Suture For Flexor Tendon Repair Research Articles

Biomechanical evaluation of the ST-knot: A new suture for flexor tendon repair

PurposeAlthough tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler). Materials and methodsForty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle. ResultsThere was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4. ConclusionsThe ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury.

Retraction: Optimization of the design of a barbed suture for flexor tendon repair using extended finite element analysis

Thesis. M.E. American University of Beirut. Department of Mechanical Engineering, 2017. ET:6588

Optimization of the design of a barbed suture for flexor tendon repair using extended finite element analysis

Optimization of the design of a barbed suture for flexor tendon repair using extended finite element analysis

Bundles of Spider Silk, Braided into Sutures, Resist Basic Cyclic Tests: Potential Use for Flexor Tendon Repair

Repair success for injuries to the flexor tendon in the hand is often limited by the in vivo behaviour of the suture used for repair. Common problems associated with the choice of suture material include increased risk of infection, foreign body reactions, and inappropriate mechanical responses, particularly decreases in mechanical properties over time. Improved suture materials are therefore needed. As high-performance materials with excellent tensile strength, spider silk fibres are an extremely promising candidate for use in surgical sutures. However, the mechanical behaviour of sutures comprised of individual silk fibres braided together has not been thoroughly investigated. In the present study, we characterise the maximum tensile strength, stress, strain, elastic modulus, and fatigue response of silk sutures produced using different braiding methods to investigate the influence of braiding on the tensile properties of the sutures. The mechanical properties of conventional surgical sutures are also characterised to assess whether silk offers any advantages over conventional suture materials. The results demonstrate that braiding single spider silk fibres together produces strong sutures with excellent fatigue behaviour; the braided silk sutures exhibited tensile strengths comparable to those of conventional sutures and no loss of strength over 1000 fatigue cycles. In addition, the braiding technique had a significant influence on the tensile properties of the braided silk sutures. These results suggest that braided spider silk could be suitable for use as sutures in flexor tendon repair, providing similar tensile behaviour and improved fatigue properties compared with conventional suture materials.

The Effect of Suture Preloading on the Force to Failure and Gap Formation After Flexor Tendon Repair

Gap formation is a common and severe complication after flexor tendon repair that can affect the outcome and prolong tendon healing. The purpose of this study was to investigate the effect that a pretensional force applied to the suture during tendon repair has on the repair strength and force that causes gap formation. We used a total of 48 flexor digitorum profundus tendons from 12 human cadaver hands. We employed a core tendon suture, using the modified Pennington technique, and a running suture for flexor tendon repair. Before tying the knots of the core suture, we preloaded the sutures in each tendon end 0, 5, 10, or 15 N for 10 seconds to compare the effect of loading magnitude on repaired tendon peak force to failure and force causing gap formation. The force to form a gap of 2 mm in the 15-N preload group was significantly increased compared with the 0-N and 5-N preload groups. At the 3-mm gap formation, the force of all preload groups was significantly higher than the nonpreload group. The peak force with a preload of 10 N and 15 N was significantly higher than 0-N preload. These findings suggest that pretensioning with 10 to 15 N at the suture-tendon interface before tying the knot has a beneficial effect on both the tendon gap formation and the peak force to failure. When the surgeons perform tendon repair, pretensioning at the suture-tendon conjunction will increase the repair strength.

A Re-exploration of the Use of Barbed Sutures in Flexor Tendon Repairs

Flexor tendon repairs continue to improve thanks to advancements in suture material and technique. The role of barbed sutures in flexor tendon repairs has been previously investigated, but with the advent of a new material, interest in their use has been rekindled. We hypothesized that the use of modern barbed sutures will have comparable maximum tensile strength and 2-mm gapping strength to that of conventional sutures, allowing their use to theoretically decrease adhesions and tissue damage in flexor tendon repairs. Flexor tendon repairs were performed on a cadaver model using either 3-0 Ethibond (Ethicon, Inc, Somerville, New Jersey) (Kessler repair) or 2-0 Quill sutures (Angiotech, Vancouver, British Columbia, Canada ) (Kessler-Bunnell repair) and were biomechanically tested. The mode of failure for the Ethibond sutures was suture pullout 2 times and knot failure 18 of 20 times, while the Quill sutures failed entirely by pullout. Maximum load to failure was 34.7+/-5.4 N and 29.6+/-3.6 N for Ethibond and Quill, respectively. This was found to be statistically significant (P=.001). Tensile load at 2-mm gapping was 22.8+/-6.3 N and 22.2+/-4.0 N for Ethibond and Quill, respectively. No statistical significance was found (P=.723). This study helps substantiate the possible role of modern barbed sutures in flexor tendon repair. Additional biomechanical studies will need to be performed to further assess the use of barbed sutures in flexor tendon repair.

A simple technique of making a looped suture for flexor tendon repair

A simple technique of making a looped suture for flexor tendon repair

A technique for introducing looped sutures in flexor tendon repair

A technique for introducing looped sutures in flexor tendon repair

A technique for introducing looped sutures in flexor tendon repair

ABSTRACTThis is the author′s experience of hypospadias reconstruction using Bracka′s technique (mainly) over a period of three years. A total of 98 procedures related to hypospadias were done in three years. The surgical technique is described. In the author′s hand, Bracka′s technique gives good result both functionally and in appearance. Its versatility enables its use in all types of hypospadias with consistently reproducible results with minimal complications. At the end of the second stage a circumcised penis with natural looking vertical slit neo-meatus at the apex of the glans is produced.

A technique for introducing looped sutures in flexor tendon repair

ABSTRACTStronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler′s technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

A technique for introducing looped sutures in flexor tendon repair

Stronger flexor tendon repairs facilitate early active motion therapy protocols. Core sutures using looped suture material provide 1 ½ to twice the strength of Kessler's technique (with four strand and six strand Tsuge technique respectively). The technique is well-described and uses preformed looped sutures (supramid). This is not available in many countries and we describe a technique whereby looped sutures can be introduced in flexor tendon repair by the use of 23 G hypodermic needle and conventional 4.0 or 5.0 sutures. This is an alternative when the custom made preformed sutures are not available. This can be practiced in zone 3 to zone 5 repairs. Technical difficulties limit its use in zone 2 repairs.

In vitro biomechanical evaluation of the double loop suture for flexor tendon repair.

Fifty-one fresh frozen human anatomic specimen flexor superficialis and profundus tendons that had been transected completely were repaired using the double loop, the single loop, and the modified Kessler techniques, and the resistances to mechanical distraction at 1, 2, and 3 mm and the ultimate load to failure were compared. The mechanical distraction at 1, 2, and 3 mm created nearly identical gaps at the tendon repair sites. There was no significant difference among the three repair techniques to resisting distraction at 1 and 2 mm. However, the double loop technique presented a mean resistance force of 22.0 N to distraction at 3 mm and 45.8 N in load to failure, which was significantly greater than the single loop (18.8 N at 3 mm distraction and 31.5 N failure load) and the modified Kessler (19.0 N at 3 mm distraction and 26.0 N failure load). This suggests the double loop technique may be superior to the single loop and the modified Kessler techniques in resisting gap in the range of forces generated in the early rehabilitation protocol.

A biomechanical analysis of a new interlock suture technique for flexor tendon repair

Using a computerised tensometer, both the gap-producing and breaking forces of a new interlocking suture for flexor tendon repair were compared to the modified Kessler and the Strickland techniques. 30 porcine deep flexor tendons were used in each group and all repairs were performed with 3/0 polypropylene sutures. The interlock technique withstood gap-producing and breaking forces significantly better than the modified Kessler and Strickland techniques. Also, the gap-producing force was closer to the breaking force with the interlock technique than with the other two techniques.

Biomechanical studies of running suture for flexor tendon repair in dogs

A new running-locking loop suture technique has been developed to increase tendon repair strength and to provide better tendon edge inversion. Biomechanical analysis documented the failure mechanism and the failure strength of various circumferential repair techniques. When compared with two well-known techniques, the simple circumferential running suture and Lembert running suture, the locking suture technique was shown to have 3.77 and 1.68 times greater tensile failure strength and 1.73 and 1.26 times greater stiffness than these traditional suture methods. A running peripheral locking suture may help augment the strength of tendon repair.