title: A barbed suture repair for flexor tendons: a novel technique with no exposed barbs.
abstract: BACKGROUND
  Barbed suture technology has shown promise in flexor tendon repairs, as there is an even distribution of load and the need for a knot is eliminated. We propose that a quick and simple, novel, barbed technique without any exposed barbs on the tendon surface has comparable strength and a smaller cross-sectional area at the repair site than traditional methods of repair.
  
  
  METHODS
  Forty porcine flexor tendons were randomized to polybutester 4-strand barbed repair or to 4-strand Adelaide monofilament repair. The cross-sectional area was measured before and after repair. Biomechanical testing was carried out and 2-mm gap formation force, ultimate strength of repair, and method of failure were recorded.
  
  
  RESULTS
  The mean ultimate strength of the barbed repairs was 54.51 ± 17.9 while that of the Adelaide repairs was 53.17 ± 16.35. The mean 2-mm gap formation force for the barbed group was 44.71 ± 17.86 whereas that of the Adelaide group was 20.25 ± 4.99. The postrepair percentage change in cross-sectional area at the repair site for the Adelaide group and barbed group was 12.0 ± 2.3 and 4.6 ± 2.8, respectively.
  
  
  CONCLUSIONS
  We demonstrated that a 4-strand knotless, barbed method attained comparable strength to that of the traditional Adelaide repair technique. The barbed method had a significantly reduced cross-sectional area at the repair site compared with the Adelaide group. The 2-mm gap formation force was less in the barbed group than the Adelaide group. Barbed repairs show promise for tendon repairs; this simple method warrants further study in an animal model.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Cormac W
authors.initials: CW
authors.lastname: Joyce
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Conor
authors.initials: C
authors.lastname: Sugrue
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Chan
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Luis
authors.initials: L
authors.lastname: Delgado
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Zeugolis
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Seam M
authors.initials: SM
authors.lastname: Carroll
authors.affiliation: Department of Plastic and Reconstructive Surgery, University Hospital Galway, Galway, Ireland; Network of Excellence for Functional Biomaterials, National University of Ireland, Galway, Ireland; and Department of Plastic and Reconstructive Surgery, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Jack L
authors.initials: JL
authors.lastname: Kelly