The biomechanical assessment of gap formation after flexor tendon repair using partial interlocking cross-stitch peripheral sutures

Abstract

The gap formation of five core plus peripheral suture techniques for flexor tendon repair was evaluated by cyclic load testing. Fifty pairs of dental roll tendon models were sutured using six-strand Pennington modified Kessler core suture with 4-0 Polypropylene. One-half or three-fourths circumferential interlocking cross-stitch, or three complete circumferential peripheral suture techniques were performed using 6-0 Polypropylene. An initial cyclic load of 10 N for 500 cycles was applied and increased by 5 N for an additional 500 cycles at each new load until rupture. The complete circumferential interlocking cross-stitch had the greatest fatigue strength. The partial circumferential cross-stitches resulted in significantly larger gap formations at both the repaired and unrepaired sides than the complete circumferential sutures, and were also associated with early rupture. The full circumference of the cut tendon must be sutured using an interlocking cross-stitch peripheral suture to improve strength and avoid gap formation.

Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair

“…Ansari et al (2009) showed that the use of circumferential repairs covering only the palmar half of the tendon surface could significantly increase the gap resistance and thus can be used together with a complex core suture, though a complete peripheral repair was even more effective in resisting gap formation at the repair site. Takeuchi et al (2011) found that a complete circumferential repair with interlocking crossstitches was better than a peripheral suture covering only one-half or two-thirds of the tendon circumference. Wit et al (2013) found that the geometry of core sutures has a great influence on the strength, but peripheral sutures did not have a significant mechanical effect on the tested core sutures.…”

Asymmetric six-strand core sutures enhance tendon fatigue strength and the optimal asymmetry

“…Biomechanical testing under cyclic loading. Immediately after completion of the sutures, the sutured rolls were mounted on a custom-made cyclic loading machine (Takeuchi et al, 2010(Takeuchi et al, , 2011). Both roll ends were gripped using two upper and lower clamps to prevent slippage.…”

“…The dental roll tendon, Parotisrolls TM (Coltene/Whaledent Gmbh+CO., Germany) consisted of compact cotton wool, and are used for dental treatment. This roll tendon has been used for biomechanical evaluation of tendon repair strength (Takeuchi et al, 2010(Takeuchi et al, , 2011Tare, 2004). A total of 120 rolls were used in six groups of 20 rolls.…”

Evaluation of the artificial cotton roll tendon model for mechanical tendon repair experiments

“…Dear Sir, We read with interest the published articles by Takeuchi et al on mechanical improvements on epitendinous tendon repair techniques (Takeuchi et al, 2010(Takeuchi et al, , 2011. The tendon model used in these experiments was an artificial cotton roll model (Parotisroll™, Coltene/ Whaledent Gmbh + Co., Germany).…”