Flexor Tendon Repair with Fast-Absorbable Sutures: A Rupture Incidence-Focused Analysis of a Case Series and a Review

Abstract

Hand flexor tendon repair with absorbable sutures has the advantage of leaving no foreign material within the tendon. However, clinical application of degradable materials in flexor tendon repair is limited to slow-absorbable PDS or Maxon sutures and commonly does not involve fast-absorbable sutures, probably, because of fear of ruptures. Meanwhile, a small number of reports have shown that in terms of tenorrhaphy failure fast-absorbable sutures are safe. It is also known that classical tendon repairs with a pull-out wire withstand intensive mobilization after wire removal. Furthermore, experimental research implies that fast-absorbable polyglycolic acid fibers seeded with tenocytes can strengthen tendon repair. The current article retrospectively analyses a series of 12 patients with predominantly complex hand injuries, in which 17 flexor digitorum profundus and four flexor pollicis longus tendon repairs with Vicryl (polyglactin 910, copolymer of polyglycolic and polylactic acid) were performed. Early postoperative passive mobilization was employed. The postoperative results were analyzed with particular reference to tenorrhaphy failure. Ruptures occurred in only two repairs. This was statistically insignificant when compared with a hypothetical set of cases consisting of only good and excellent outcomes. These results imply that hand flexor tendon repair with fast-absorbable sutures is rupture-safe if moderate postoperative mobilization is employed. However, as the calculated postoperative dynamics of the tenorrhaphy strength predicts failure of all fast-absorbable suture repairs during active motion at six weeks, more research is needed to clarify why this was not the case in the presented and other published series of patients.