MODIFIED BRUNELLI PULL-OUT SUTURE TECHNIQUE IN ZONE II FLEXOR TENDON RUPTURE: A FRESH HUMAN CADAVER STUDY

Hand Surgery ◽  
2014 ◽  
Vol 19 (03) ◽  
pp. 349-355
Author(s):  
Hakan Başar ◽  
Cihangir Tetik
Keyword(s):  
Suture Technique ◽  
Flexor Digitorum Profundus ◽  
Control Group ◽  
Study Group ◽  
Gap Formation ◽  
Active Motion ◽  
Average Load ◽  
Pull Out ◽  
Pull Out Suture ◽  
Flexion And Extension

Purpose: The aim of our study is to develop a suture technique that has sufficient strength of active mobilization. Methods: Thirty two fingers of six fresh human cadavers were divided into two groups. Flexor digitorum profundus (FDP) tendons in the study group were repaired by modified Brunelli suture technique and modified Kessler suture technique, while those in the control group were repaired by Modified Kessler suture technique. Flexion and extension movements were performed with 10 N of load, increasing 1 N at a time to the tendons in both groups. Rupture and significant gap formation was evaluated up to 20 N of load. In the study, to evaluate the resistance to active motion, 1000 times flexion and extension motion cycle was performed with a load of 20 N. The succeeding repaired tendons was also tested with flexion and extension movements increasing the load 1 N at a time. Results: In the study group, failure and significant gap formation on the repair zone were not observed after 20 N of load and 1000 times cyclic flexion and extension movements for resisting to active motion. The rupture and significant gap formation was observed on a average load of 98.43 ± 0.47 N. In the Modified Kessler suture technique, on the eight tendons before reaching the 20 N of load for resisting to active motion, and the remaining eight tendons, during the 20 N loaded motion cycle essential for active motion, rupture and significant gap formation was observed. The failure and significant gap formation was observed on a average load of 18.37 ± 1.89 N. It is measured that by accompanying Modified Brunelli suture to the Modified Kessler suture technique, the resistance was increased up to 5–6 times. Discussion: By the Modified Brunelli suture technique, active motion can be started to the finger without a dorsal block sling immediately after the surgery. Clinical Relavans: By the modified technique, the rehabilitation difficulty and joint stiffness will be minimized.

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.

Opening wedge phalangeal osteotomy for correction of Wassel type IV-D thumb duplication

2019 ◽  
Vol 52 (02) ◽  
pp. 147-150
Author(s):  
Kun Wang ◽  
Fangxin Ai ◽  
Pan Zhou ◽  
Zhiwei Liu ◽  
Zhenbing Chen ◽  
...  
Keyword(s):  
Metacarpophalangeal Joint ◽  
Suture Technique ◽  
Wedge Osteotomy ◽  
Angular Deformity ◽  
Opening Wedge ◽  
Type Iv ◽  
Pull Out ◽  
Thumb Duplication ◽  
The Right ◽  
Pull Out Suture

Abstract Background Thumb duplication is one of common anomalies of the hand. Among of Wassel type IV subtypes, type IV-D duplication with a zigzag deformity is most challenging for reconstructing. Several factors may affect the surgical outcomes. This study aimed to present an opening wedge osteotomy at proximal phalangeal neck for treating type IV-D duplication. Methods Data from 14 patients are presented in this study. Eight patients had duplication of the right thumb, and six left thumb. After removal of radial supernumerary thumb, a snug collateral ligament was repaired to correct angular deformity of metacarpophalangeal joint (MCP). Angular deformity of the interphalangeal (IP) joint was corrected by an opening wedge osteotomy at the proximal phalangeal neck. A wedge bone from ablated thumb was grafted to correct the malalignment. IP joint was further stabilized by plication of the ulnar capsule. The relocation of radial part of FPL to the center of distal phalangeal base by use of pull-out suture technique Results After surgery, the angulations of the IP joints and the MCP joints were improved. Bone union was observed in all patients. According to the Japanese Society for Surgery of the Hand evaluation form, twelve cases were rated good, 2 cases fair. Stability of IP and MCP joints was good in all cases. The active ROM of IP was less in residual thumb than in normal thumb. Small nails were observed in some patients. Conclusions Although the reconstructed thumbs were smaller than normal counterparts, they were aligned and with stable joints. The opening wedge osteotomy at proximal phalangeal neck could improve realignment of IP joint and prevent reoccurrence of deformity over time.

The longer pull-out suture as a transmission suture for early active motion of repaired flexor tendon at the proximal zone-2

2010 ◽  
Vol 131 (4) ◽  
pp. 573-580 ◽  
Author(s):  
İbrahim E. Ökçesiz ◽  
Ahmet Ege ◽  
Egemen Turhan ◽  
Murat Songür ◽  
Ahmet Bayar ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Active Motion ◽  
Pull Out ◽  
Pull Out Suture ◽  
Proximal Zone

Repair Technique Using a Combination of Suture Anchor and Miniscrew in Flexor Digitorum Profundus Bony Avulsion Fracture with Bone Fragment in Zone 1

2018 ◽  
Vol 23 (03) ◽  
pp. 430-436
Author(s):  
Jae-Hwi Nho ◽  
Sang-Woo Lee ◽  
Mi-Ae Nam ◽  
Byung-Sung Kim ◽  
Ki Jin Jung
Keyword(s):  
Suture Anchor ◽  
Avulsion Fracture ◽  
Flexor Tendon ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Rare Injury ◽  
Pull Out ◽  
Bony Avulsion ◽  
Flexor Tendon Injuries ◽  
Pull Out Suture

Avulsion fracture of the volar base of the distal phalanx is a rare injury. Zone 1 flexor tendon injuries can be treated with either internal or external fixation techniques. Pull-out suture repairs are often used for FDP tendon avulsion injuries. However, the pull out suture technique is associated with a number of well documented complications including nail bed injury and pressure necrosis. Despite the variety of techniques available for the repair of acute distal zone 1 flexor tendon injuries, no one technique has proven to be superior to all others. We address our experience with treatment of FDP avulsion injuries using suture anchor and miniscrew. Our technique supplements the suture anchor technique, which often causes a lack of strength, with an additional miniscrew. We introduce two cases of combined method using both suture anchor and miniscrew for treatment of FDP avulsion injuries.

scholarly journals Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Li Xiahou ◽  
Chunlan Liu ◽  
Weihong Zhou ◽  
Shasha Yang
Keyword(s):  
Intraocular Pressure ◽  
Anterior Chamber ◽  
Suture Technique ◽  
Control Group ◽  
Study Group ◽  
Treatment Technique ◽  
Scleral Flap ◽  
Combination Technique ◽  
Primary Glaucoma ◽  
One Year

Objective: To investigate the clinical effect of microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique in the treatment of primary glaucoma. Methods: One hundred primary glaucoma patients (120 eyes) in Xinyu People’s Hospital of Jiangxi province were selected from July 2014 to June 2016. The patients were randomly divided into control group and study group. The control group was treated with compound trabeculectomy, while the study group was treated with microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique. In both groups of patients, intraocular pressure, functional filtering bleb formation, and complications before and after surgery were monitored for three days, one week, one month, three months, six months and one year, while anterior chamber depth was determined one week after operation. The extent of success of operation was compared between the two groups. Results: At three days, one week, one month, three months, six months and one year after surgery, intraocular pressure of study group was significantly lower than that of the control group (P<0.05). There was 93.33% formation of functional filtering blebs in the study group, which was significantly higher than that in the control group (60.00%, P<0.001). Moreover, normal anterior chamber formation was significantly higher in the study group (91.67%) than in the control group (71.67%, P<0.01). There was 95.00% operation success in the study group, relative to 68.33% success in the control group (P<0.001). Conclusion: Microsurgical scleral drainage and trabeculectomy combined with scleral flap adjustable suture technique has better curative effect on primary glaucoma than compound trabeculectomy. Moreover, it does not exacerbate complications. Therefore, the combination treatment technique merits clinical application. doi: https://doi.org/10.12669/pjms.36.2.1439 How to cite this:Xiahou L, Liu C, Zhou W, Yang S. Microsurgical scleral drainage and trabeculectomy-scleral flap adjustable suture combination technique in the treatment of primary glaucoma. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1439 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Tratamiento artroscópico de las lesiones tipo 1B del fibrocartílago triangular

2004 ◽  
Vol 32 (65) ◽  
pp. 008-017
Author(s):  
C. Reina ◽  
M. Gutiérrez ◽  
A. Luna ◽  
F. Martín ◽  
J. Sánchez-Heredero ◽  
...  
Keyword(s):  
Surgical Techniques ◽  
Distal Radioulnar Joint ◽  
Variable Number ◽  
Suture Technique ◽  
Regeneration Ability ◽  
Radioulnar Joint ◽  
Pull Out ◽  
Triangular Fibrocartilage ◽  
Centre Of Rotation ◽  
Pull Out Suture

El complejo del fibrocartílago triangular (CFCT) desempeña un papel fundamental en la biomecánica de la muñeca. Actúa absorbiendo y transmitiendo cargas, y sirve como punto de pivote para la rotación del radio y del carpo alrededor del cúbito, por lo que funciona como centro de rotación del antebrazo. Además constituye el principal elemento estabilizador de la articulación radiocubital distal. Estudios histológicos han demostrado que la parte central del CFCT, también denominada disco articular, es avascular, mientras que su periferia está bien vascularizada, por lo que las lesiones de esta porción tienen mayor capacidad de regeneración. Las lesiones del CFCT constituyen una causa primaria de dolor en el lado cubital de la muñeca y de inestabilidad de la articulación radiocubital distal. Su tratamiento ha incluido una serie de medidas conservadoras así como un número variable de técnicas quirúrgicas, entre las que destacan en los últimos años el desbridamiento artroscópico en las lesiones centrales, y la reinserción artroscópica en las lesiones periféricas. Presentamos un estudio retrospectivo sobre los resultados del tratamiento artroscópico de las lesiones periféricas tipo 1B, realizado en 10 pacientes que fueron intervenidos quirúrgicamente en nuestro departamento entre los meses de febrero de 1999 y enero de 2002. Se realizó una reinserción artroscópica mediante técnica dentro-afuera y sutura en pull-out, obteniéndose resultados excelentes en 7 casos, buenos en 2 y malos en 1.The triangular fibrocartilage complex (TFCC) plays an important role in the biomechanics of the wrist. It acts by absorbing and transmitting loads, and serves as a pivot point for the rotation of the radiocarpal unit around the ulnar axis, and so it works as a centre of rotation for the forearm. It is also the main stabilising element of the distal radioulnar joint. Histological studies have shown that the central part of the TFCC, also known as the articular disc, is avascular, while its periphery is well vascularised, and so lesions in this section have a greater regeneration ability. TFCC lesions are a primary cause of pain in the ulnar side of the wrist and instability of the distal radioulnar joint. Treatment for this has included a series of conservative measures as well as a variable number of surgical techniques, particularly in recent years arthroscopic debridement in central lesions and athroscopic reinsertion in peripheral lesions. We present a retrospective study of the results of arthroscopic treatment of type 1B lesions, carried out on 10 patients who were operated on in our department between February 1999 and January 2002. Arthroscopic reinsertion was carried out using the internal-external and pull-out suture technique, with excellent results being obtained in 7 cases, good results in 2, and an unfavourable result in 1 case.

Double transosseous pull out suture technique for transection of posterior horn of medial meniscus

2008 ◽  
Vol 129 (3) ◽  
pp. 387-392 ◽  
Author(s):  
Jin Hwan Ahn ◽  
Joon Ho Wang ◽  
Hong Chul Lim ◽  
Ji Hoon Bae ◽  
Joon Soo Park ◽  
...  
Keyword(s):  
Medial Meniscus ◽  
Suture Technique ◽  
Posterior Horn ◽  
Pull Out ◽  
Pull Out Suture
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