Vein grafts to augment flexor tendon repairs: a biomechanical study on strength and gap resistance

Abstract

The ultimate tensile repair strength and gap formation of the pig extensor tendons repaired with a standard 4-strand Savage with epitendinous suture repair, was compared with a new technique of adding a vein sleeve. Force and displacement data were recorded, and video images during linear cyclic loading up to failure. At 35 N, video-graphic observation detected significantly smaller gap lengths in the standard and vein repair specimens compared with standard repair specimens (p = 0.047). The incidence of 3 mm gaps between the repaired tendon ends in the standard repair group was 20 %, but no 3 mm gaps were seen in the standard and vein specimens. The addition of a vein sleeve increased the ultimate tensile strength of the standard repair from 50.4 N (4.5) to 55.4 N (4.5); this was statistically significant (p = 0.03). This study demonstrated that the addition of a vein graft prevented gap formation and increased ultimate tensile strength of tendon repair.

Biomechanical investigation of ‘figure of 8’ flexor tendon repair techniques

“…An ideal flexor tendon repair is one that is easy to master, strong enough to allow immediate controlled active mobilization (Haddad et al, 2015), with minimal gap formation (Peltz et al, 2014; Rodger et al, 2015) and minimal gliding resistance during tendon excursion. Most multi-strand flexor tendon repairs meet the latter two criteria, but are technically demanding with a steep learning curve.…”

“…However, investigators continue to explore different methods, which include the use of bio-glue, barbed sutures, vein grafts, etc., to further enhance repair performance by attempting to improve gap forces, minimize repair bulk, etc. (Jordan et al, 2015; Joyce et al, 2014; Peltz et al, 2014; Rodger et al, 2015).…”

Surgical adhesive BioGlue™ does not benefit tendon repair strength: an ex vivo study

“…It is unknown how the separation from the synovial fluid affects tendon healing. These should also be considered in future investigations (Rodger et al, 2015). Bulkiness of the tendon repair site caused by applying a surgical adhesive can be a major concern, as the digital flexor tendon in the hand is confined in a narrow space by segmental rigid annular pulleys (Lowrie and Lees, 2014), which would greatly increase gliding resistance during early active tendon motion after surgery.…”

Re: Jordan et al. Surgical adhesive BioGlue™ does not benefit tendon repair strength: an ex vivo study. J Hand Surg Eur. 2015, 40: 700–4

“…Wu and Tang, 2014). Moreover, there are mechanical augmentation techniques that show better results than the application of surgical adhesives (Rodger et al, 2015).…”