Arch Plast Surg.  2019 May;46(3):228-234. 10.5999/aps.2018.00962.

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis

Affiliations
  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Okmeydani Training and Research Hospital, Ä°stanbul, Turkey. drozlemcolak@hotmail.com
  • 2Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey.
  • 3Department of Plastic, Reconstructive and Aesthetic Surgery, Aydın State Hospital, Aydın, Turkey.
  • 4Department of Biomedical Engineering, Ä°zmir Democracy University, Ä°zmir, Turkey.

Abstract

BACKGROUND
The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model.
METHODS
The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded.
RESULTS
The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05).
CONCLUSIONS
This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

Keyword

Suture techniques; Instrumentation; Tendon injuries; Surgery

MeSH Terms

Adult
Chickens
Consensus
Foot
Humans
Models, Animal
Rehabilitation
Suture Techniques
Sutures*
Tendon Injuries
Tendons*
Tensile Strength
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