scholarly journals Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials—Are We Following the Evidence?

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
W. B. J. Rudge ◽  
M. James
Keyword(s):  
Functional Outcomes ◽  
Surgical Repair ◽  
Suture Material ◽  
Flexor Tendon ◽  
Postal Survey ◽  
Current Evidence ◽  
Suture Materials ◽  
Flexor Tendon Injuries ◽  
Repair Techniques

Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries.

The Effect of Suture Materials on the Biomechanical Performance of Different Flexor Tendon Repairs and the Concept of Construct Efficiency

2018 ◽  
Vol 23 (02) ◽  
pp. 243-247
Author(s):  
Yoke Rung Wong ◽  
Austin Mun Kitt Loke ◽  
Shian Chao Tay
Keyword(s):  
Tensile Strength ◽  
Ultimate Tensile Strength ◽  
Tensile Testing ◽  
Flexor Tendon ◽  
Experimental Results ◽  
Suture Materials ◽  
Nylon Suture ◽  
Biomechanical Strength ◽  
Repair Techniques

Background: To propose a new term (‘construct efficiency’) for the evaluation of multi strands flexor tendon repairs using different suture materials. Methods: A total of twenty specimens from 4-0 braided polyblend sutures (FiberLoop/FiberWire; Arthrex, Naples, FL) and 4-0 nylon sutures (Supramid Extra II; S. Jackson, Inc., Alexandria, VA) were subjected to tensile testing using Pneumatic Cord-and-Yarn Grips (Instron Corp., Canton MA, USA). The ultimate tensile strengths of the suture materials were measured. The expected repair strengths and construct efficiencies were computed based on the experimental results and from available literature on actual repair strengths of the 4-strand Becker, Cruciate repairs and 6-strand Tang, modified Lim-Tsai repairs. Results: The ultimate tensile strength of nylon suture was 15.4 ± 0.6N, lower than that of braided polyblend suture (45.3 ± 2.3N) with a difference of 194%. The construct efficiency of multi strand repairs varied with respect to different repair techniques and suture materials. It was found that the Becker repairs using FiberWire had the highest construct efficiency (55.7%) followed by the modified Lim-Tsai using Supramid (50.9%), Tang repair using Supramid (49.8%), Cruciate repair using Fiberwire (49.1%), and modified Lim-Tsai repair using FiberLoop (33.5%). Conclusions: The construct efficiency is more accurate in showing that, in terms of biomechanical strength, the use of FiberWire for the 4-strand Becker and Cruciate repair is more efficient than that of using FiberLoop for 6-strand modified Lim-Tsai repair.

Proximal Hamstring Injuries: Review of Operative and Nonoperative Management

2018 ◽  
Vol 02 (04) ◽  
pp. 176-188
Author(s):  
Kyle Duchman ◽  
Ned Amendola ◽  
Joseph Buckwalter V
Keyword(s):  
Surgical Repair ◽  
Nonoperative Management ◽  
Current Evidence ◽  
Surgical Indications ◽  
Endoscopic Repair ◽  
Hamstring Injuries ◽  
Partial Tears ◽  
And Function ◽  
Proximal Hamstring ◽  
Repair Techniques

AbstractWhile uncommon, proximal hamstring injuries can result in significant pain and dysfunction, while also posing considerable treatment dilemmas due to the spectrum of injury that exists. Recent literature suggests that outcomes are improved with acute surgical repair of complete proximal hamstring avulsions, highlighting the importance of timely management of these unique injuries. While chronic repair or reconstruction can result in predictable improvements in pain and function postoperatively, the results are less predictable than acute surgical repair. Nonoperative management should be considered as the initial treatment strategy for patients with proximal hamstring tendinopathy or partial tears, as delayed surgical intervention in this setting has not been shown to significantly affect outcomes. Although current evidence is limited, evolving therapeutic techniques, including biologic injections and endoscopic repair techniques, need to be carefully evaluated to determine their role moving forward. This review aims to provide updated information on the relevant anatomy, mechanism of injury, diagnosis, and management of proximal hamstring injuries, with a specific focus on surgical indications, techniques, and outcomes.

Long-term outcome of paediatric flexor tendon injuries of the hand

2017 ◽  
Vol 70 (7) ◽  
pp. 908-913 ◽  
Author(s):  
Georg Singer ◽  
Thomas Zwetti ◽  
Ruth Amann ◽  
Christoph Castellani ◽  
Holger Till ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Tendon Injuries ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Flexor Tendon Injuries

Flexor tendon surgery: Advances in the field of hand surgery

2012 ◽  
Vol 153 (21) ◽  
pp. 811-820 ◽  
Author(s):  
Vilmos Bíró
Keyword(s):  
Flexor Tendon ◽  
Tendon Healing ◽  
Hand Surgery ◽  
Postoperative Treatment ◽  
Suture Materials ◽  
Flexor Tendon Injuries ◽  
Tendon Surgery ◽  
History Of ◽  
Detailed List ◽  
Near Future

Reconstruction of the flexor tendon injuries is one of the most difficult problems in hand surgery, because the postoperative end-results are often unfavorable. The author discusses the history of the flexor tendon surgery, and then he describes the development of the knowledge regarding the anatomy, the blood supply and the tendon healing of the flexor tendons from the beginning until now. After that he describes the development in suture materials, suture techniques, primary and secondary tendon reconstruction operations, postoperative treatment and rehabilitation programmes. The author describes what kind of progress to be expected in this field in the near future, and then he expresses his viewpoint about the development in the international and national hand surgical societies. He encloses a detailed list of literature for those who are interested in the field. Orv. Hetil., 2012, 153, 811–820.

Penile fracture: Long-term functional outcomes following surgical repair

2017 ◽  
Vol 16 (13) ◽  
pp. e3020
Author(s):  
P.M. Simoes De Oliveira ◽  
T. Ribeiro De Oliveira ◽  
J. Lemos Almeida ◽  
D. Martinho ◽  
S. Gaspar ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Surgical Repair ◽  
Penile Fracture

scholarly journals Short- and long-term results of chordal reconstruction using artificial suture material (polytetrafluoroethylene and polypropylene) in the dog

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Isamu Kanemoto ◽  
Tomonari Masumoto ◽  
Kiminari Ohara ◽  
Yusuke Kimura ◽  
Noboru Machida
Keyword(s):  
Suture Material ◽  
Long Term Results ◽  
Short Term ◽  
Suture Materials ◽  
Mitral Valve Plasty ◽  
Polypropylene Suture ◽  
Group 12 ◽  
Short And Long Term ◽  
Polypropylene Sutures

No previous reports have compared the suitability of expanded polytetrafluoroethylene (ePTFE) and polypropylene as artificial suture materials for chordal reconstruction in mitral valve plasty (MVP) in the dog. Twelve normal dogs were subjected to MVP using surfaceinduced deep hypothermia. In the short-term group (1.5-4 months after surgery), all ePTFE sutures were covered by a tissue sheath including the paired suture arms, which gave the appearance of native chordae from 2 months after surgery. In contrast, all polypropylene sutures were not covered by tissue, and appeared the same as the paired polypropylene suture arms at the operation. In the long-term group (12 months after surgery), all ePTFE sutures were covered by a tissue sheath, which appeared the same as that in the short-term group, and had flexibility without increased thickness with time. In contrast, although the polypropylene suture was covered completely by a tissue sheath in 1 dog, all the other polypropylene sutures were exposed except for both ends of the suture. ePTFE may be superior to polypropylene as an artificial suture material for chordal reconstruction in MVP.

A Comparison of Two Monofilament Suture Materials for Repair of Partial Flexor Tendon Lacerations: A Controlled In-vitro Study

2017 ◽  
Vol 22 (01) ◽  
pp. 18-22
Author(s):  
Abhinav Gulihar ◽  
Thomas Whitehead-Clarke ◽  
Ladan Hajipour ◽  
Joseph J. Dias
Keyword(s):  
Surgical Repair ◽  
Flexor Tendon ◽  
Tendon Repair ◽  
In Vitro Study ◽  
Suture Repair ◽  
Suture Materials ◽  
Flexor Tendons ◽  
Before And After ◽  
Materials Used

Background: Surgical repair is advocated for flexor tendon lacerations deeper than 70%. Repair can be undertaken with different suturing techniques and using different materials. Different materials used for tendon repair will have a different gliding resistance (GR) at the joint. Previous studies have compared strength of repair and gliding resistance for various braided suture materials and for 100% laceration of flexor tendons. We directly compare the GR of two monofilament sutures when used for a peripheral running suture repair of partially lacerated tendons. Methods: Sixteen flexor tendons and A2 pulleys were harvested from Turkey feet. They were prepared, partially lacerated to 50% depth, and then repaired with a core suture (modified Kessler technique with 4-0 Ethibond) as well as an additional superficial running suture of either 6-0 Prolene or Nylon (half randomised to each). Gliding resistance was measured for all tendons before and after repair, at different flexion angles (40 and 60 degrees) and for different loads (2N and 4N). Results: After surgical repair, gliding resistance was increased for all tendons (P < 0.01). The tendons repaired with Prolene had a higher mean gliding resistance than those repaired with Nylon (P = 0.02). Increased flexion angle and load amplified the gliding resistance (both P < 0.01). Conclusions: 6-0 Nylon was associated with a lower gliding resistance than 6-0 Prolene but the minor differences bare unknown clinical significance.

scholarly journals Long-Term Outcomes following Pediatric Peripheral Nerve Injury Repair

2019 ◽  
Vol 12 (01) ◽  
pp. 27-31
Author(s):  
Benjamin Langridge ◽  
Michelle F. Griffin ◽  
M. A. Akhavani ◽  
Peter E. Butler
Keyword(s):  
Peripheral Nerve ◽  
Retrospective Analysis ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Functional Outcomes ◽  
Surgical Repair ◽  
Postoperative Recovery ◽  
Clinical Records ◽  
Sensorimotor Recovery

Abstract Introduction Peripheral nerve injuries in children are uncommon and can be challenging to diagnose. There is a paucity of data on long-term sensorimotor and functional outcomes following surgical repair. We present a 12-year retrospective analysis of pediatric peripheral nerve repair with long-term functional outcomes. Materials and Methods We performed a retrospective analysis of pediatric patients with peripheral nerve injury requiring surgical repair. Clinical records were analyzed for procedure type, time to surgery, mechanism of injury, postoperative recovery, and complications. Results A total of 108 patients were identified and 87 patients were included. Out of 87 patients, 83 (95.4%) had partial or complete sensorimotor recovery at final follow-up and 4 did not improve. Minor complications occurred in 10.3% of patients, all resolved with conservative management. Mechanisms of injury were predominantly lacerations with sharp objects or crush injuries. Age at time of injury was inversely correlated with sensorimotor recovery, and time to surgical repair was not. Conclusion Surgical repair with long-term hand therapy results in excellent functional outcomes following pediatric peripheral nerve injury. A low threshold for exploration and repair should be used in instances of diagnostic uncertainty. Timing of surgical repair is dependent on a patient’s clinical presentation; however, repair within 48 hours is sufficient for optimal sensorimotor recovery.

Repair of frontal sinus fractures: clinical and radiological long-term outcomes

2021 ◽  
pp. 1-4
Author(s):  
E E Alon ◽  
E Glikson ◽  
Y Shoshani ◽  
A Dobriyan ◽  
R Yahalom ◽  
...  
Keyword(s):  
Frontal Sinus ◽  
Surgical Repair ◽  
Trauma Centre ◽  
Inclusion Criteria ◽  
Long Term Outcomes ◽  
Long Term Follow Up ◽  
Frontal Sinus Fracture ◽  
Repair Techniques

Abstract Objective The long-term clinical and radiological outcomes of patients surgically treated for frontal sinus fracture were assessed. Methods A retrospective, single-centre analysis was conducted of patients treated for frontal sinus fracture in a tertiary trauma centre between 2000 and 2017. Patients who underwent surgical repair for frontal sinus fracture followed by clinical and radiographical evaluation for at least six months were included. Results Of 338 patients admitted with frontal sinus fracture, 77 were treated surgically. Thirty patients met the inclusion criteria for long-term follow-up. The average follow-up duration was 37 months (range, 6–132 months). Reconstruction, obliteration and cranialisation of the frontal sinus fracture were performed in 14, 9 and 7 patients, respectively. Two patients with a reconstructed frontal sinus and one with an obliterated frontal sinus developed mucoceles. One patient developed forehead disfigurement following obliteration. Conclusion Long-term complications of frontal sinus repair using the chosen repair techniques are rare, but patients need to be made aware of these potential complications.

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