scholarly journals Anatomy and histomorphology of the flexor digitorum profundus enthesis: functional implications for tissue engineering and surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jeremy W. Mortimer ◽  
Hamad Alsaykhan ◽  
Subashan Vadibeler ◽  
Philippa A. Rust ◽  
Jennifer Z. Paxton
Keyword(s):  
Flexor Digitorum Profundus ◽  
Specific Knowledge ◽  
Linear Mixed Effects ◽  
Angle Change ◽  
Morphological Adaptations ◽  
Functional Implications ◽  
Fresh Frozen ◽  
Flexor Digitorum ◽  
Surgical Treatments ◽  
Histological Architecture

Abstract Background The enthesis possesses morphological adaptations across the soft-hard tissue junction which are not fully restored during surgical avulsion repairs. This loss of anatomical structure, highly related to function, contributes to poor clinical outcomes. Investigating the native macro- and micro-structure of a specific enthesis can provide functional and biomechanical insights to develop specialised, novel tissue-engineered therapeutic options and potentially improve current surgical treatments for avulsion injuries. Methods This study examines the anatomy and histomorphology of the flexor digitorum profundus (FDP) enthesis in 96 fresh-frozen human cadaveric fingers, quantitatively and qualitatively analyzing the shape, size, angle of tendon fibres and histological architecture, and explores differences in sex, finger and distance along the enthesis using linear mixed effects models. Results Macroscopically, results showed a consistent trapezoidal insertion shape of 29.29 ± 2.35 mm2 mean surface area, but with significant morphometric size differences influenced primarily by the smaller dimensions of the little finger. Microscopically, a fibrocartilaginous enthesis was apparent with a 30.05 ± 0.72o mean angle of inserting tendon fibres, although regional variation in fibrocartilage and the angle change of tendon fibres before insertion existed. Conclusions The implication of these findings on native and specific FDP enthesis function is discussed whilst providing recommendations for optimal FDP enthesis recreation for interfacial tissue engineers and hand surgeons. The study emphasizes the importance of region-specific knowledge whilst also describing methods applicable to assessing any soft tissue insertion.

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.

Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications

Hand ◽  
2020 ◽  
pp. 155894472096388
Author(s):  
Michele R. Colonna ◽  
Maria Piagkou ◽  
Andrea Monticelli ◽  
Cesare Tiengo ◽  
Franco Bassetto ◽  
...  
Keyword(s):  
Ulnar Nerve ◽  
Cadaveric Study ◽  
Flexor Digitorum Profundus ◽  
Branching Patterns ◽  
Fresh Frozen ◽  
Innervation Patterns ◽  
Muscle Innervation ◽  
Lumbrical Muscle ◽  
Lumbrical Muscles ◽  
Flexor Digitorum

Background Lumbrical muscles originate in the palm from the 4 tendons of the flexor digitorum profundus and course distally along the radial side of the corresponding metacarpophalangeal joints, in front of the deep transverse metacarpal ligament. The first and second lumbrical muscles are typically innervated by the median nerve, and third and fourth by the ulnar nerve. A plethora of lumbrical muscle variants has been described, ranging from muscles’ absence to reduction in their number or presence of accessory slips. The current cadaveric study highlights typical and variable neural supply of lumbrical muscles. Materials Eight (3 right and 5 left) fresh frozen cadaveric hands of 3 males and 5 females of unknown age were dissected. From the palmar wrist crease, the median and ulnar nerve followed distally to their terminal branches. The ulnar nerve deep branch was dissected and lumbrical muscle innervation patterns were noted. Results The frequency of typical innervations of lumbrical muscles is confirmed. The second lumbrical nerve had a double composition from both the median and ulnar nerves, in 12.5% of the hands. The thickest branch (1.38 mm) originated from the ulnar nerve and supplied the third lumbrical muscle, and the thinnest one (0.67 mm) from the ulnar nerve and supplied the fourth lumbrical muscle. In 54.5%, lumbrical nerve bifurcation was identified. Conclusion The complex innervation pattern and the peculiar anatomy of branching to different thirds of the muscle bellies are pointed out. These findings are important in dealing with complex and deep injuries in the palmar region, including transmetacarpal amputations.

Dorsal and Palmar Material Properties of the Adult Human Flexor Profundus Tendon in Zone II

Hand Surgery ◽  
2003 ◽  
Vol 08 (01) ◽  
pp. 53-58 ◽  
Author(s):  
Osamu Soejima ◽  
Edward Diao ◽  
Jeffrey C. Lotz ◽  
Jayaram S. Hariharan ◽  
Masatoshi Naito
Keyword(s):  
Material Properties ◽  
Flexor Tendon ◽  
Dorsal Side ◽  
Flexor Digitorum Profundus ◽  
Single Bundle ◽  
Cross Sectional ◽  
Adult Human ◽  
Fresh Frozen ◽  
Zone Ii ◽  
Flexor Digitorum

Nineteen fresh frozen adult human flexor digitorum profundus (FDP) tendons in Zone II were studied to compare the differences in material properties between the dorsal (dFDP) and palmar (pFDP) side of each tendon biomechanically, biochemically and histologically. We have found that tissue from the dorsal side of each flexor tendon has (1) greater strength; (2) less collagen crosslinking (hydroxypyridinium); and (3) a larger single bundle cross-sectional area than tissue from the palmar side of the same tendon. These data clearly demonstrate that the dorsal and palmar sides of the adult human (FDP) tendon in Zone II differ materially. These differences suggest that there may be biomechanical advantages in placing core sutures dorsally when repairing flexor tendons, a technique that we have previously described.

scholarly journals The effect of tissue culture on suture holding strength and degradation in canine tendon

2009 ◽  
Vol 34 (5) ◽  
pp. 643-650 ◽  
Author(s):  
H. OMAE ◽  
C. ZHAO ◽  
Y.-L. SUN ◽  
M. E. ZOBITZ ◽  
S. L. MORAN ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Tensile Load ◽  
Flexor Digitorum Profundus ◽  
Tendon Suture ◽  
Pull Out ◽  
Culture Model ◽  
Static Tensile ◽  
Tissue Culture Model ◽  
Flexor Digitorum ◽  
Pull Out Strength

The purpose of this study was to assess tendon metabolism and suture pull-out strength after simple tendon suture in a tissue culture model. One hundred and twelve flexor digitorum profundus tendons from 28 dogs were cultured for 7, 14, or 21 days with or without a static tensile load. In both groups increased levels of matrix metalloproteinase (MMP) mRNA was noted. Suture pull-out strength did not decrease during tissue culture. While the presence of a static load had no effect on the pull-out strength, it did affect MMP mRNA expression. This tissue culture model could be useful in studying the effect of factors on the tendon-suture interface.

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.

Sign in / Sign up

Export Citation Format

Share Document