A biomechanical study of pediatric flexor profundus tendon repair

Abstract

Objectives:To investigate the tensile strength of repaired flexor profundus tendons in young lambs, which would be equivalent to repairs in children older than 2 years of age.Methods:A comparative in-vitro experimental study conducted at King Saud University, Riyadh, Kingdom of Saudi Arabia from October 2014 to December 2015. We utilized 30 flexor profundus tendons of young lambs with a width of 4 mm. All tendons were repaired with a 4-strand repair technique using 4/0 polypropylene core sutures. In group I (n=10 tendons), 2 separate figure-of-eight sutures were applied. In group II (n=10 tendons), simple locking sutures were added to the corners of 2 separate figure-of-eight sutures. In group III (n=10 tendons), the locked cruciate repair was used. All tendon repairs were tested to single-cycle tensile failure.Results:There was no significant difference between groups II and III with regards to gap and breaking forces; and all forces of these 2 groups were significantly higher than the forces in group I.Conclusion:It was concluded that 4 mm-wide pediatric flexor tendons allow a 4-strand repair and the use of 4/0 sutures. The use of locking sutures increases the tensile strength to values that may allow protective mobilization in children.

Surgical Sutures: The Necessary Update of Current Knowledge

“…The variations in the behavior of the different types of suture materials have been widely studied in vivo, in vitro, experimentally and clinically, each study emphasizing the qualities of each one of them. In general, the monofilaments are appointed as more advantageous, because the multifilamentary provide conditions for the development of infection, since bacterial colonies are formed in spaces between filaments [5,6]. Absorbable natural yarns (catgut) are responsible for the most intense inflammatory reaction among all suture, besides presenting a time very short and unpredictable absorption.…”

“…Absorbable natural yarns (catgut) are responsible for the most intense inflammatory reaction among all suture, besides presenting a time very short and unpredictable absorption. The emergence of the synthetic absorbable was very promising for several reasons: a) trigger inflammatory reactions significantly smaller than natural absorbable; b) keep much of your resistance until the absorption process begins and if complete; c) are available with times of absorption short, medium and long, giving opportunity to the surgeon choose the suitable wire for each case; d) quality mechanics of us is the same for all the wires tested synthetic absorbable [4][5][6].…”

Estudo biomecânico in vitro das suturas em “oito” e de Kessler de tendões flexores de porcos

“… 2 The six-passage “figure-of-eight” suture is easy to perform, it can be made with various types of surgical threads, has great mechanical resistance for active postoperative movement, and its efficiency has been proven in clinical and biomechanical studies. 3 4 5 6 7 Although there are no studies on the preference of Brazilian surgeons for the suture technique used in the flexor tendons of the fingers, it is believed, by empirical observation, that the Kessler suture is one of the most widely used. The classic method to study the mechanical properties of intact or sutured tendons is to subject the specimen to strain deformation at constant speed.…”

“… 2 A sutura em “oito” com seis passadas é de fácil realização, pode ser feita com vários tipos de fios cirúrgicos, apresenta grande resistência mecânica para movimentação ativa no pós-operatório, e sua eficiência tem sido comprovada em estudos clínicos e biomecânicos. 3 4 5 6 7 Apesar de não haver estudos sobre a preferência dos cirurgiões brasileiros em relação ao ponto de sutura dos tendões flexores dos dedos da mão, acredita-se, por observação empírica, que o de Kessler seja um dos mais utilizados. O método clássico para estudar as propriedades mecânicas de tendões, íntegros ou suturados, é submeter o corpo de prova a deformações de tensão com velocidade constante.…”