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.

Sonographic study of repair, gapping and tendon bowstringing after primary flexor digitorum profundus repair in zone 2

2018 ◽  
Vol 43 (5) ◽  
pp. 480-486 ◽  
Author(s):  
Lisa Reissner ◽  
Nadja Zechmann-Mueller ◽  
Holger Jan Klein ◽  
Maurizio Calcagni ◽  
Thomas Giesen
Keyword(s):  
Clinical Outcomes ◽  
Ultrasound Examination ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Repair Site ◽  
Heterotopic Ossifications ◽  
Finger Motion ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report sonographic findings with clinical outcomes after zone 2 flexor digitorum profundus tendon repairs in ten fingers. The tendons underwent a six-strand M-Tang core repair, no circumferential suture, and partial or complete division of the pulleys. Over 12 months after surgery and using ultrasound, we found no gapping at the repair site during finger motion. When the pulleys were divided, there was sonographic evidence of tendon bowstringing, but the bowstringing was minimal. Clinically, we did not find any fingers that displayed tendon bowstringing or had functional loss. With ultrasound examination, the repaired tendons remained enlarged over 12 months. Two patients developed heterotopic ossifications at the repair site without tendon gliding, and these required tenolysis. We conclude that the tendon repair site does not gap when a strong core suture is used in the repair without adding peripheral sutures. There is no notable tendon bowstringing clinically, though the repaired tendons have sonographic evidence of minor bowstringing. Level of evidence: III

Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries

2020 ◽  
Vol 45 (10) ◽  
pp. 1034-1044
Author(s):  
Ahmed F. Sadek
Keyword(s):  
Tendon Repair ◽  
Flexion Contracture ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Power Grip ◽  
Contralateral Hand ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

A total of 53 patients with complete cuts of two flexor tendons in Zone 2B treated over a 9-year period was reviewed. Twenty-three patients (28 fingers) had only flexor digitorum profundus repair, while 30 patients (36 fingers) had both flexor digitorum profundus and flexor digitorum superficialis repairs, with a mean follow-up of 21 months (range 12–84). The decision to repair the flexor digitorum superficialis was made according to intraoperative judgement of ease of repair and gliding of the flexor digitorum profundus tendon. Two groups of patients showed no significant differences in total range of active or passive digital motion and power grip percentage to the contralateral hand. However, the values of power grip were statistically superior in the patients with both tendons repaired. The patients after flexor digitorum profundus-only repairs showed significantly greater but still mild flexion contracture (mean 20 °) of the operated digits. The Tang gradings were the same with 89% good and excellent rates in both groups. The conclusion is that although repair of both flexor digitorum profundus and flexor digitorum superficialis tendons is slightly more preferable based on increased grip strength, the repair of the flexor digitorum superficialis together with flexor digitorum profundus is not mandatory. Whether or not to repair flexor digitorum superficialis is an intraoperative decision based on the ease of gliding of the repaired tendon(s). Level of evidence: III

Isolated flexor digitorum profundus tendon injuries in zones IIA and IIB repaired with figure of eight sutures

2010 ◽  
Vol 36 (2) ◽  
pp. 147-153 ◽  
Author(s):  
M. M. Al-Qattan
Keyword(s):  
Tendon Repair ◽  
Suture Technique ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Major Disadvantage ◽  
Zone Ii ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Tendon Laceration

The ‘figure of eight’ suture technique for flexor tendon repair is known to be simple and strong but it has the major disadvantage of being bulky, with the knots outside the repair site. When the superficialis tendon is intact it may cause impingement and/or increase the work of flexion with postoperative mobilization and it is not known whether this bulky repair is suitable for isolated profundus injuries in zone II. A series of 36 patients (36 fingers) with clean-cut isolated flexor digitorum profundus tendon injuries in zones IIA/IIB were reviewed retrospectively. Repairs were done with three ‘figure of eight’ sutures and the pulleys proximal to the tendon laceration level were vented. Postoperatively, early active exercises were carried out. There were no ruptures. At a mean final follow-up of 6 months, the outcome (in range of motion) was excellent in 27 fingers and good in the remaining nine fingers by the Strickland criteria. It was concluded that the bulky ‘figure of eight’ technique can be used in isolated profundus tendon injuries in zones IIA/IIB.

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.

Primary Flexor Tendon Repair in Zone 1

2000 ◽  
Vol 25 (1) ◽  
pp. 78-84 ◽  
Author(s):  
N. S. MOIEMEN ◽  
D. ELLIOT
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Range Of Movement ◽  
Realistic Assessment ◽  
Distal Interphalangeal ◽  
Active Mobilization ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon ◽  
Distal Tendon

This paper presents an analysis of the results of repair of 102 complete flexor tendon disruptions in zone 1 which were rehabilitated by an early active mobilization technique during a 7 year period from 1992 to 1998. These injuries were subdivided into: distal tendon divisions requiring reinsertion; more proximal tendon divisions but still distal to the A4 pulley; tendon divisions under or just proximal to the A4 pulley; and closed avulsions of the flexor digitorum profundus tendon from the distal phalanx. Assessment by Strickland’s original criteria showed good and excellent results of 64%, 60%, 55% and 67% respectively in the four groups. However, examination of the results measuring the range of movement of the distal interphalangeal (DIP) joint alone provided a more realistic assessment of the affect of this injury on DIP joint function, with good and excellent results of only 50%, 46%, 50% and 22% respectively in the four groups.

scholarly journals Travelling along the Clinical Roadmap: Developing Electrospun Scaffolds for Tendon Repair

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Lucy A. Bosworth
Keyword(s):  
Material Properties ◽  
Tendon Repair ◽  
Human Mesenchymal Stem Cells ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Cell Orientation ◽  
Tendon Tissue ◽  
Electrospun Scaffolds ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

Biopolymers, such as poly(ε-caprolactone), can be easily electrospun to create fibrous scaffolds. It is also possible to control the alignment of the emitted fibres and further manipulate these scaffolds to create 3D yarn structures, which resemble part of the tendon tissue hierarchy. Material properties, such as tensile strength, can be tailored depending on the selection and combination of polymer and solvent used during electrospinning. The scaffolds have been proven to separately support the adhesion and proliferation of equine tendon fibroblasts and human mesenchymal stem cells whilst simultaneously directing cell orientation, which caused their alignment parallel to the underlying fibres. Implantation of scaffolds into the flexor digitorum profundus tendon of mice hindpaws yielded encouraging results with minimal inflammatory reaction and observation of cell infiltration into the scaffold. This research demonstrates the progression of electrospun fibres along the clinical roadmap towards becoming a future medical device for the treatment of tendon injuries.

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