title: Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation - an animal study.
abstract: BACKGROUND
  Treatment of ruptured Achilles tendons currently constitutes of conservative early functional treatment or surgical treatment either by open or minimal invasive techniques. We hypothesize that an experimental Achilles tendon suture in an animal model significantly deteriorates Achilles tendon microcirculation immediately following suturing.
  
  
  METHODS
  Fifteen Achilles tendons of eight male Wistar rats (275-325 g) were included. After preparation of the Achilles tendon with a medial paratendinous approach, Achilles tendon microcirculation was assessed using combined Laser-Doppler and spectrophotometry (Oxygen-to-see) regarding:- tendinous capillary blood flow [arbitrary units AU]- tendinous tissue oxygen saturation [%]- tendinous venous filling pressure [rAU]The main body of the Achilles tendon was measured in the center of the suture with 50 Hz. 10 minutes after Achilles tendon suture (6-0 Prolene), a second assessment of microcirculatory parameters was performed.
  
  
  RESULTS
  Achilles tendon capillary blood flow decreased by 57% following the suture (70 +/- 30 AU vs. 31 +/- 16 AU; p < 0.001). Tendinous tissue oxygen saturation remained at the same level before and after suture (78 +/- 17% vs. 77 +/- 22%; p = 0.904). Tendinous venous filling pressure increased by 33% (54 +/- 16 AU vs. 72 +/- 20 AU; p = 0.019) after suture.
  
  
  CONCLUSIONS
  Achilles tendon suture in anaesthetised rats causes an acute loss of capillary perfusion and increases postcapillary venous filling pressures indicating venous stasis. The primary hypothesis of this study was confirmed. In contrast, tendinous tissue oxygen saturation remains unchanged excluding acute intratendinous hypoxia within the first 10 minutes after suture. Further changes of oxygen saturation remain unclear. Furthermore, it remains to be determined to what extent reduced capillary blood flow as well as increased postcapillary stasis might influence tendon healing from a microcirculatory point of view in this animal setting.
authors.affiliation: Plastic, Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. robertkraemer@arcor.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Kraemer
authors.forename: Johan
authors.initials: J
authors.lastname: Lorenzen
authors.forename: Robert
authors.initials: R
authors.lastname: Rotter
authors.forename: Peter M
authors.initials: PM
authors.lastname: Vogt
authors.forename: Karsten
authors.initials: K
authors.lastname: Knobloch
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