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DOI: 10.3415/VCOT-14-11-0174
Ex vivo biomechanical comparison of barbed suture and standard polypropylene suture for acute tendon laceration in a canine model
Publikationsverlauf
Received:24. November 2014
Accepted:27. April 2015
Publikationsdatum:
28. Dezember 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035023/201504/lookinside/thumbnails/10-3415-vcot-14-11-0174-1.jpg)
Summary
Objectives: Evaluate performance and resistance to gap formation of a non-absorbable, barbed, monofilament suture, in comparison with a non-absorbable, smooth, monofilament polypropylene suture, in two different suture patterns: three-loop pulley (3LP) and modified Bunnell-Mayer (BM).
Sample size: Seventy-two medium-sized cadaveric superficial digital flexor muscle tendon units.
Methods: After manual transection and suture repair, individual specimens were placed in an electromechanical tensile testing machine and tested to monotonic failure using tensile ramp loading. Video data acquisition allowed evaluation of failure mode and quantification of gap formation.
Results: Incidence of gap formation between tendon ends was significantly greater in tenorrhaphies repaired with barbed suture compared to those repaired with smooth polypropylene. Use of a 3LP suture pattern caused significantly less gapping between tendon ends when compared to the BM pattern.
Conclusion: Smooth polypropylene suture was consistently superior in load performance than a unidirectional barbed suture. The 3LP pattern was more resistant than a BM pattern at preventing gap formation.
Clinical significance: Smooth polypropylene should be recommended over barbed unidirectional suture for use in canine tendinous repair to provide increased resistance to gap formation. The 3LP is superior to the BM suture pattern, requiring significantly more force to cause tenorrhaphy gap formation and failure, which may translate to increased accrual of repair site strength and tendinous healing in clinical situations.
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References
- 1 Johnson J, Austin C, Breur G. Incidence of canine appendicular musculoskeletal disorders in 16 veterinary teaching hospitals from 1980 Through 1989. Vet Comp Orthop Traumatol 1994; 7: 56-69.
- 2 Gelberman RH, Manske PR, Akeson WH. et al. Flexor tendon repair. J Orthop Res 1986; 4: 119-128.
- 3 Gelberman RH, Boyer MI, Brodt MD. et al. The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. An experimental study on the early stages of tendon-healing in dogs. J Bone Joint Surg Am 1999; 81: 975-982.
- 4 Gelberman RH, Khabie V, Cahill CJ. The revascularization of healing flexor tendons in the digital sheath. A vascular injection study in dogs. J Bone Jt Surg 1991; 73: 868-881.
- 5 Silva MJ, Boyer MI, Gelberman RH. Recent progress in flexor tendon healing. J Orthop Sci 2002; 7: 508-514.
- 6 Gall TT, Santoni BG, Egger EL. et al. In vitro biomechanical comparison of polypropylene mesh, modified three-loop pulley suture pattern, and a combination for repair of distal canine achilles’ tendon injuries. Vet Surg 2009; 38: 845-851.
- 7 Pijanowski GJ, Stein LE, Turner TA. Strength characteristics and failure modes of suture patterns in severed goat tendons. Vet Surg 1989; 18: 335-339.
- 8 Montgomery R, Barnes S, Wenzel J. et al. In-vitro comparison of the Krackow and locking loop suture patterns for tenorrhaphy of flat tendons. Vet Comp Orthop Traumatol 1994; 7: 31-34.
- 9 Berg R, Egger EL. In vitro comparison of the three loop pulley and locking loop suture patterns for repair of canine weightbearing tendons and collateral ligaments. Vet Surg 1986; 15: 107-110.
- 10 Corr SA, Draffan D, Kulendra E. et al. Retrospective study of Achilles mechanism disruption in 45 dogs. Vet Rec 2010; 167: 407-411.
- 11 Cervi M, Brebner N, Liptak J. Short- and long-term outcomes of primary Achilles tendon repair in cats: 21 cases. Vet Comp Orthop Traumatol 2010; 23: 348-353.
- 12 Moores AP, Comerford EJ, Tarlton JF. et al. Biomechanical and clinical evaluation of a modified 3-loop pulley suture pattern for reattachment of canine tendons to bone. Vet Surg 2004; 33: 391-397.
- 13 Moores AP, Owen MR, Tarlton JF. The three-loop pulley suture versus two locking-loop sutures for the repair of canine Achilles tendons. Vet Surg 2004; 33: 131-137.
- 14 Krackow KA, Thomas SC, Jones LC. A new stitch for ligament-tendon fixation. Brief note. J Bone Joint Surg Am 1986; 68: 764-766.
- 15 Renberg WC, Radlinsky MG. In vitro comparison of the locking loop and continuous cruciate suture patterns. Vet Comp Orthop Traumatol 2001; 14: 15-18.
- 16 Moya AP. Barbed sutures in body surgery. Aesthetic Surg J Am Soc Aesthetic Plast Surg 2013; 33: 57-71.
- 17 Ingle NP, King MW, Zikry MA. Finite element analysis of barbed sutures in skin and tendon tissues. J Biomech 2010; 43: 879-886.
- 18 Rashid R, Sartori M, White LE. et al. Breaking strength of barbed polypropylene sutures: rater-blinded, controlled comparison with nonbarbed sutures of various calibers. Arch Dermatol 2007; 143: 869-872.
- 19 Rubin JP, Hunstad JP, Polynice A. et al. A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures. Aesthetic Surg J Am Soc Aesthetic Plast Surg 2014; 34: 272-283.
- 20 Trimbos JB, Brohim R, van Rijssel EJ. Factors relating to the volume of surgical knots. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 1989; 30: 355-359.
- 21 Templeton MM, Krebs AI, Kraus KH, wt al. Ex vivo biomechanical comparison of V-LOC 180® absorbable wound closure device and standard polyglyconate suture for diaphragmatic herniorrhaphy in a canine model. Vet Surg 2015; 44: 65-69.
- 22 Miller J, Zaruby J, Kaminskaya K. Evaluation of a barbed suture device versus conventional suture in a canine enterotomy model. J Investig Surg Off J Acad Surg Res 2012; 25: 107-111.
- 23 Ehrhart NP, Kaminskaya K, Miller JA. et al. In vivo assessment of absorbable knotless barbed suture for single layer gastrotomy and enterotomy closure. Vet Surg 2013; 42: 210-216.
- 24 Hansen LA, Monnet EL. Evaluation of a novel suture material for closure of intestinal anastomoses in canine cadavers. Am J Vet Res 2012; 73: 1819-1823.
- 25 Spah CE, Elkins AD, Wehrenberg A. et al. Evaluation of two novel self-anchoring barbed sutures in a prophylactic laparoscopic gastropexy compared with intracorporeal tied knots. Vet Surg 2013; 42: 932-942.
- 26 Imhoff DJ, Cohen A, Monnet E. Biomechanical analysis of laparoscopic incisional gastropexy with intracorporeal suturing using knotless polyglyconate. Vet Surg 2014 March 11 [Epub ahead of print].
- 27 Perry BS, Harper TA, Mitchell MA. et al. Barbed versus smooth poly-propylene three-loop pulley sutures for repair of canine gastrocnemius tendon. Vet Comp Orthop Traumatol 2014; 27: 436-440.
- 28 Goh KL, Chen Y, Chou SM. et al. Effects of frozen storage temperature on the elasticity of tendons from a small murine model. Anim Int J Anim Biosci 2010; 4: 1613-1617.
- 29 McClellan WT, Schessler MJ, Ruch DS. et al. A knotless flexor tendon repair technique using a bidirectional barbed suture: an ex vivo comparison of three methods. Plast Reconstr Surg 2011; 128: 322-327.
- 30 Peltz TS, Haddad R, Scougall PJ. et al. Performance of a knotless four-strand flexor tendon repair with a unidirectional barbed suture device: a dynamic ex vivo comparison. J Hand Surg Eur 2014; 39: 30-39.
- 31 Joyce CW, Whately KE, Chan JC. et al. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur 2014; 39: 40-45.
- 32 Zeplin PH, Henle M, Zahn RK. et al. Tensile strength of flexor tendon repair using barbed suture material in a dynamic ex vivo model. J Hand Microsurg 2012; 4: 16-20.
- 33 Pruitt DL, Tanaka H, Aoki M. et al. Cyclic stress testing after in vivo healing of canine flexor tendon lacerations. J Hand Surg 1996; 21: 974-977.