title: Modified Brunelli pull-out suture technique in zone II flexor tendon rupture: a fresh human cadaver study.
abstract: OBJECTIVE
  The aim of our study is to develop a suture technique that has sufficient strength of active mobilization.
  
  
  METHODS
  Thirty two fingers of six fresh human cadavers were divided into two groups. Flexor digitorum profundus (FDP) tendons in the study group were repaired by modified Brunelli suture technique and modified Kessler suture technique, while those in the control group were repaired by Modified Kessler suture technique. Flexion and extension movements were performed with 10 N of load, increasing 1 N at a time to the tendons in both groups. Rupture and significant gap formation was evaluated up to 20 N of load. In the study, to evaluate the resistance to active motion, 1000 times flexion and extension motion cycle was performed with a load of 20 N. The succeeding repaired tendons was also tested with flexion and extension movements increasing the load 1 N at a time.
  
  
  RESULTS
  In the study group, failure and significant gap formation on the repair zone were not observed after 20 N of load and 1000 times cyclic flexion and extension movements for resisting to active motion. The rupture and significant gap formation was observed on a average load of 98.43 ± 0.47 N. In the Modified Kessler suture technique, on the eight tendons before reaching the 20 N of load for resisting to active motion, and the remaining eight tendons, during the 20 N loaded motion cycle essential for active motion, rupture and significant gap formation was observed. The failure and significant gap formation was observed on a average load of 18.37 ± 1.89 N. It is measured that by accompanying Modified Brunelli suture to the Modified Kessler suture technique, the resistance was increased up to 5-6 times.
  
  
  CONCLUSIONS
  By the Modified Brunelli suture technique, active motion can be started to the finger without a dorsal block sling immediately after the surgery. Clinical Relavans: By the modified technique, the rehabilitation difficulty and joint stiffness will be minimized.
authors.affiliation: Department of Orthopaedic and Traumatology, Sakarya Training and Research Hospital, Sakarya, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Başar
authors.forename: Cihangir
authors.initials: C
authors.lastname: Tetik
mesh_terms: D002102:Cadaver; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D016059:Range of Motion, Articular; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength; D016474:Weight-Bearing
keywords: Flexor Tendon Rupture; Modified Brunelli Suture Technique; Modified Kessler Suture Technique; Tendon Repair; Zone 2