title: Comparison of Flexor Tendon Suture Techniques Including 1 Using 10 Strands.
abstract: OBJECTIVE
  To compare mechanical properties of a multistrand suture technique for flexor tendon repair with those of conventional suture methods through biomechanical and clinical studies.
  
  
  METHODS
  We describe a multistrand suture technique that is readily expandable from 6 to 10 strands of core suture. For biomechanical evaluation, 60 porcine flexor tendons were repaired using 1 of the following 6 suture techniques: Kessler (2-strand), locking cruciate (4-strand), Lim/Tsai's 6-strand, and our modified techniques (6-, 8-, or 10-strand). Structural properties of each tenorrhaphy were determined through tensile testing (ultimate failure load and force at 2-mm gap formation). Clinically we repaired 25 flexor tendons using the described 10-strand technique in zones I and II. Final follow-up results were evaluated according to the criteria of Strickland and Glogovac.
  
  
  RESULTS
  In the biomechanical study, tensile properties were strongly affected by repair technique; tendons in the 10-strand group had approximately 106%, 66%, and 39% increased ultimate load to failure (average, 87 N) compared with those in the 4-, 6-, and 8-strand groups, respectively. Tendons in the 10-strand group withstood higher 2-mm gap formation forces (average, 41 N) than those with other suture methods (4-strand, 26 N; 6-strand, 27 N; and 8-strand, 33 N). Clinically, we obtained 21 excellent, 2 good, and 2 fair outcomes after a mean of 16 months (range, 6-53 mo) of follow-up. No patients experienced poor results or rupture.
  
  
  CONCLUSIONS
  The 10-strand suture repair technique not only increased ultimate strength and force at the 2-mm gap formation compared with conventional suture methods, it also showed good clinical outcomes. This multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Hyun Il
authors.initials: HI
authors.lastname: Lee
authors.affiliation: Department of Orthopedic Surgery, College of Medicine, Chung-Ang University, Seoul, Korea.
authors.forename: Jae Sung
authors.initials: JS
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Tae Hyuk
authors.initials: TH
authors.lastname: Kim
authors.affiliation: School of Mechanical Engineering, Chung-Ang University, Seoul, Korea.
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Orthopedic Surgery, Samsung Medical Center, SungKyunKwan University School of Medicine, Seoul, Korea.
authors.forename: Min Jong
authors.initials: MJ
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea. Electronic address: leegjos@yahoo.co.kr.
authors.forename: Gi Jun
authors.initials: GJ
authors.lastname: Lee
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength
keywords: Core suture; biomechanical study; flexor tendon; porcine; tenorrhaphy