Scientific articleA Biomechanical Comparison of 3 Loop Suture Materials in a 6-Strand Flexor Tendon Repair Technique
Section snippets
Flexor tendon specimens and repair technique
We harvested 30 fresh flexor tendons from the central 2 rays of porcine forelimbs. We then divided the flexor tendons transversely at the level of the A2 pulley and repaired them using a 6-strand, modified version of the Lim-Tsai technique with 1 of the 3 suture materials: (1) cable nylon (Supramid Extra II 4-0; S. Jackson, Inc., Alexandria, VA; n = 10), (2) braided polyester (Tendo-Loop 4-0; B. Braun, Melsungen AG, Germany; n = 10); and (3) braided polyblend (FiberLoop 4-0; FiberWire, Arthrex,
Mechanism of failure
The braided polyblend repairs failed by suture breakage (50%) and suture pullout (50%). All of the cable nylon repairs failed by suture breakage. Most of the braided polyester repairs (80%) failed by suture breakage; the remaining 20% failed by suture pullout. There were no knot failures.
Ultimate tensile strength
Specimens repaired with the braided polyblend suture had the highest mean ultimate tensile strength (97 N; standard deviation [SD] 22), followed by braided polyester (52 N; SD 11) and then cable nylon (47 N; SD
Discussion
Pennington20 first suggested the locking loop suture configuration in 1979 as an effective repair technique for flexor tendons, conferring enough strength for an early mobilization protocol. Pennington also emphasized that the correct orientation of the intratendinous (longitudinal and transverse) components was a critical factor affecting a repair's strength. In 1997, Hotokezaka and Manske21 described locking and grasping suture methods and demonstrated the superiority of the locking suture
References (30)
- et al.
The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen
J Hand Surg
(1994) - et al.
Evaluation of suture caliber in flexor tendon repair
J Hand Surg
(2001) - et al.
Repair of zone II flexor digitorum profundus lacerations using varying suture sizes: a comparative biomechanical study
J Hand Surg
(2005) - et al.
Effect of suture locking and suture caliber on fatigue strength of flexor tendon repairs
J Hand Surg
(2001) - et al.
Influence of core suture purchase length on strength of four-strand tendon repairs
J Hand Surg
(2006) - et al.
The mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques
J Hand Surg
(2000) - et al.
Comparative mechanical analysis of dorsal versus palmar placement of core suture for flexor tendon repairs
J Hand Surg
(1995) Suture materials and suture techniques used in tendon repair
Hand Clin
(1985)- et al.
Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations
J Hand Surg
(2002) - et al.
Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair
J Hand Surg
(2004)
A comparative analysis of the biomechanical behaviour of five flexor tendon core sutures
J Hand Surg
The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading
J Hand Surg
Flexor tendon repairs: the impact of FiberWire on grasping and locking core sutures
J Hand Surg
A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair
J Hand Surg
Comparative biomechanic study of flexor tendon repair using FiberWire
J Hand Surg
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2017, Journal of Hand SurgeryCitation Excerpt :Intact vincula were preserved. The technique of the tendon repair was a combination of a core and peripheral sutures: The core suture was 4-0 Fiber-Loop (Arthrex, Naples, FL) locking 6-strand repair, inserted using the Lim-Tsai configuration, modified by Gan et al,14 and the peripheral suture was 5-0 polypropylene suture (Surgipro; Covidien, Minneapolis, MN) using a continuous over-and-over configuration. If both the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) were transected, the FDP was always repaired, but if the FDS was transected near its distal insertion, only the radial or ulnar slip was repaired with 5-0 polypropylene suture using a mattress suture, and the unrepaired slip was resected.
Supported by Singhealth Foundation Grant SHF/FG446S/2009 and National Medical Research Council Grants NMRC/1116/2007 and NMRC/1148/2007.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.