AN INVERTING CIRCUMFERENTIAL SUTURE FOR FLEXOR TENORRAPHY

Hand Surgery ◽  
2011 ◽  
Vol 16 (02) ◽  
pp. 133-139 ◽  
Author(s):  
P. J. Sullivan ◽  
K. M. Hirpara ◽  
C. E. Healy ◽  
P. Dockery ◽  
J. L. Kelly
Keyword(s):  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
Improved Outcomes ◽  
Load To Failure ◽  
Poor Outcomes ◽  
Suturing Methods

Zone two flexor tendon repair remains challenging with significant outcome variation using recognised techniques. Tendon adhesion formation results in poor outcomes and rehabilitation regimes aim to limit this. Some repairs augment strength, but increasing bulk mitigates against movement. This novel epitendinous technique causes tendon inversion with potential gliding benefits and improved outcomes. 60 porcine tendons were randomised to a 2-stranded modified Kessler or a 4-stranded Adelaide repair, then sudivided into three different circumferential technique groups: locked running, Silfverskiold, or a new inverting repair. Tendon load to failure (LTF), 2 mm gap formation, bulking effect and method of failure were analysed during digital tensiometry. Four-stranded repairs demonstrated better LTF than 2-stranded techniques. The inverting epitendinous and Silfverskiold repairs showed higher LTF characteristics than the locked running suture, and better tissue holding capacity. The inverting repair has similar properties to commonly used suturing methods and the conformation creates a smooth inverted repair.

Gap Formation During Cyclic Testing of Flexor Tendon Repair

2018 ◽  
Vol 43 (6) ◽  
pp. 570.e1-570.e8 ◽  
Author(s):  
Lasse Linnanmäki ◽  
Harry Göransson ◽  
Jouni Havulinna ◽  
Petteri Sippola ◽  
Teemu Karjalainen ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Cyclic Testing ◽  
Gap Formation ◽  
Flexor Tendon Repair

scholarly journals Systemic EP4 Inhibition Increases Adhesion Formation in a Murine Model of Flexor Tendon Repair

PLoS ONE ◽  
2015 ◽  
Vol 10 (8) ◽  
pp. e0136351 ◽  
Author(s):  
Michael B. Geary ◽  
Caitlin A. Orner ◽  
Fatima Bawany ◽  
Hani A. Awad ◽  
Warren C. Hammert ◽  
...  
Keyword(s):  
Murine Model ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair

Digital Oedema, Adhesion Formation and Resistance to Digital Motion after Primary Flexor Tendon Repair

2008 ◽  
Vol 33 (6) ◽  
pp. 745-752 ◽  
Author(s):  
Y. CAO ◽  
C. H. CHEN ◽  
Y. F. WU ◽  
X. F. XU ◽  
R. G. XIE ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Subcutaneous Tissue ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Postoperative Changes ◽  
Three Stages

The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue. The degree of digital swelling correlated with the resistance to tendon motion between days 3 and 7. At day 9, granulation tissues were observed around the tendon and loose adhesions were observed at day 14. Resistance to digital motion increased significantly from day 0 to day 3, but did not increase between days 3 and 9. The early postoperative changes appear to have three stages: initial (days 0–3, increasing resistance with development of oedema), delayed (days 4–7, higher resistance with continuing oedema) and late (after day 7–9, hardening of subcutaneous tissue with development of adhesions).

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.

The Pathology of Flexor Tendon Repair

HAND ◽  
1979 ◽  
Vol os-11 (3) ◽  
pp. 233-242 ◽  
Author(s):  
Phillip Matthews
Keyword(s):  
Recent Work ◽  
Flexor Tendon ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Tendon Tissue ◽  
Flexor Tendon Repair ◽  
Long Time ◽  
The Subject ◽  
Methods Of Treatment

This paper discusses the problems of failure after tendon repair. For a long time the subject has been dominated by the problem of adhesion formation. Recent work has shown that this is not inevitable, and consideration of other factors, particularly the nutrition of tendon tissue is leading to the possibilities of other methods of treatment.

Primary Repair Of Flexor Tendons In The Hand Without Immobilisation – Preliminary Report

HAND ◽  
1978 ◽  
Vol os-10 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Hilton Becker
Keyword(s):  
Blood Supply ◽  
Preliminary Report ◽  
Suture Material ◽  
Flexor Tendon ◽  
Primary Repair ◽  
Tendon Repair ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
New Approach ◽  
Flexor Tendons

summary A new approach to the problem of flexor tendon repair within the fibro-osseous canal is presented. Using a technique of bevelling the tendon ends and suturing with a fine suture material, under magnification, a sufficiently strong junction is obtained, which enables immediate active mobilisation without strangulation of the blood supply. The junction can resist gap formation up to tensions of 4 Kg. It is postulated that under these conditions tendon nutrition is minimally interfered with, adhesions do not form, and the tendon heals by its own intrinsic healing ability.

scholarly journals Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Alice Wichelhaus ◽  
Sascha Tobias Beyersdoerfer ◽  
Brigitte Vollmar ◽  
Thomas Mittlmeier ◽  
Philip Gierer
Keyword(s):  
Suture Material ◽  
Flexor Tendon ◽  
Healing Process ◽  
Adhesion Formation ◽  
Rabbit Model ◽  
Tendon Repair ◽  
Initial Increase ◽  
Suture Repair ◽  
Flexor Tendon Repair ◽  
The Third

Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs.Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining.Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly.Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.

A cyclic testing comparison of two flexor tendon repairs: asymmetric and modified Lim-Tsai techniques

2018 ◽  
Vol 43 (5) ◽  
pp. 494-498 ◽  
Author(s):  
Rebecca Q. R. Lim ◽  
Yoke-Rung Wong ◽  
Austin M. K. Loke ◽  
Shian-Chao Tay
Keyword(s):  
Cyclic Load ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Stage I ◽  
Stage Ii ◽  
Cyclic Testing ◽  
Gap Formation ◽  
Flexor Tendon Repair ◽  
The Mean

This study compared the biomechanical performance of a novel 6-strand asymmetric flexor tendon repair with the modified Lim-Tsai technique using cyclic testing. Two groups of ten porcine tendons each were repaired and tested. Gap formation at every 100 cycles was measured. Survival was defined as maximum gap formation below 2 mm. All the repairs survived Stage I. With increased cyclic load in Stage II, the mean gap formation of modified Lim-Tsai repairs exceeded 2 mm at the 600th cycle and reached 4.2 mm (SD 1.93) at the end of Stage II, resulting in 0% survival. The mean gap formation of asymmetric repairs reached 2.0 mm (SD 1.43) at the 800th cycle and was 2.4 mm (SD 1.52) at the end of Stage II, with 60% survival. The asymmetric repair has better biomechanical performance under cyclic testing as compared with the modified Lim-Tsai repair.

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