Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

Sang Hwan Lee; Seok Hwan Kim; Hwa Young Oh; Eun Soo Park; Ho Seong Shin; Sung Gyun Jung

doi:10.12790/jkssh.2016.21.4.198

Journal List > J Korean Soc Surg Hand > v.21(4) > 1106536

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Lee, Kim, Oh, Park, Shin, and Jung: Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(4):198-204.

Published online: 11 December 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.4.198

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

Sang Hwan Lee¹, Seok Hwan Kim¹, Hwa Young Oh², Eun Soo Park¹, Ho Seong Shin¹, Sung Gyun Jung^3,

¹Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea

²Jayjun Plastic Surgery and Aesthetic, Seoul, Korea

³Department of Plastic and Reconstructive Surgery, National Medical Center, Seoul, Korea

Correspondence to: Sung Gyun Jung, Department of Plastic and Reconstructive Surgery, National Medical Center, 245 Euljiro, Jung-gu, Seoul 04564, Republic of Korea, TEL: +82-2-2260-7114, FAX: +82-32-621-5314, E-mail: sangwind@hanmail.net

^* This work was supported by the Soonchunhyang University Research Fund.

Received 26 July 201620 September 2016 Accepted 30 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy.

Methods:

Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout.

Results:

In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture.

Conclusion:

For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.

Keywords: Barbed suture, Tenorrhaphy, Tensile strength

REFERENCES

1. Strickland JW. Development of flexor tendon surgery: twenty-five years of progress. J Hand Surg Am. 2000; 25:214–35.

2. Aoki M, Kubota H, Pruitt DL, Manske PR. Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization. J Hand Surg Am. 1997; 22:107–14.

3. Bainbridge LC, Robertson C, Gillies D, Elliot D. A comparison of post-operative mobilization of flexor tendon repairs with “passive flexion-active extension” and “controlled active motion” techniques. J Hand Surg Br. 1994; 19:517–21.

4. 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.

5. Sirotakova M, Elliot D. Early active mobilization of primary repairs of the flexor pollicis longus tendon with two Kessler two-strand core sutures and a strengthened circumferential suture. J Hand Surg Br. 2004; 29:531–5.

6. Ketchum LD. Suture materials and suture techniques used in tendon repair. Hand Clin. 1985; 1:43–53.

7. Bunnell S. Gig pull-out suture for tendons. J Bone Joint Surg Am. 1954; 36:850–1.

8. Jennings ER, Mansberger AR Jr, Smith EP Jr, Yeager GH. A new technique in primary tendon repair. Surg Gynecol Obstet. 1952; 95:597–600.

9. Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg. 2009; 124:1551–8.

10. Trail IA, Powell ES, Noble J. An evaluation of suture materials used in tendon surgery. J Hand Surg Br. 1989; 14:422–7.

11. Momose T, Amadio PC, Zhao C, Zobitz ME, An KN. The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons. J Biomed Mater Res. 2000; 53:806–11.

12. McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers: preliminary report. J Bone Joint Surg Br. 1967; 49:440–7.

13. Amadio P, An KN, Ejeskar A, et al. IFSSH flexor tendon committee report. J Hand Surg Br. 2005; 30:100–16.

14. Clemente A, Bergamin F, Surace C, Lepore E, Pugno N. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthop Traumatol. 2015; 16:251–7.

Fig. 1.

Test machine for the (A) wire strength test and (B) suture strength test.

Fig. 2.

Graph of break load and extension. PDS, polydioxanone.

Fig. 3.

(A) 2-strand and (B) 4-strand barbed suture technique.

Fig. 4.

Analysis of results. The panel shows (A) suture break, (B) knot rupture, and (C) pullout, respectively.

Fig. 5.

Load of failure in 2-strand tenorrhaphy. NS, not significant; PDS, polydioxanone. A p<0.05 was considered significant.

Fig. 6.

Load of failure in 4-strand tenorrhaphy. S, not significant; PDS, polydioxanone. A p<0.05 was considered significant.

Table 1.

Load of failure in 2-strand tenorrhaphy

Wire	Suture	Sample no.	1st Failure load (N)
Quill 2-0	2S	12	26.83±7.47
PDS 3-0	2S	6	17.20±4.93
Prolene 2-0	2S	6	21.96±6.78

PDS, polydioxanone.

Table 2.

Load of failure in 4-strand tenorrhaphy

Wire	Suture	Sample no.	1st Failure load (N)
Quill 2-0	4S	12	62.50±13.34
PDS 3-0	4S	6	18.67±4.27
Prolene 2-0	4S	6	22.35±5.72

PDS, polydioxanone.

Table 3.

Mode of failure

Rupture type	Barbed	Unbarbed
Suture break	23/24	3/24
Knot rupture	None	11/24
Pullout	1/24	10/24

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