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Flexor tendon repair

Thomas Giesen, Lisa Reissner, Inga Besmens, Olga Politikou, Maurizio Calcagni
We report outcomes in 29 patients with flexor tendon repairs in 32 digits (five thumbs and 27 fingers) with our modified protocols. We repaired the lacerated flexor digitorum profundus tendons with core suture repairs using the 6-strand M-Tang method and without circumferential sutures. We divided the pulleys as much as needed to allow excursion of the repaired tendons, including complete division of the A4 or A2 pulleys when necessary. In nine fingers, we repaired one slip of the flexor digitorum superficialis tendon and resected the other half...
January 1, 2018: Journal of Hand Surgery, European Volume
Rebecca Q R Lim, Yoke-Rung Wong, Austin M K Loke, Shian-Chao Tay
This study compared the biomechanical performance of a novel 6-strand asymmetric flexor tendon repair with the modified Lim-Tsai technique using cyclic testing. Two groups of ten porcine tendons each were repaired and tested. Gap formation at every 100 cycles was measured. Survival was defined as maximum gap formation below 2 mm. All the repairs survived Stage I. With increased cyclic load in Stage II, the mean gap formation of modified Lim-Tsai repairs exceeded 2 mm at the 600th cycle and reached 4.2 mm (SD 1...
January 1, 2018: Journal of Hand Surgery, European Volume
Janice C Y Liao, Min He, Aaron W T Gan, Feng Wen, Lay Poh Tan, Alphonsus K S Chong
Progressive tendon adhesion is a major challenge in flexor tendon repair. The authors developed a bifunctional anti-adhesion scaffold and hypothesized that its application would reduce adhesion formation and deliver mesenchymal stem cells (MSCs) to enhance tendon healing. The scaffold was fabricated by an electrospinning machine before surface modification. The flexor tendons of 29 New Zealand rabbits underwent surgical repair and randomized to control, scaffold and scaffold loaded with MSC group. At 3 and 8 weeks post-surgery, range of motion (ROM), biomechanical properties, and histology were examined...
February 9, 2018: Journal of Biomedical Materials Research. Part B, Applied Biomaterials
Michael J Schreck, Hayden S Holbrook, L Andrew Koman
Pseudo-boutonniere deformity is an uncommon complication from long-standing proximal interphalangeal (PIP) joint contracture in Dupuytren disease. Prolonged flexion contracture of the PIP joint can lead to central slip attenuation and resultant imbalances in the extensor mechanism. We present a technique of flexor digitorum superficialis (FDS) tendon transfer to the lateral bands to correct pseudo-boutonniere deformity at the time of palmar fasciectomy for the treatment of Dupuytren disease. The FDS tendon is transferred from volar to dorsal through the lumbrical canal and sutured into the dorsally mobilized lateral bands...
February 2018: Journal of Hand Surgery
Qian Qian Yang, Yi Xiang Shao, Lu Zhong Zhang, You Lang Zhou
Tendon injuries are a common injury of musculocutaneous system. Due to the lack of sufficient cellularity and low growth factor activity, healing of disrupted digital flexor tendon is troublesome and the process is lengthy and ineffective. bFGF and VEGFA gene were proved to be responsible and critical for promoting tendon healing. How to continuously enhance expression of these genes is a challenge. In this study, we developed a combination therapeutic approach that corrects the fundamental problem underlying intrasynovial tendon healing with introduction of growth factor genes via non-viral vector nanoparticle...
January 27, 2018: Colloids and Surfaces. B, Biointerfaces
Wei Le, Andre Eu-Jin Cheah, Jeffrey Yao
BACKGROUND: To investigate the effect of myostatin (GDF-8) stimulation of bone marrow derived mesenchymal stem cells (BMSCs) on tenogenesis in the setting of tendon repair. GDF-8 has demonstrated the ability to augment tenogenesis and we sought to identify if this effect could lead to the focused differentiation of pluripotential stem cells down a tenocyte lineage ex vivo. METHODS: Cadaveric upper limb flexor tendons were harvested, decellularized and divided into 1 cm segments...
March 2018: Journal of Hand Surgery Asian-Pacific Volume
Kazufumi Sano, Yosuke Akiyama, Satoru Ozeki
Asymptomatic pisotriquetral arthroses caused ruptures of the flexor digitorum profundus tendon of the little finger in 2 elderly patients. Ruptures occurred with unnoticeable onset, and bilateral ruptures separately occurred with interval of several years in one patient. The tendon was ruptured in zone IV with perforation of the gliding floor through which the degenerative pisiform was visible. The gliding floor was repaired followed with excision of the pisiform, and the ruptured tendon was then transferred to the profundus tendon of the ring finger...
March 2018: Journal of Hand Surgery Asian-Pacific Volume
T H Lui, C Y D Mak
BACKGROUND: This research studied the safety and efficacy of a new portal to the spring ligament. This portal is located just plantar to the insertion of the posterior tibial tendon and above the fibrous septum between the posterior tibial and the flexor digitorum longus tendons. METHODS: Twelve fresh frozen foot and ankle specimens were used. The distance between the accessory medial portal and the medial plantar nerve was measured. The relation between the medial plantar nerve and the spring ligament was studied...
March 8, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Don Koh, Jeremy Lim, Jerry Y Chen, Inderjeet R Singh, Kevin Koo
BACKGROUND: Repairs of chronic Achilles tendon ruptures are technically challenging due to large defects after scar excision. Multiple techniques for repair have been proposed but little consensus on best practice established. This study aims to compare flexor hallucis longus (FHL) transfers versus turndown flaps augmented by FHL transfers. METHODS: Between 2005 and 2015, 49 unilateral repairs of chronic Achilles tendon ruptures were performed. We retrospectively compared the outcomes of 20 patients who underwent FHL transfer with 19 patients who underwent turndown flaps augmented with FHL transfer before surgery and at three time points after surgery (three, six and twelve months)...
November 10, 2017: Foot and Ankle Surgery: Official Journal of the European Society of Foot and Ankle Surgeons
Jia-Lin Wu, Chian-Her Lee, Chan-Tsung Yang, Chia-Ming Chang, Guoan Li, Cheng-Kung Cheng, Chih-Hwa Chen, Hsu-Shan Huang, Yu-Shu Lai
Transtibial pullout suture (TPS) repair of posterior medial meniscus root (PMMR) tears was shown to achieve good clinical outcomes. The purpose of this study was to compare biomechanically, a novel technique designed to repair PMMR tears using tendon graft (TG) and conventional TPS repair. Twelve porcine tibiae (n = 6 each) TG group: flexor digitorum profundus tendon was passed through an incision in the root area, created 5 mm postero-medially along the edge of the attachment area. TPS group: a modified Mason-Allen suture was created using no...
2018: PloS One
Akinobu Nishimura, Shigeto Nakazora, Naoya Ito, Aki Fukuda, Ko Kato, Akihiro Sudo
Longitudinal flexor hallucis longus (FHL) tendon tears are sometimes complicated by posterior ankle impingement syndrome (PAIS), especially in ballet dancers. In recent years, PAIS has been treated endoscopically, but it is difficult to suture FHL tendon tears endoscopically. In this report, we describe how to suture the FHL tendon endoscopically with the Meniscal Viper Repair system (Arthrex, Naples, FL). Without our endoscopic technique, when a patient is found to have a longitudinal tear of the FHL under endoscopy, we must choose to either neglect the tear or convert to an open repair...
October 2017: Arthroscopy Techniques
Lasse Linnanmäki, Harry Göransson, Jouni Havulinna, Petteri Sippola, Teemu Karjalainen, Olli V Leppänen
PURPOSE: Substantial gap formation of a repaired finger flexor tendon is assumed to be harmful for tendon healing. The purpose of this study was to investigate the relationship between gap formation and the failure of the repair during cyclic loading. METHODS: Thirty-five porcine flexor tendons were repaired and tested cyclically using variable forces until failure or a maximum of 500 cycles. Depending on the biomechanical behavior during cyclic testing, specimens were divided into 3 groups: Sustained (no failure), Fatigued (failure after 50 cycles), and Disrupted (failure before 50 cycles)...
January 23, 2018: Journal of Hand Surgery
Kyle D Lineberry, Shirley Shue, Kyle J Chepla
BACKGROUND: Penetrating trauma or lacerations within zone II of the flexor sheath may result in partial tendon injury. The proper management of this injury is controversial; the literature contains differing indications for surgical treatment and post-operative rehabilitation. METHODS: A literature review of the Cochrane, Medline and Pubmed databases was performed using the following search criteria: partial, flexor, tendon, laceration. All English language studies that evaluated biomechanical strength, complications, and outcomes after partial tendon injury in human and animal studies were included and reviewed by two of the authors...
January 12, 2018: Plastic and Reconstructive Surgery
Christopher S Klifto, John T Capo, Anthony Sapienza, S Steven Yang, Nader Paksima
Flexor tendon injuries of the hand are uncommon, and they are among the most challenging orthopaedic injuries to manage. Proper management is essential to ensure optimal outcomes. Consistent, successful management of flexor tendon injuries relies on understanding the anatomy, characteristics and repair of tendons in the different zones, potential complications, rehabilitation protocols, recent advances in treatment, and future directions, including tissue engineering and biologic modification of the repair site...
January 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Jamie L Engel, Joseph N Gabra, Andrew R Esterle, William D Lanzinger, John J Elias
Purpose  The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Methods  Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction...
December 2017: Journal of Hand and Microsurgery
Y M Shen, C X Ma, F J Qin, C Zhang, C Wang, X H Hu
Objective: To explore the methods and effects of wound repair and functional reconstruction of high-voltage electrical burns in wrists. Methods: From January 2009 to June 2016, 71 patients with high-voltage electrical burns in wrists were hospitalized, with 118 wrist wounds including 21 of type Ⅰ, 69 of type Ⅱ, 9 of type Ⅲ, and 19 of type Ⅳ. According to the wrist injuries, different surgical operations were performed. Forearm amputation was conducted in 20 wrists with necrosis in the distal end. On the basis of fasciotomy for decompression, early debridement was performed on the other 98 wrist wounds...
December 20, 2017: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
A Duprat, L-E Gayet, C Breque, M Freslon
Tendon grafts are a component of the therapeutic arsenal for managing chronic flexor tendons injuries in the hand, especially during two-stage Hunter reconstruction. The purpose of this anatomical study was to compare the strength of the Pulvertaft weave versus the step-cut suture used for flexor tendon reconstruction to determine their role in early active mobilization. We performed a biomechanical study with cadaver specimens. Thirty-four hands were randomized and the tendons from both hands were equally assigned to each group...
February 2018: Hand Surgery and Rehabilitation
Marlene Mauch, Markus Ulrich, Xaver Kaelin, Bernhard Segesser, Jochen Paul
Background  Muscles and tendons are subjected to a high level of stress in everyday life and sports. This often leads to injuries and is associated with training failure and reduced performance as well as with high costs for treatment and rehabilitation. Fast and successful treatment is therefore very important, both from an athletic and economic point of view. This study aims to demonstrate the relevance of biomechanical procedures for the objective monitoring of rehabilitation. At the same time, the results are to be used to establish progress and evaluation criteria for an efficient and controlled rehabilitation...
December 2017: Sportverletzung Sportschaden: Organ der Gesellschaft Für Orthopädisch-Traumatologische Sportmedizin
Takenori Matsuda, Akira Taniguchi, Koji Hayashi, Yasuaki Nakanishi, Yasuhito Tanaka
Wide-awake surgery has potential advantages for treating extensor or flexor tendon injury. We present a case of chronic extensor hallucis longus injury treated with turn-down reconstruction using wide-awake surgery with a selective nerve block. To the best of our knowledge, this is the first such case reported. The patient had dropped a knife proximal to the right hallux metatarsophalangeal joint. Because direct suturing was thought to be difficult, turn-down reconstruction was performed under a selective nerve block...
March 2018: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
A Poggetti, M Novi, M Rosati, D Ciclamini, M Scaglione, B Battiston
INTRODUCTION: Secondary repair of flexor tendon injuries remain a challenging procedure for hand surgeons. Usually, secondary reconstruction should be performed by staged approach. When the tendon and pulley integrity are intact, tenolysis may be the first surgical option. One-/two-stage tendon grafts are suggested when the integrity of flexor tendon is compromised. Active tendon implants (Brunelli prostheses) may represent an efficient option in patients with a poor prognosis, as well as whenever classical techniques fail...
December 7, 2017: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
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