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.

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.

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.

Results of heterodigital flexor digitorum profundus hemi-tendon transfer for 23 flexor tendon injuries in zones 1 or 2

2017 ◽  
Vol 43 (5) ◽  
pp. 487-493 ◽  
Author(s):  
Aude Bommier ◽  
Duncan McGuire ◽  
Patrick Boyer ◽  
Asan Rafee ◽  
Sami Razali ◽  
...  
Keyword(s):  
Tendon Transfer ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injuries ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Flexor Tendon Injuries ◽  
Flexor Digitorum

We report outcomes of reconstruction of zone 1 or 2 flexor tendon injuries using a heterodigital hemi-tendon transfer of the flexor digitorum profundus in 23 fingers of 23 patients. At mean follow-up of 57 months, the mean total active motion of the three finger joints including the metacarpophalangeal joint was 128 degrees preoperatively and 229 degrees at final follow up. According to Strickland criteria, the function was excellent for 14 fingers, good for seven fingers and poor for two fingers. The subgroup analysis showed that the results were better in cases of primary surgery, children, and for the index and little fingers. Complications included stiffness of three fingers, and rupture in one finger that was converted to a two-stage tendon reconstruction. We conclude that this technique restores good function in most patients with zone 1 and 2 flexor tendon injuries, in which primary tendon repair has not been performed or was unsuccessful, and where pulley reconstruction is not required. Level of evidence: IV

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.

Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers

2019 ◽  
Vol 44 (4) ◽  
pp. 361-366 ◽  
Author(s):  
Zhang Jun Pan ◽  
Yun Fei Xu ◽  
Lei Pan ◽  
Jing Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Level Of Evidence ◽  
Active Motion ◽  
Repair Site ◽  
The Core ◽  
Active Flexion ◽  
Flexor Digitorum

We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8–33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV

A Prospective Study of Flexor Tendon Repair in Zone 5

1998 ◽  
Vol 23 (5) ◽  
pp. 642-648 ◽  
Author(s):  
N. W. YII ◽  
M. URBAN ◽  
D. ELLIOT
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Active Motion ◽  
Flexor Tendons ◽  
Active Flexion ◽  
A Prospective Study ◽  
Flexor Digitorum

A prospective study of postoperative mobilization of flexor tendon repairs in zone 5 was conducted over a 2-year period between 1994 and 1996 using a controlled active motion (active extension - active flexion) regimen of mobilization. Fifty-two patients, who had a total of 151 flexor digitorum superficialis (FDS) and 103 flexor digitorum profundus (FDP) divisions, were available for review at a mean follow-up of 10 months. Of the 161 fingers with division of one or both flexor tendons, 66% exhibited independent FDS function and 90% achieved good or excellent results of digital range of motion. No rupture of an FDP tendon repair occurred during the study period. The data allowed us to define a new method of classifying the results of treatment of these injuries in terms of the injured wrists as a whole and not simply as a series of isolated observations for each individual finger with divided flexor tendons. The results of recovery of independent FDS action and range of finger movement achieved for injuries in which the flexors of all four fingers had been divided indicate a statistically significant interdependence of injuries of finger flexors of adjacent fingers at the wrist. Multivariate analysis showed the presence of a “spaghetti wrist” injury to have a significant adverse effect on the recovery of the independent FDS action but not on the recovery of the digital range of motion.

Flexor tendon repair in the hand with the M-Tang technique (without peripheral sutures), pulley division, and early active motion

2018 ◽  
Vol 43 (5) ◽  
pp. 474-479 ◽  
Author(s):  
Thomas Giesen ◽  
Lisa Reissner ◽  
Inga Besmens ◽  
Olga Politikou ◽  
Maurizio Calcagni
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Flexor Digitorum Superficialis ◽  
Level Of Evidence ◽  
Active Motion ◽  
Post Surgery ◽  
A2 Pulley ◽  
Flexor Digitorum ◽  
Flexor Digitorum Profundus Tendon

We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half. When the flexor digitorum profundus tendon would not glide under the A2 pulley, we excised the remaining slip of the flexor digitorum superficialis tendon. The wrist was splinted in mild extension post-surgery with early commencement of tenodesis exercises. No tendon repair ruptured. By the Strickland criteria, out of 27 fingers, 18 had excellent, six had good, two had fair, and one had poor results. We conclude that a strong core suture (such as the M-Tang repair) without peripheral sutures, and with division of pulleys as necessary is safe for early active motion and yields good outcomes. Level of evidence: IV

Preventing postoperative adhesions after hand tendon repair using acellular dermal matrix

2021 ◽  
Vol 30 (11) ◽  
pp. 890-895
Author(s):  
Hyung Sup Shim ◽  
Kyeong Soo Park ◽  
Sang Wha Kim
Keyword(s):  
Range Of Motion ◽  
Tendon Repair ◽  
Acellular Dermal Matrix ◽  
Tendon Injury ◽  
Interphalangeal Joint ◽  
Control Group ◽  
Dermal Matrix ◽  
Active Motion ◽  
Significant Difference ◽  
Acellular Dermal

Aims: Postoperative tendon adhesions contribute to functional disability and reconstructive failure. In this study, we present the long-term outcomes of a prospective study in which acellular dermal matrix (ADM) was used to prevent postoperative adhesion after tendon injury. Methods: The study was conducted between March 2014 and February 2017. Patients, aged 19–65 years, with an acute single flexor tendon injury in zones 1 or 2, distal to the palmar digital crease were candidates for the study. Patients were allocated to either an ADM treatment group or a control group without ADM treatment. Results: A total of 37 patients were enrolled in the study: 21 patients in the ADM group and 16 patients in the control group. At six months after surgery, the range of motion in the proximal interphalangeal joint was 81.0±5.1 degrees in the ADM group and 75.8±6.9 degrees in the control group. The range of motion in the distal interphalangeal joint was 79.9±7.1 in the ADM group and 71.2±5.7 degrees in the control group, with significant difference (p=0.03 and p<0.05, respectively). In addition, the total active motion was higher in the ADM group than in the control group. The patients' scores on the Patient Satisfaction Questionnaire were also significantly different, with higher satisfaction scores in the ADM group (p=0.02). The minimal follow-up period was six months. Conclusion: The use of ADM after tendon repair has the potential to significantly improve the outcome of tendon surgery in terms of range of motion. Declaration of interest: None of the authors has any financial interest in the products, devices, or drugs mentioned in this article.

Reinforcement of the Flexor Tendon Repair Using Human Amniotic Membrane

2016 ◽  
Vol 106 (5) ◽  
pp. 319-322 ◽  
Author(s):  
Yunus Dogramaci ◽  
Ibrahim Gökhan Duman
Keyword(s):  
Amniotic Membrane ◽  
Mechanical Performance ◽  
Testing Machine ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Human Amniotic Membrane ◽  
Load To Failure ◽  
Group A ◽  
Group B ◽  
Flexor Digitorum

Background: Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane. Methods: Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure. Results: The mean ± SD value of the failure strength was 34.6 ± 1.64 N for group A and 50.6 ± 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P &lt; .001). All of the specimens failed due to suture breakage at the repair site. Conclusions: The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.

scholarly journals Surgery and Rehabilitation Following Flexor Tendon Zone II Injury Of The Hand: A Literature Review

2018 ◽  
Vol 4 (1) ◽  
pp. 73-81
Author(s):  
Loelita Marcelia Lumintang ◽  
Beta Subakti Nata’atmadja
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Tendon Injury ◽  
Suture Repair ◽  
Suture Materials ◽  
Active Motion ◽  
Definitive Answer ◽  
Polyester Suture ◽  
Significant Difference ◽  
Zone Ii

Background : Flexor tendon injury of the hand is common and it used to end up with poor outcomes. It gives negative effects to patient’s daily life. Successful treatment for these cases is a challenge for surgeons. Before 1967, Injury in Zone II was called as “No Man’s Land”. Flexor tendon repair and rehabilitation have been substantially improved through advances in repair and rehabilitation. Method : We reviewed literatures from PubMed, MEDLINE, Cochrane and Google Scholar. It was researched using the terms flexor tendon zone II injury, flexor tendon zone II repair and flexor tendon zone II rehabilitation. Topics covered included anatomy, suture repair and material, and rehabilitation. Result : There is no significant difference of rupture rates and functional outcomes in the number of core suture. Braided polyester suture is the choice for core suture and monofilament for peripheral suture. There is no significant difference in rehabilitation using early passive motion or early active motion. The preference for post operative treatment is by using short splint without immobilization of the wrist. Discussion : Repair sutures techniques and suture materials have been improved as well as active mobilization rehabilitation protocols including a change of wrist position by modification of splints. Improvement in putting splint from a traditional dorsal blocking splint into splint that not immobilize the wrist. Despite all of these modifications, tendon ruptures have not been eliminated. The definitive answer remains elusive.

Sign in / Sign up

Export Citation Format

Share Document