title: Flexor tendons repair: effect of core sutures caliber with increased number of suture strands and peripheral sutures. A sheep model.
abstract: BACKGROUND
  Surgeons have aimed to achieve strong repair so as to begin early active rehabilitation programs for flexor tendon injury. Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques. In vivo studies indicate that multiple strands may cause ischemia during the intrinsic healing process by decreasing the total cross-sectional area of the injured site, unless the total cross-sectional area of the sutures is not decreased.
  
  
  OBJECTIVE
  The hypothesis was to design an in vitro study to understand the biomechanical relationship between suture calibers of core sutures with increased number of suture strands and peripheral suture on final repair strength.
  
  
  METHODS
  Sixty fresh sheep forelimb flexor digitorum profundus tendons were randomly placed into three groups (A, B, and C), each containing 20 specimens, for tendon repair. Two-, four-, and eight-strand suture techniques were respectively used in Groups A, B, and C. A simple running peripheral suture technique was used in Subgroups A2, B2, and C2. For each repaired tendon, the 2-mm gap-formation force, 2-mm gap-formation strength, maximum breaking force and maximum breaking strength were determined.
  
  
  RESULTS
  Differences in 2-mm gap-formation force and 2-mm gap-formation strength were found between Subgroups A1 and A2, B1 and B2, and C1 and C2. Between Groups A and B, A and C, and B and C, there was no difference as well.
  
  
  CONCLUSIONS
  Both the number of strands and the ratio between the total suture volume and tendon volume at the repair site are important for ideal repair. If the total cross-sectional area of the sutures is equal in 2-strand, 4-strand, and 8-strand procedure, there is no difference in the strength of the repair. A decrease in caliber size suture requires more passes to achieve the same strength. Instead, it is much better to use peripheral suture techniques to improve the strength of the repair with larger diameter 2-strand core sutures.
authors.affiliation: Düzce University Medical School, Department of Orthopaedics and Traumatology, Düzce, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Uslu
authors.affiliation: Abant Izzet Baysal University Medical School, Department of Orthopaedics and Traumatology, School of medicine, 14280 Golkoy/Bolu, Turkey. Electronic address: drcengiz034@yahoo.com.
authors.forename: C
authors.initials: C
authors.lastname: Isik
authors.affiliation: Düzce University Medical School, Department of Physical Treatment and Rehabilitation, Düzce, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Ozsahin
authors.affiliation: Düzce University, Technology Faculty, Department of Manufactering Engineering, Düzce, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Ozkan
authors.affiliation: Düzce University Medical School, Department of General Surgery, Düzce, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Yasar
authors.affiliation: Düzce University Medical School, Department of Orthopaedics and Traumatology, Düzce, Turkey.
authors.forename: Z
authors.initials: Z
authors.lastname: Orhan
authors.affiliation: Sakarya University Medical School, Department of Orthopaedics and Traumatology, Sakarya, Turkey.
authors.forename: M
authors.initials: M
authors.lastname: Erkan Inanmaz
authors.affiliation: Abant Izzet Baysal University Medical School, Department of Orthopaedics and Traumatology, School of medicine, 14280 Golkoy/Bolu, Turkey.
authors.forename: H
authors.initials: H
authors.lastname: Sarman
mesh_terms: D000818:Animals; D023421:Models, Animal; D011897:Random Allocation; D012756:Sheep; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength
keywords: Early active movement; Flexor tendon injury; Flexor tendon laceration; Multi-strand saturation; Peripheral suture; Suture caliber