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 < .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.

The consistency and reliability of six-strand and four-strand flexor tendon repairs: a comparative porcine cadaveric study

2022 ◽  
pp. 175319342110665
Author(s):  
Jaakko A. E. Kuronen ◽  
Benjamin Riski ◽  
Olli V. Leppänen ◽  
Teemu Karjalainen ◽  
Lasse Linnanmäki
Keyword(s):  
Flexor Tendon ◽  
Testing Machine ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Load To Failure ◽  
Level Of Experience ◽  
Flexor Digitorum ◽  
Material Testing Machine ◽  
Technical Reliability

The aim of this study was to compare the consistency and reliability of the six-strand Gan modification of the Lim-Tsai flexor tendon repair with the four-strand Adelaide repair, both with 3-0 sutures and with eight to ten runs of simple 5-0 running peripheral suture as well as the influence of the surgeons’ level of experience on the strength of the repair in a cadaveric animal setup. Thirty-nine surgeons repaired 78 porcine flexor digitorum profundus tendons with either the Adelaide technique (39 tendons) or the modified Lim-Tsai technique (39 tendons). Each repaired tendon was tested in a material testing machine under a single cycle load-to-failure test. The forces were recorded when the gap between the two tendon stumps reached 1 and 2 mm and when irreversible elongation or total rupture occurred. We found no significant differences in gap formation force and yielding strength of the tendons between the two methods. The surgeon’s previous experience in tendon repairs did not improve the consistency, reliability or tensile strength of the repairs. We conclude that if a strong peripheral suture is added, the modified Lim-Tsai repair has the same technical reliability and consistency as the Adelaide repair in term of ultimate loading strength in this test setup.

scholarly journals Amniotic Membrane Transplantation in the Treatment of Primary Pterygium: A Comparative Study of Two Techniques

2014 ◽  
Vol 48 (1) ◽  
pp. 1-7
Author(s):  
Reema Bansal ◽  
R Sehgal
Keyword(s):  
Comparative Study ◽  
Amniotic Membrane ◽  
Free Edge ◽  
Amniotic Membrane Transplantation ◽  
Human Amniotic Membrane ◽  
Purse String ◽  
Group A ◽  
End To End ◽  
Group B ◽  
Primary Pterygium

ABSTRACT Purpose To compare two techniques of human amniotic membrane transplantation (AMT) following pterygium excision: (1) end to end suturing of the amniotic membrane graft (AMG) with the conjunctiva versus (2) a new technique of purse-string suturing of the AMG and tucking of AMG under the free edge of conjunctiva. Materials and methods Pterygium surgery with human AMT was done in 42 eyes with primary pterygium. Twenty four eyes (group A) underwent end-to-end suturing of AMG with conjunctiva. Eighteen eyes (group B) underwent purse-string suturing of AMG with underlying sclera with free edge of AMG tucked under conjunctiva on three sides. The two groups were compared in terms of the outcome measures, i.e. complete epithelialization time of AMG and recurrence of pterygium within 1 year. Results The complete epithelialization of AMG occurred in 21 days (range 14 to 28 days) and 14 days (range 7 to 21 days) in groups A and B respectively. In group A, 7 eyes (29.17%) developed recurrence. In group B, 2 eyes (11.11%) developed recurrence. Conclusion Purse string suturing and tucking of AMG resulted in faster epithelization of AMG and lower recurrences in comparison with end to end suturing of AMG in the management of primary pterygium. How to cite this article Bansal R, Jain AK, Sehgal R. Amniotic Membrane Transplantation in the Treatment of Primary Pterygium: A Comparative Study of Two Techniques. J Postgrad Med Edu Res 2014;48(1):1-7.

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.

scholarly journals The use of amniotic membrane in the repair of duodenal wounds in Wistar rats

2010 ◽  
Vol 25 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Luciano Rodrigues Schimidt ◽  
Edson José Cardoso ◽  
Rogério Rodrigues Schimidt ◽  
Luiz Augusto Back ◽  
Maria Beatriz Schiazawa ◽  
...  
Keyword(s):  
Amniotic Membrane ◽  
Wistar Rats ◽  
Muscle Layer ◽  
Wall Structure ◽  
Duodenal Wall ◽  
Control Group ◽  
Human Amniotic Membrane ◽  
New Material ◽  
Group A ◽  
Group B

Purpose: In the search of a new material to repair duodenal wounds, a trial was conducted to assess the behavior of human amniotic membrane in the repair of the duodenal wall in rats. METHODS: Fifty Wistar rats weighing between 250 and 350g, male, were submitted to duodenotomy and randomly distributed into two groups. Group A (n=8) had no treatment and was used as the control group. In Group B (n=42) the duodenal wound was treated with a patch of human amniotic membrane. RESULTS: All animals in Group A died. In Group B no changes were observed with regards to death or the formation of duodenal fistula. All animals presented peritoneal adherences in the region on the duodenal wall repair and intestinal obstruction was observed in two animals. Healing of the duodenal wall in the region of the patch took place progressively as the post-operatory period increased, with regeneration of the mucosa and of the smooth muscle layer. CONCLUSION: From the clinical standpoint, the amniotic membrane proved to be a biological tissue which served as a temporary seal and allowed the wound to heal by second-intention, with re-establishment of the duodenal wall structure.

scholarly journals Human amniotic membrane: an improvement in the treatment of Medication-related osteonecrosis of the jaw (MRONJ)? A case–control study

2021 ◽  
Author(s):  
Mirko Ragazzo ◽  
Matteo Val ◽  
Giulia Montagner ◽  
Diletta Trojan ◽  
Stefano Fusetti ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Amniotic Membrane ◽  
Osteonecrosis Of The Jaw ◽  
Case Control ◽  
Human Amniotic Membrane ◽  
Surgical Wound ◽  
Resective Surgery ◽  
Significant Difference ◽  
Group A ◽  
Group B

AbstractThe aim of this article is to report the results obtained by the use of HAM in surgical wound healing and the reduction of relapse in patients affected by Medication-related osteonecrosis of the jaw (MRONJ).The study involved patients with the diagnosis of MRONJ, surgically treated between October 2016 and April 2019, in a case–control setting. Enrolled patients were randomly divided into 2 groups. One group will be treated with resective surgery and with the insertion of HAM patch (Group A), while the second group had been treated exclusively with resective surgery (Group B).The patients underwent MRONJ surgical treatment with the placement of amniotic membrane patches at the wound site. Data regarding the long-term complications/functions were evaluated at 3, 6, 12, and 24 months after surgery. Pain measurements were performed before the intervention (T0), 7(T1) and 30(T2) days after surgery. 49 patients were included in the study. 2 patients of GROUP A after 30 days since they were surgically treated showed persistent bone exposure. 5 patients of group B demonstrated a lack of healing of the surgical wound with the persistence of bone exposed to 30 days after surgery. Statistical analysis ruled out any difference in OUTCOME (relapse) between GROUP A and B (p = 0.23). However, the Fisher test highlighted a significant difference between the use of HAM and only surgical treatment in pain at rest (p = 0.032). The use of amniotic membrane implement the patient's quality of life and reduce pain perception. has a learning curve that is fast enough to justify its routine use.

scholarly journals Biomechanical Comparison of Flexor Digitorum Profundus Avulsion Repair

2019 ◽  
Vol 08 (04) ◽  
pp. 312-316 ◽  
Author(s):  
Jill G. Putnam ◽  
Damon Adamany
Keyword(s):  
Suture Anchor ◽  
Tendon Repair ◽  
Maximum Load ◽  
Flexor Digitorum Profundus ◽  
Anchor Group ◽  
Load To Failure ◽  
Group 3 ◽  
Group 2 ◽  
Flexor Digitorum ◽  
Group 1

Purpose Multiple repair techniques have been investigated for flexor digitorum profundus (FDP) tendon avulsions. The purpose of this study is to compare the biomechanical characteristics of a new fully threaded titanium suture anchor with previously examined fixation techniques. Methods Repair of FDP tendon avulsions was performed in 18 fresh-frozen cadavers using one of three implants: Nano Corkscrew FT 1.7 mm suture anchor (Group 1; Arthrex, Inc., Naples, FL; n = 6), Mitek Micro 1.3 mm suture anchor (Group 2; Mitek Surgical Products, Westwood, MA; n = 6), or pullout suture button fixation (Group 3; n = 6). Constructs were preloaded before testing load to failure. For each trial, elongation at 20 N and maximum load, mean load to failure, stiffness, and failure mechanism were recorded. Results Load to failure occurred in all trials. Mean load to failure was significantly greater for Group 1 (61.6 ± 18.9 N) compared to Group 2 (42.5 ± 4.2 N; p < 0.05) and Group 3 (41.6 N ± 8.0 N; p < 0.05). Stiffness was significantly greater in Groups 1 and 2 compared to Group 3 (6.9 ± 2.2 N/mm vs. 6.1 ± 0.8 N/mm vs. 3.1 N/mm ± 0.5 N/mm, respectively, p < 0.01). Mechanism of failure differed between the groups: Group 1 broke at the anchor in two trials and tore through the tendon in three trials, Group 2's suture universally broke at the anchor, and Group 3's trials mainly failed at the button. Conclusions The Nano Corkscrew anchor (Group 1) has a significantly higher load to failure when compared with the other techniques. The higher load to failure of the corkscrew anchor provides a secure method for flexor tendon repair in zone I. Clinical Relevance A fully threaded titanium suture anchor used for FDP tendon avulsion injuries is likely to withstand early active range of motion protocols.

Flexor Tendon Repair Using a Stainless Steel External Splint

1999 ◽  
Vol 24 (6) ◽  
pp. 654-657 ◽  
Author(s):  
L. GORDON ◽  
F. A. DYSARZ ◽  
K. T. VENKATESWARA ◽  
A. P. MOK ◽  
R. O. RITCHIE ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Stainless Steel ◽  
Testing Machine ◽  
Biomechanical Testing ◽  
Tendon Repair ◽  
Flexor Digitorum Profundus ◽  
Tensile Testing Machine ◽  
In Vivo Testing ◽  
Flexor Digitorum

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion excercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

Vascularized dorsal digital fascial flap improves flexor tendon repairs

2013 ◽  
Vol 39 (7) ◽  
pp. 714-718 ◽  
Author(s):  
L.-Q. Sun ◽  
G. Zhao ◽  
S.-H. Gao ◽  
C. Chen
Keyword(s):  
Flexor Tendon ◽  
Tendon Repair ◽  
Distal Interphalangeal Joint ◽  
Flexor Tendon Repair ◽  
Fascial Flap ◽  
Group A ◽  
Distal Interphalangeal ◽  
Zone Ii ◽  
Group B ◽  
Flexor Digitorum

We report a new method of flexor tendon repair in zone II using a standard modified Kessler technique combined with a vascularized dorsal fascial flap from the finger pedicled on a dorsal cutaneous branch of the proper digital artery, which is placed as a mechanical barrier between the flexor digitorum superficialis and profundus tendons. The functional outcomes of 14 patients (Group A) with flexor tendon repairs in zone II by this new technique were compared with those of 32 patients (Group B) with flexor tendon repairs in zone II using a standard modified Kessler technique only. Patients in Group A had a higher proportion of excellent results (on the modified Strickland system) and more movement in the distal interphalangeal joint than the patients in Group B.

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.

Repairs of Partial Oblique Tendon Injuries: A Biomechanical Evaluation

2004 ◽  
Vol 29 (4) ◽  
pp. 381-385 ◽  
Author(s):  
J. TAN ◽  
L. MING ◽  
Z.J. JIA ◽  
J.B. TANG
Keyword(s):  
Ultimate Strength ◽  
Cross Section ◽  
Testing Machine ◽  
Transverse Cross Section ◽  
Flexor Digitorum Profundus ◽  
Gap Formation ◽  
Tensile Testing Machine ◽  
Load To Failure ◽  
Biomechanical Evaluation ◽  
Flexor Digitorum

This study evaluated the tensile properties of oblique partial tendon lacerations and the effects of peripheral sutures on their strength. Seventy-four fresh pig flexor digitorum profundus tendons were divided into eight groups and were transected across 90% of their diameter. The lacerations in the tendons of five of the groups were at 0°, 15°, 30°, 45°, and 60° to their transverse cross-section, respectively. In the other three groups the lacerations were 0°, 45°, and 60° to the cross-section and were repaired with running peripheral sutures. The tendons were subjected to load-to-failure tests in a tensile testing machine to determine the initial, 1 and 2 mm gap formation forces, and the ultimate strength. Obliquity of tendon lacerations affected the strength of partially lacerated tendons. The tendons with 45° and 60° oblique lacerations had a significantly lower ultimate strengths than those with transverse (0°), or 15° or 30° oblique lacerations. Running peripheral sutures significantly increased both the gap formation forces and the ultimate strength of the tendons with oblique partial lacerations.

Sign in / Sign up

Export Citation Format

Share Document