Subscribe to RSS
Download PDF
DOI: 10.5999/aps.2018.00962
Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis
Authors
This article was presented at the 9th Congress of the Balkan Association of Plastic Reconstructive and Aesthetic Surgeons (BAPRAS) on September 17–20, 2015, in Thessaloniki, Greece.
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.
Publication History
Received: 10 August 2018
Accepted: 16 February 2019
Article published online:
28 March 2022
© 2019. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
REFERENCES
- 1 Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg 2009; 124: 1551-8
- 2 Sull A, Inceoglu S, August A. et al. Comparison of barbed sutures in porcine flexor tenorrhaphy. Hand 2016; 11: 475-8
- 3 Engel JL, Gabra JN, Esterle AR. et al. In vitro comparison of two barbed suture configurations for flexor tendon repair. J Hand Microsurg 2017; 9: 126-30
- 4 Cortez R, Lazcano E, Miller T. et al. Barbed sutures and wound complications in plastic surgery: an analysis of outcomes. Aesthet Surg J 2015; 35: 178-88
- 5 Shin JY, Kim JS, Roh SG. et al. Biomechanical analysis of barbed suture in flexor tendon repair versus conventional method: systematic review and meta-analysis. Plast Reconstr Surg 2016; 138: 666e-674e
- 6 Viinikainen A, Goransson H, Ryhanen J. Primary flexor tendon repair techniques. Scand J Surg 2008; 97: 333-40
- 7 Chauhan A, Schimoler P, Miller MC. et al. Comparing biomechanical properties, repair times, and value of common core flexor tendon repairs. Hand 2018; 13: 313-8
- 8 Nayak AN, Nguyen DV, Brabender RC. et al. A mechanical evaluation of zone II flexor tendon repair using a knotless barbed suture versus a traditional braided suture. J Hand Surg Am 2015; 40: 1355-62
- 9 Cao Y, Zhu B, Xie RG. et al. Influence of core suture purchase length on strength of four-strand tendon repairs. J Hand Surg Am 2006; 31: 107-12
- 10 Tang JB, Wang B, Chen F. et al. Biomechanical evaluation of flexor tendon repair techniques. Clin Orthop Relat Res 2001; 252-9
- 11 Marrero-Amadeo IC, Chauhan A, Warden SJ. et al. Flexor tendon repair with a knotless barbed suture: a comparative biomechanical study. J Hand Surg Am 2011; 36: 1204-8
- 12 Clemente A, Bergamin F, Surace C. et al. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthop Traumatol 2015; 16: 251-7
- 13 O’Brien 3rd FP, Parks BG, Tsai MA. et al. A knotless bidirectional-barbed tendon repair is inferior to conventional 4-strand repairs in cyclic loading. J Hand Surg Eur Vol 2016; 41: 809-14
- 14 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 Vol 2014; 39: 30-9
- 15 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 Vol 2014; 39: 40-5
- 16 Joyce CW, Sugrue C, Chan JC. et al. A barbed suture repair for flexor tendons: a novel technique with no exposed barbs. Plast Reconstr Surg Glob Open 2014; 2: e237
- 17 Tang JB, Zhang Y, Cao Y. et al. Core suture purchase affects strength of tendon repairs. J Hand Surg Am 2005; 30: 1262-6
- 18 Merrell GA, Wolfe SW, Kacena WJ. et al. The effect of increased peripheral suture purchase on the strength of flexor tendon repairs. J Hand Surg Am 2003; 28: 464-8
- 19 Kadar A, Thoreson AR, Reisdorf RL. et al. Turkey model for flexor tendon research: in vitro comparison of human, canine, turkey, and chicken tendons. J Surg Res 2017; 216: 46-55