Barbed Suture in Tendon Repair

Authors

  • Abhishek Vijayakumar The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • Pavan Murdeshwar The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India
  • Hemang Sanghvi The Bangalore Medical College and Research Institute, Krishna Rajendra Road, Fort, Kalasipalyam, Bengaluru, Karnataka 560002, India

DOI:

https://doi.org/10.31907/2414-2093.2015.01.2

Keywords:

Barbed suture, Vloc, Quill, Stratafix, Tendon repair, Gliding resistance, Breaking strength.

Abstract

Hand tendon lacerations are difficult to treat with over 25% of patients achieving an unsatisfactory clinical outcome as assessed by the clinician, and 7.7% of repairs re-rupture, requiring further surgery. The suture materials, which are available today possess tensile strengths capable of withstanding forces far above what occurs during active treatment. The current suture techniques have some disadvantages of bulky repair, adhesion formation and delayed tendon rupture. With availability of better designs of Barbed sutures like QuillTM, VlocTM and StratafixTM it has opened up a scope for new research into tendon repair. Various ex vivo studies have shown that a four strand repair using barbed suture has similar strength to conventional repair and adding an epitendinous suture adds on to repair strength. The Barbed suture repair reduces the cross sectional area at repair site, which may translate to reduced gliding resistance. There is need for clinical studies to analyze the effectiveness of Barbed suture in tendon repair in clinical setting and explore the potential advantages. Level of evidence II.

References

Su BW, Solomons M, Barrow A, Senoge ME, Gilberti M, Lubbers L, et al. Device for zone-II flexor tendon repair. A multicenter, randomized, blinded, clinical trial. J Bone Joint Surg Am. 2005; 87(5): 923-935. http://dx.doi.org/10.2106/JBJS.C.01483

Bainbridge LC, Robertson C, Gillies D, Elliota D. 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: 517-521. http://dx.doi.org/10.1016/0266-7681(94)90219-4

Wada A, Kubota H, Miyanishi K, Hatanaka H, Miura H, Iwamoto Y. Comparison of postoperative early active mobilization and immobilization in vivo utilising a four-strand flexor tendon repair. J Hand Surg Br. 2001; 26: 301-306. http://dx.doi.org/10.1054/jhsb.2000.0547

Schuind F, Garcia-Elias M, Cooney WP 3rd, An KN. Flexor tendon forces: in vivo measurements. J Hand Surg Am. 1992; 17: 291-298. http://dx.doi.org/10.1016/0363-5023(92)90408-H

Mishra V, Kuiper JH, Kelly CP. Influence of core suture material and peripheral repair technique on the strength of Kessler flexor tendon repair. J Hand Surg Br. 2003; 28: 357- 362. http://dx.doi.org/10.1016/S0266-7681(03)00080-9

Shaieb MD, Singer DI. Tensile strengths of various suture techniques. J Hand Surg Br. 1997; 22: 764-767. http://dx.doi.org/10.1016/S0266-7681(97)80444-5

Lawrence TM, Davis TR. A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair. J Hand Surg Am. 2005; 30: 836-841. http://dx.doi.org/10.1016/j.jhsa.2005.03.011

Trail IA, Powell ES, Noble J. An evaluation of suture materials used in tendon surgery. J Hand Surg Br. 1989; 14: 422-427. http://dx.doi.org/10.1016/0266-7681(89)90160-5

Kubota H, Aoki M, Pruitt DL, Manske PR. Mechanical properties of various circumferential tendon suture techniques. J Hand Surg Br. 1996; 21: 474-480. http://dx.doi.org/10.1016/S0266-7681(96)80049-0

Xie RG, Tang JB. Investigation of locking configurations for tendon repair. J Hand Surg Am. 2005; 30: 461-465. http://dx.doi.org/10.1016/j.jhsa.2005.02.006

Xie RG, Xue HG, Gu JH, Tan J, Tang JB. Effects of locking area on strength of 2- and 4-strand locking tendon repairs. J Hand Surg Am. 2005; 30: 455-460. http://dx.doi.org/10.1016/j.jhsa.2004.12.012

Aoki M, Pruitt DL, Kubota H, Manske PR. Effect of suture knots on tensile strength of repaired canine flexor tendons. J Hand Surg Br. 1995; 20: 72-75. http://dx.doi.org/10.1016/S0266-7681(05)80020-8

Amadio PC. Friction of the gliding surface. Implications for tendon surgery and rehabilitation. J Hand Ther. 2005; 18(2): 112-119. http://dx.doi.org/10.1197/j.jht.2005.01.005

Zhao C, Amadio PC, Zobitz ME, An KN. Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons. J Orthop Res. 2001; 19(4): 580-586. http://dx.doi.org/10.1016/S0736-0266(00)00055-3

Angeles JG, Heminger H, Mass DP. Comparative biomechanical performances of 4-strand core suture repairs for zone II flexor tendon lacerations. J Hand Surg Am. 2002; 27(3): 508-517. http://dx.doi.org/10.1053/jhsu.2002.32619

Noguchi M, Seiler JG, Gelberman RH, Sofranko RA, Woo SL. In vitro biomechanical analysis of suture methods for flexor tendon repair. J Orthop Res. 1993; 11(4): 603-611. http://dx.doi.org/10.1002/jor.1100110415

Wong JK, Cerovac S, Ferguson MW, McGrouther DA. The cellular effect of a single interrupted suture on tendon. J Hand Surg Br. 2006; 31(4): 358-367. http://dx.doi.org/10.1016/j.jhsb.2006.03.162

Wong JK, Alyouha S, Kadler KE, Ferguson MW, McGrouther DA. The cell biology of suturing tendons. Matrix Biol. 2010; 29(6): 525-536. http://dx.doi.org/10.1016/j.matbio.2010.06.002

Bunnell S. Gig pull-out suture for tendons. J Bone Joint Surg Am. 1954; 36: 850-851.

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: 440-447.

Shaw PC. A method of flexor tendon suture. J Bone Joint Surg Br. 1968; 50(3): 578-87.

Ingle NP, King MW. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues. J Biomech. 2010; 43(2): 302-309. http://dx.doi.org/10.1016/j.jbiomech.2009.08.033

Ingle NP, King MW, Zikry MA. Finite element analysis of barbed sutures in skin and tendon tissues. J Biomech. 2010; 43(5): 879-86. http://dx.doi.org/10.1016/j.jbiomech.2009.11.012

Pranay P, Steven M, Davison P, James P. Higgins. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plastic Reconstruct. Surg. 2009; 124(5): 1551-1558. http://dx.doi.org/10.1097/PRS.0b013e3181babb77

Aran T, Heather M, Aho N, Sobol G. A re-exploration of the use of barbed sutures in flexor tendon repairs. Orthopedics 2009; 32(10): 731. http://dx.doi.org/10.3928/01477447-20090818-12

McClellan WT, Schessler MJ, Ruch DS, Levin LS, Goldner RD. A knotless flexor tendon repair technique using a bidirectional barbed suture: an ex vivo comparison of three methods. Plastic Reconstruct Surg. 2011; 128(4): 322e327e. http://dx.doi.org/10.1097/PRS.0b013e3182268c1f

Zeplin PH, Zahn, RK, Meffert, RH, Schmidt K. Biomechanical evaluation of flexor tendon repair using barbed suture material: A comparative Ex Vivo study. J Hand Surg. 2011; 36(3): 446-449. http://dx.doi.org/10.1016/j.jhsa.2010.11.031

Marrero-Amadeo IC, Chauhan A, Warden SJ, Merrell GA. Flexor tendon repair with a knotless barbed suture: a comparative biomechanical study. J Hand Surg. 2011; 36(7): 1204-1208. http://dx.doi.org/10.1016/j.jhsa.2011.04.003

Zeplin PH, Henle M, Zahn RK, Meffert RH, Schmidt K. Tensile strength of flexor tendon repair using barbed suture material in a dynamic ex vivo model. J Hand Microsurg. 2012; 4(1): 16-20. http://dx.doi.org/10.1007/s12593-012-0063-1

Lin TE, Lakhiani C, Lee MR, Saint-Cyr M, Sammer DM. Biomechanical analysis of knotless flexor tendon repair using large-diameter unidirection barbed suture. Hand 2013; 8(3): 315-319. http://dx.doi.org/10.1007/s11552-012-9491-4

Sato M, Matsumura H, Gondo M, Shimada K, Watanabe K. Flexor tendon repair with barbed suture: an experimental study. Eur J Orthop Surg Traumatol. 2013; 12. http://link.springer.com/article/10.1007/s00590-013-1335-6

Peltz TS, Haddad R, Scougall PJ, Gianoutsos MP, Bertollo N, Walsh WR. Performance of a knotless four-strand flexor tendon repair with a unidirectional barbed suture device: a dynamic ex vivo comparison. J Hand Surg Eur Vol. 2014: 39(1): 30-39. http://dx.doi.org/10.1177/1753193413476607 Barbed Suture in Tendon Repair Journal of Advanced Plastic Surgery Research, 2015, Vol. 1 9

Joyce CW, Whately KE, Chan JC, Murphy M, O’Brien FJ, Carroll SM. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur Vol. 2014: 39(1): 40-45. http://dx.doi.org/10.1177/1753193413487470

Maddox GE, Ludwig J, Craig ER, Woods D, Joiner A, Chaudhari N, et al. Flexor tendon repair with a knotless, bidirectional barbed suture: An in vivo biomechanical analysis. J Hand Surg Am. 2015; 40(5): 963e-968e. http://dx.doi.org/10.1016/j.jhsa.2015.01.013

Clemente A, Bergamin F, Surace C, Lepore E, Pugno N. Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthopaed Traumatol. 2015; 1-7.

Nayak AN, Nguyen DV, Brabender RC, Hiro ME, Miles JJ, Smithson IR, et al. A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture. J Hand Surg. 2015; 40(7): 1355- 1362. http://dx.doi.org/10.1016/j.jhsa.2015.04.009

Downloads

Published

2015-09-26

Issue

Section

Articles