Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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The effect of increasing the contact surface on tendon healing

  • Bilgen, Fatma (Department of Plastic, Reconstructive, and Aesthetic Surgery, Kahramanmaras Sutcu Imam University School of Medicine) ;
  • Duman, Yakup (Department of Plastic, Reconstructive, and Aesthetic Surgery, Kahramanmaras Sutcu Imam University School of Medicine) ;
  • Bulut, Omer (Department of Plastic, Reconstructive, and Aesthetic Surgery, Gaziantep 25 December Hospital) ;
  • Bekerecioglu, Mehmet (Department of Plastic, Reconstructive, and Aesthetic Surgery, Kahramanmaras Sutcu Imam University School of Medicine)
  • Received : 2017.07.29
  • Accepted : 2018.04.30
  • Published : 2018.07.15
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Abstract

Background The most common complication after tendon repair is the development of adhesion, with subsequent rupture. Methods In this study, we present a new method in which the tendon healing contact surface is increased to reduce these complications. The tendons of chickens in groups 1, 3, and 5 were transversely cut and repaired with in the traditional fashion with double-modified Kessler method and 5/0 polypropylene. In the other groups, 3 mm of the tendon was removed from the proximal half of the upper end and from the distal half of the lower end of the tendon, and they were repaired with the modified Kessler method. The tendons of the chickens in groups 1 and 2 were evaluated immediatelly after surgery. Groups 3 and 4 were evaluated at 4 weeks after surgery. Groups 5 and 6 were evaluated at 6 weeks. Results Increases in transient inflammation and connective tissue formation were observed more clearly in the group treated with the new method in histopathological investigations at weeks 4 and 6. The stretching test showed statistically significant differences between groups 3 and 4 (P<0.05) and groups 5 and 6 (P<0.05). Conclusions When repairing tendons with the new method, the healing surface increases and the direction of collagen fibers at the surface changes. Because of these effects, the strength of the tendon healing line increases; we therefore expect that this technique will enable patients to safely engage in early active exercise after the operation, with less risk of tendon rupture.

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References

  1. Peltz TS, Haddad R, Scougall PJ, et al. Influence of locking stitch size in a four-strand cross-locked cruciate flexor tendon repair. J Hand Surg Am 2011;36:450-5. https://doi.org/10.1016/j.jhsa.2010.11.029
  2. Sandvall BK, Kuhlman-Wood K, Recor C, et al. Flexor tendon repair, rehabilitation, and reconstruction. Plast Reconstr Surg 2013;132:1493-503. https://doi.org/10.1097/01.prs.0000434411.78335.63
  3. Moriya K, Yoshizu T, Maki Y, et al. Clinical outcomes of early active mobilization following flexor tendon repair using the six-strand technique: short- and long-term evaluations. J Hand Surg Eur Vol 2015;40:250-8. https://doi.org/10.1177/1753193414551682
  4. Frueh FS, Kunz VS, Gravestock IJ, et al. Primary flexor ten- don repair in zones 1 and 2: early passive mobilization ver- sus controlled active motion. J Hand Surg Am 2014;39: 1344-50. https://doi.org/10.1016/j.jhsa.2014.03.025
  5. Farzad M, Layeghi F, Asgari A, et al. A prospective random- ized controlled trial of controlled passive mobilization vs. place and active hold exercises after zone 2 flexor tendon re pair. Hand Surg 2014;19:53-9. https://doi.org/10.1142/S0218810414500105
  6. Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg Am 2000;25:214-35. https://doi.org/10.1053/jhsu.2000.jhsu25a0214
  7. Tang JB, Wang B, Chen F, et al. Biomechanical evaluation of flexor tendon repair techniques. Clin Orthop Relat Res 2001;(386):252-9.
  8. Akasaka T, Nishida J, Araki S, et al. Hyaluronic acid diminishes the resistance to excursion after flexor tendon repair: an in vitro biomechanical study. J Biomech 2005;38:503-7. https://doi.org/10.1016/j.jbiomech.2004.04.021
  9. Karakurum G, Buyukbebeci O, Kalender M, et al. Seprafilm interposition for preventing adhesion formation after tenolysis. An experimental study on the chicken flexor tendons. J Surg Res 2003;113:195-200. https://doi.org/10.1016/S0022-4804(03)00204-X
  10. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: a comparison of immobilization and controlled passive motion techniques. J Hand Surg Am 1980;5:537-43. https://doi.org/10.1016/S0363-5023(80)80101-8
  11. Gelberman RH, Vande Berg JS, Lundborg GN, et al. Flexor tendon healing and restoration of the gliding surface: an ultrastructural study in dogs. J Bone Joint Surg Am 1983;65: 70-80. https://doi.org/10.2106/00004623-198365010-00010
  12. Small JO, Brennen MD, Colville J. Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg Br 1989;14:383-91. https://doi.org/10.1016/0266-7681(89)90152-6
  13. Tang JB, Gu YT, Rice K, et al. Evaluation of four methods of flexor tendon repair for postoperative active mobilization. Plast Reconstr Surg 2001;107:742-9. https://doi.org/10.1097/00006534-200103000-00014
  14. Kessler I. The "grasping" technique for tendon repair. Hand 1973;5:253-5. https://doi.org/10.1016/0072-968X(73)90038-7
  15. Urbaniak JR, Cahill JD, Mortenson RA. Tendon suturing methods: analysis of tensile strength. American Academy of Orthopaedic Surgeons Symposium on Tendon Surgery in the hand. St. Louis: CV Mosby; 1975. p. 70-80.
  16. Tsuge K, Yoshikazu I, Matsuishi Y. Repair of flexor tendons by intratendinous tendon suture. J Hand Surg Am 1977;2: 436-40. https://doi.org/10.1016/S0363-5023(77)80024-5
  17. Barmakian JT, Lin H, Green SM, et al. Comparison of a su- ture technique with the modified Kessler method: resis- tance to gap formation. J Hand Surg Am 1994;19:777-81. https://doi.org/10.1016/0363-5023(94)90182-1
  18. Cao Y, Tang JB. Biomechanical evaluation of a four-strand modification of the Tang method of tendon repair. J Hand Surg Br 2005;30:374-8. https://doi.org/10.1016/J.JHSB.2005.04.003
  19. Zidel P. Tendon healing and flexor tendon surgery. In: Thorne CH, editor. Grabb and Smith's plastic surgery. Philadelphia: LWW; 2007. p. 803-10.
  20. Silfverskiold KL, May EJ. Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am 1994;19:53-60. https://doi.org/10.1016/0363-5023(94)90224-0
  21. Wang B, Xie RG, Tang JB. Biomechanical analysis of a modification of Tang method of tendon repair. J Hand Surg Br 2003;28:347-50. https://doi.org/10.1016/S0266-7681(03)00019-6
  22. Tang JB, Zhang Y, Cao Y, et al. Core suture purchase affects strength of tendon repairs. J Hand Surg Am 2005;30:1262- 6. https://doi.org/10.1016/j.jhsa.2005.05.011
  23. Chang P. Repair and grafting of tendon. In: Mathes SJ, editor. Plastic surgery. Philadelphia: Saunders Elsevier; 2006. p. 591-603.
  24. Becker H, Orak F, Duponselle E. Early active motion following a beveled technique of flexor tendon repair: report on fifty cases. J Hand Surg Am 1979;4:454-60. https://doi.org/10.1016/S0363-5023(79)80043-X
  25. Hashimoto T, Thoreson AR, An KN, et al. Comparison of step-cut and Pulvertaft attachment for flexor tendon graft: a biomechanics evaluation in an in vitro canine model. J Hand Surg Eur Vol 2012;37:848-54. https://doi.org/10.1177/1753193412442460