Floor plan - 2013 Annual Meeting - American Association for Hand ...
Floor plan - 2013 Annual Meeting - American Association for Hand ...
Floor plan - 2013 Annual Meeting - American Association for Hand ...
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Flexor Tendon Repair with Barbed Suture<br />
Institution where the work was prepared: UT SouthWestern Medical center, Dallas, TX, USA<br />
Fatemeh Abtahi, MD1; Michel Saint-Cyr2; Spencer A. Brown2; Debby Noble, BS3; Dan Hatef, MD4; Jordan Farkas,<br />
MD3; (1)UT SouthWestern Medical Center, (2)University of Texas Southwestern Medical Center, (3)UTSW medical center,<br />
(4)UT Southwestern<br />
PURPOSE:<br />
This study evaluated the tensile strength properties (maximum tensile load, gapping at the repair site, and the pattern of failure) of flexor<br />
tendon repaired with barbed sutures.<br />
INTRODUCTION:<br />
According to Strickland an ideal tendon repair should permit easy placement of sutures in the tendon, would allow smooth gliding,<br />
have secure suture knots with a smooth junction of tendon ends without gapping at the repair site, create minimal interference with<br />
tendon vascular, and have sufficient strength throughout healing to permit early motion of the tendon. The difficulty in satisfying all<br />
these criteria by any repair technique is probably reflected in the multitude of repairs described and currently utilized by practitioners.<br />
There are many variations in the suture technique of placing core sutures. The described technique include Bunnel, Strikland, Kessler,<br />
modified Kessler, Becker, modified Becker, repair. Tendon repair ruptures usually occur at the suture knots. Adhesion <strong>for</strong>mation remains<br />
the most common complication after flexor tendon repair, despite the widespread use of early-motion protocols. With these factors<br />
related to tendon repair failure considered, our department per<strong>for</strong>med a pilot study using barbed sutures to repair lacerated flexor digit<br />
rum tendons. Barbed sutures (self-anchoring)have been developed by Quill Medical, in which bidirectional barbs are introduced into a<br />
suture that eliminates the need <strong>for</strong> tying a knot to obtain suture closure. The barbs are designed to grip tissue and obviate the need<br />
<strong>for</strong> tying a knot during tissue approximation. They can pass easily through tissue in one direction, but can not be reversed, there<strong>for</strong>e<br />
providing knot security.<br />
MATERIALS/ METHODS:<br />
160 cadaveric and porcine flexor tendons were harvested and cut. Repairs were per<strong>for</strong>med using 0 or 2-0 barbed Nylons and same sizes<br />
standard Nylon. Modified Bunnell and Modified Kessler techniques were used.All repairs have been done without epitendonous<br />
suture.The repaired tendons were then tested <strong>for</strong> Maximum Load, Gap Strength, and Initial Gap, using a Tensiometer. Result:Overall<br />
mean Maximum Load <strong>for</strong> barbed sutures was 41.12 N. Mean Maximum Load <strong>for</strong> 0 barbed Nylon was 55.90 N. Mean Maximum Load<br />
<strong>for</strong> 2-0 barbed Nylon was 37.46 N,and mean Maximum Load <strong>for</strong> 2-0 Nylon was 53.76. Mean Maximum Load <strong>for</strong> conventional 3-0<br />
Ethibond was 31.25 N. These data are fairly consistent with what has been seen previously in the literature.<br />
SUMMARY:<br />
Overall,barbed sutures gave a stronger repair, especially when 0 barbed Nylons were used. Conventional 0 barbed Nylons would be<br />
clinically unfeasible,as the knots would be far too bulky.The ability to use this size of suture without the need <strong>for</strong> knot tying gives hand<br />
surgeons this option in repair of flexor tendon injuries.<br />
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