sufentanil for Ambulatory Labor Analgesia

1997 ◽  
Vol 86 (3) ◽  
pp. 525-531 ◽  
Author(s):  
David C. Campbell ◽  
Robert Banner ◽  
Lesley-Ann Crone ◽  
Wendy Gore-Hickman ◽  
Ray W. Yip
Keyword(s):  
Labor Analgesia ◽  
Saline Control ◽  
Control Group ◽  
Double Blind Study ◽  
Saline Control Group ◽  
Double Blind ◽  
Prolonged Labor ◽  
Intrathecal Analgesia ◽  
Limited Duration ◽  
Effective Analgesia

Background The intrathecal combination of sufentanil and bupivacaine provides rapid, effective analgesia for labor with a limited duration. Many anesthesiologists have concerns that the use of intrathecal local anesthetics precludes maternal ambulation. This prospective, randomized, double-blind study was designed to determine whether the addition of epinephrine to the combination of sufentanil and bupivacaine would prolong intrathecal analgesia for labor. Patients' ability to ambulate was also assessed. Methods Thirty-nine patients received either an intrathecal control dose of 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml normal saline (control group); or 10 micrograms sufentanil plus 2.5 mg bupivacaine plus 0.2 ml (0.2 mg) of epinephrine (EPI group). Results Seven patients (3 control, 4 EPI) delivered vaginally and two (1 control, 1 EPI) required cesarean delivery before requesting epidural analgesia. The duration (mean +/- SD) of intrathecal labor analgesia was prolonged significantly by the addition of epinephrine: control (n = 15): 145 +/- 23 min; EPI (n = 15): 188 +/- 25 min (P < 0.0001). Maternal ambulation was demonstrated in 100% (19 of 19) of the control group and in 80% (16 of 20) of the EPI group (P = NS). Conclusions The addition of 0.2 mg epinephrine to the intrathecal combination of sufentanil and bupivacaine significantly prolonged labor analgesia without causing adverse effects to the mother or fetus. The intrathecal combination of sufentanil and bupivacaine, with or without epinephrine, provided rapid, profound labor analgesia and allowed most patients to ambulate.

OUTCOME OF TRACTION TENOLYSIS IN OPEN TRIGGER FINGER RELEASE — A RETROSPECTIVE REVIEW

Hand Surgery ◽  
2013 ◽  
Vol 18 (03) ◽  
pp. 375-379 ◽  
Author(s):  
Muntasir Mannan Choudhury ◽  
Shian Chao Tay
Keyword(s):  
Flexor Tendon ◽  
Group Versus ◽  
Trigger Finger ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Active Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Flexor Digitorum ◽  
A1 Pulley

Surgical treatment for trigger finger involves division of the A1 pulley. Some surgeons perform an additional step of traction tenolysis by sequentially bringing the flexor digitorum superficialis and flexor digitorum profundus tendons out of the wound gently with a Ragnell retractor. There is currently no study which states whether flexor tendon traction tenolysis should be routinely performed or not. The objective of this study is to compare the outcome in patients who have traction tenolysis performed (A group) versus those who did not have traction tenolysis (B group) performed. It was noted that even though the mean total active motion (TAM) for the B group in our study was lower preoperatively, it was consistently higher than the A group in all the 3 post-operative visits demonstrating a better outcome in the B group. Even though it was not statistically significant, our data also showed that patients with traction tenolysis appeared to have more postoperative pain compared to those without.

Investigation of TAp63 gene Expression and Follicle Count Using Melatonin in Cisplatin-induced Ovarian Toxicity

2020 ◽  
Author(s):  
Hacı Öztürk Şahin ◽  
Mehmet Nuri Duran ◽  
Fatma Sılan ◽  
Ece Sılan ◽  
Duygu Sıddıkoglu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Female Rats ◽  
Histological Evaluation ◽  
Saline Control ◽  
Control Group ◽  
Ovarian Toxicity ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Background: Premature ovarian failure is among the most important side effects of chemotherapy during reproductive period. Preserving ovarian function is gradually gaining importance during oncologic treatment. The present study aims to investigate the potential of melatonin to protect from cisplatin-induced ovarian toxicity in rats. Twenty nine female rats were divided to three groups: Saline control group (Group 1), cisplatin group (Group 2), and cisplatin+melatonin group (Group 3). While the rats in Groups 2 and 3 were administered 5 mg/kg single dose of cisplatin via intra-peritoneal (IP) route, the rats in Group 3 were started on melatonin (20 mg/kg IP) before cisplatin administration and continued during 3 consecutive days. Ovaries were removed one week after cisplatin administration in all groups. Blood samples were obtained before the rats were decapited. Histological evaluation, follicle count, and classification were performed. TAp63 mRNA expression was evaluated using mRNA extraction and real-time polymerase chain reaction (PCR) method. Serum estradiol (E2) and anti-mullerian hormone (AMH) values were measured with enzyme immune-assay technology. Results: While primordial follicles were seen to decrease in Group 2 as compared to Group 1 (p:0.023), primordial follicle count was observed to be preserved significantly in melatonin group as compared to Group 2 (p:0.047). Moreover, cisplatin-induced histo-pathological morphology was preserved in favor of normal histology in melatonin group. A significant difference was not observed between groups with regard to mean serum AMH and E2 values (p:0.102 and p:0.411, respectively). While TAp63 gene expression significantly increased in Group 2 as compared to control group (p:0.001), we did not detect a statistically significant difference in cisplatin+melatonin group, although gene expression decreased (p:0.34). Conclusion: We conclude that concurrent administration of melatonin and cisplatin may protect from ovarian damage.

Sliding Position of the Flexor Tendons Relative to the Hook of Hamate in CT Scans

2019 ◽  
Vol 24 (01) ◽  
pp. 72-75
Author(s):  
Kenji Goto ◽  
Kiyohito Naito ◽  
Yoichi Sugiyama ◽  
Nana Nagura ◽  
Ayaka Kaneko ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Injury ◽  
Ct Scans ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Ulnar Side ◽  
Flexor Tendon Injury ◽  
Hook Of Hamate ◽  
Flexor Digitorum ◽  
Little Finger

Background: The aim of this study was to assess the height of nonunion formation injuring the ulnar-side finger flexor tendon, the positional relationship between the hook of the hamate and little finger flexor tendon was evaluated on CT scans. Methods: The subjects were 20 healthy patients (40 hands) (14 males and 6 females, mean age: 28 years old). Their hands were imaged in extension and flexion of the fingers on CT. The position of the little finger flexor tendon was determined regarding the height of the hook of the hamate as 100%. Results: The heights of the flexor digitorum profundus tendons were 46 ± 6% in extension and 44 ± 9% in flexion, and those of the flexor digitorum superficialis tendons were 87 ± 8% in extension and 91 ± 9% in flexion. Conclusions: Our study suggested that 40% of the base of the hook of the hamate does not contact with the flexor tendon, suggesting that flexor tendon injury is unlikely to occur in that region.

Flexor Tendon Repair Using a Stainless Steel Internal Anchor

1998 ◽  
Vol 23 (1) ◽  
pp. 37-40 ◽  
Author(s):  
L. GORDON ◽  
M. TOLAR ◽  
K. T. VENKATESWARA RAO ◽  
R. O. RITCHIE ◽  
S. RABINOWITZ ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Tendon Repair ◽  
Active Flexion ◽  
Active Range Of Motion ◽  
Flexor Digitorum

We have developed a stainless steel internal tendon anchor that is used to strengthen a tendon repair. This study tested its use in vitro to produce a repair that can withstand the tensile strength demands of early active flexion. Fresh human cadaver flexor digitorum profundus tendons were harvested, divided, and then repaired using four different techniques: Kessler, Becker or Savage stitches, or the internal tendon anchor. The internal splint repairs demonstrated a 99–270% increase in mean maximal linear tensile strength and a 49–240% increase in mean ultimate tensile strength over the other repairs. It is hoped that this newly developed internal anchor will provide a repair that will be strong enough to allow immediate active range of motion.

Patterns of Cellular Activation after Tendon Injury

1996 ◽  
Vol 21 (6) ◽  
pp. 813-820 ◽  
Author(s):  
U. KHAN ◽  
J. C. W. EDWARDS ◽  
D. A. McGROUTHER
Keyword(s):  
Flexor Tendon ◽  
Rabbit Model ◽  
Early Period ◽  
Tendon Injury ◽  
Flexor Digitorum Profundus ◽  
Cellular Activation ◽  
Relative Response ◽  
Tendon Surgery ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Mechanisms which lead to disabling adhesions following flexor tendon surgery of the hand were investigated in a rabbit model which was used to assess the relative response of the cells of the synovial sheath, epitenon and the endotenon to injury. A transverse laceration, cutting through 50% of the tendon, was made just outside the synovial sheath on the flexor aspect of the flexor digitorum profundus tendon. The synovial sheath was preserved intact. Using monoclonal antibodies for localizing specific inflammatory markers, we were able to follow the response and activity of the synovial sheath, epitenon and endotenon with respect to these markers at various times after surgery. Our findings suggest that the synovial sheath and the epitenon are relatively more reactive in the early period after injury, as judged by a range of inflammatory indices with the notable exception of the expression of the potent neovascularizing agent, basic fibroblast growth factor (bFGF).

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