A Lateral Approach To Flexor Tendon Repair
Weifeng Zeng, MD, Nicholas J. Albano, MD, Ruston Sanchez, MD, Ronald McCabe, PhD, Ray Vanderby, Jr., PhD, Samuel O. Poore, MD, PhD, Aaron M. Dingle, PhD.
University of Wisconsin- Madison, Madison, WI, USA.
PURPOSE: The currently practiced methods of Zone II flexor tendon repair in fingers are limited. Decades of research have focused on applying stronger suture material and increasing the number of core sutures. Despite these efforts outcomes remain unpredictable. This study utilizes the would be discarded or notrepaired flexor digitorum superficialis (FDS) tendon tissue along with novel lateral suture techniques to enhance the strength of the repair and redistribute the forces away from the regenerative front of the healing tendon. Additionally, we believe this technique will prevent adhesion formation around the repair site.
METHODS: Two novel methods of flexor digitorum profundus tendon repair were tested in a cadaveric sheep model. Each novel method of repair incorporates a portion of the FDS tendon. The Asymmetric Repair (AR), utilizes the FDS tendon as an onlay support, while the Circumferential Repair (CR) incorporates the FDS tendon as a wrap. Clinical standard repairs using 2strand, 4strand Kessler method, 6strand MTang method served as controls. Ultimate tensile strength was used to compare techniques. All repairs were performed in sheep tendons (n=10/group) by a single surgeon. All tensile strength testing was performed with 2 newtons (N) of preload, at a rate of 20mm/minute until failure.
RESULTS AND CONCLUSIONS: These entirely new approaches using the autologous tendon tissue from the FDS secured with lateral sutures to redistribute force away from the repair site are achievable. Furthermore, greater peak force is required before failure of both AR (66.38±15.24N) and CR (65.86 ± 15.17N) than the strongest clinical standard (6strands:56.84 ± 8.79N).The native reclaimed FDS tissue redistributes the force away from the repair site, which can produce a more robust repair. Both novel techniques and the 6strand repair are currently undergoing cyclical testing prior to implementation within in vivo studies.
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