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Beyond the Core Suture: A New Approach to Tendon Repair
BACKGROUND: Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) r...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787298/ https://www.ncbi.nlm.nih.gov/pubmed/33425594 http://dx.doi.org/10.1097/GOX.0000000000003280 |
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author | Zeng, Weifeng Albano, Nicholas J. Sanchez, Ruston J. Mccabe, Ronald Vanderby, Ray Poore, Samuel O. Dingle, Aaron M. |
author_facet | Zeng, Weifeng Albano, Nicholas J. Sanchez, Ruston J. Mccabe, Ronald Vanderby, Ray Poore, Samuel O. Dingle, Aaron M. |
author_sort | Zeng, Weifeng |
collection | PubMed |
description | BACKGROUND: Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) repair site without the use of core sutures. The hypothesis being that the reclaimed FDS tendon autograft will redistribute tensile forces away from the FDP repair site, increasing overall strength and resistance to gapping in Zone II flexor tendon injuries compared with the current clinical techniques. METHODS: Two novel FDP repair methods utilizing portions of FDS have been described: (1) asymmetric repair (AR), and (2) circumferential repair. Ultimate tensile strength and cyclical testing were used to compare novel techniques to current clinical standard repairs: 2-strand (2-St), 4-strand (4-St), and 6-strand (6-St) methods. All repairs were performed in cadaveric sheep tendons (n = 10/group), by a single surgeon. RESULTS: AR and circumferential repair techniques demonstrated comparable ultimate tensile strength to 6-St repairs, with all 3 of these techniques able to tolerate significantly stronger loads than the 2-St and 4-St repairs (P < 0.0001). Cyclical testing demonstrated that AR and circumferential repair were able to withstand a significantly higher total cumulative force (P < 0.001 and P = 0.0064, respectively) than the 6-St, while only AR tolerated a significantly greater force to 2-mm gap formation (P = 0.042) than the 6-St repair. CONCLUSION: Incorporating FDS as an autologous graft for FDP repair provides at least a comparable ultimate tensile strength and a significantly greater cumulative force to failure and 2-mm gap formation than a traditional 6-St repair. |
format | Online Article Text |
id | pubmed-7787298 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-77872982021-01-07 Beyond the Core Suture: A New Approach to Tendon Repair Zeng, Weifeng Albano, Nicholas J. Sanchez, Ruston J. Mccabe, Ronald Vanderby, Ray Poore, Samuel O. Dingle, Aaron M. Plast Reconstr Surg Glob Open Experimental BACKGROUND: Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) repair site without the use of core sutures. The hypothesis being that the reclaimed FDS tendon autograft will redistribute tensile forces away from the FDP repair site, increasing overall strength and resistance to gapping in Zone II flexor tendon injuries compared with the current clinical techniques. METHODS: Two novel FDP repair methods utilizing portions of FDS have been described: (1) asymmetric repair (AR), and (2) circumferential repair. Ultimate tensile strength and cyclical testing were used to compare novel techniques to current clinical standard repairs: 2-strand (2-St), 4-strand (4-St), and 6-strand (6-St) methods. All repairs were performed in cadaveric sheep tendons (n = 10/group), by a single surgeon. RESULTS: AR and circumferential repair techniques demonstrated comparable ultimate tensile strength to 6-St repairs, with all 3 of these techniques able to tolerate significantly stronger loads than the 2-St and 4-St repairs (P < 0.0001). Cyclical testing demonstrated that AR and circumferential repair were able to withstand a significantly higher total cumulative force (P < 0.001 and P = 0.0064, respectively) than the 6-St, while only AR tolerated a significantly greater force to 2-mm gap formation (P = 0.042) than the 6-St repair. CONCLUSION: Incorporating FDS as an autologous graft for FDP repair provides at least a comparable ultimate tensile strength and a significantly greater cumulative force to failure and 2-mm gap formation than a traditional 6-St repair. Lippincott Williams & Wilkins 2020-12-17 /pmc/articles/PMC7787298/ /pubmed/33425594 http://dx.doi.org/10.1097/GOX.0000000000003280 Text en Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Experimental Zeng, Weifeng Albano, Nicholas J. Sanchez, Ruston J. Mccabe, Ronald Vanderby, Ray Poore, Samuel O. Dingle, Aaron M. Beyond the Core Suture: A New Approach to Tendon Repair |
title | Beyond the Core Suture: A New Approach to Tendon Repair |
title_full | Beyond the Core Suture: A New Approach to Tendon Repair |
title_fullStr | Beyond the Core Suture: A New Approach to Tendon Repair |
title_full_unstemmed | Beyond the Core Suture: A New Approach to Tendon Repair |
title_short | Beyond the Core Suture: A New Approach to Tendon Repair |
title_sort | beyond the core suture: a new approach to tendon repair |
topic | Experimental |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787298/ https://www.ncbi.nlm.nih.gov/pubmed/33425594 http://dx.doi.org/10.1097/GOX.0000000000003280 |
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