Abstract
ObjectiveThis study was designed to compare the ultimate tensile strength and force to 2 mm gap formation among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture in human cadaver flexor tendon.Materials and methodsForty-five flexor tendons from four soft human cadavers were used to evaluate the biomechanical property among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture.ResultsThe force to 2 mm gap of complete epitendinous was significantly greater than partial epitendinous suture (P < 0.05); however, there was no difference between 50% partial and 75% partial epitendinous suture (P > 0.05). For the ultimate strength, there was no significant difference between partial and complete epitendinous suture (P > 0.05). The partial epitendinous was approximately 60% of the complete epitendinous suture in force to 2 mm gap and also 70% of complete epitendinous suture in ultimate tensile strength with a combination of core sutures.ConclusionsThe complete epitendinous suture showed better ultimate tensile strength and force to 2 mm gap compared with a partial 50% and 75% epitendinous suture. However, in some clinical scenario which the complete epitendinous suture is not possible to perform, the authors suggested only partial epitendinous suture with 50% circumference is recommended as the additional epitendinous repair up 75% circumference cannot provide any mechanical benefit to the repaired site.
Highlights
Flexor tendon injury is a common problem in hand surgery, and its treatment with a good result is a continuing challenge
All of the flexor digitorum profundus tendon (FDP), flexor digitorum superficialis tendon (FDS), and flexor pollicis longus tendon (FPL) were collected in this study
The flexor tendons were harvested at the level of 5 cm proximal to wrist crease and distal to A4 pulley for FDP and FDS tendons while FPL tendon was harvested distal to A2 pulley
Summary
Flexor tendon injury is a common problem in hand surgery, and its treatment with a good result is a continuing challenge. It has been reported in several studies that at least 4 to 6 strands of core suture were preferred for sufficient tensile strength to allow early motion [1,2,3,4]. The repair sites are located near the tendon insertion such as flexor tendon injury zone 1 or beneath the unresectable pulley, the A2 and A4 pulleys. These injury sites are difficult for rotating or flipping the backside of the tendon and performing the complete circumferential epitendinous suture. Our hypothesis is using the standard core suture with the partially epitendinous suture would be sufficient to provide the tensile strength for early rehabilitation
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