Early Outcomes of Tendon Repair and Reconstruction in the Hand using Barbed

Sutures

Daniel Hap, R VaikunthanDepartment of Orthopaedic Surgery

Khoo Teck Puat Hospital

Introduction

Tendon repair and reconstruction an integral part of Hand Surgery

Advancements in suture material, suture techniques1

Conventional sutures pose problems of 2

Knot rupture, unravelling Bulky knot material inhibit tendon gliding

Barbed sutures may be the solution Knotless

1Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-,four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg. 1998;23: 261–5.2 A Shah, M Rowlands. Barbed Sutures and Tendon Repair—a Review; HAND (2015) 10:6–15

Objectives

To examine the early outcomes of tendon repair and reconstruction in the hand using barbed sutures

Identify potential complications

Methods

Retrospective study Conducted in KTPH from August 2015 to July 2016 ‘OT Sys’ used as search tool

All patients who underwent tendon repair and reconstruction of the hand using barbed sutures included

Case-notes reviewed for Patient demographics Diagnosis Surgery performed Surgical technique Type of suture used

Methods

Clinic notes and records from Hand Occupational Therapist reviewed Range of motion Complications Revision surgery

Results

16 patients underwent repair or reconstruction of tendon of hand using barbed sutures.

1 patient with repaired EPL laceration lost to follow-up 15 patients with of 18 operated hand tendons

• 3 patients with concomitant injuries to 2 tendons on the same hand 9 females and 6 males Age ranged from 23 to 80 years old, Follow-up duration ranged from 3 to 8 months

Results – Surgical technique

All repairs performed using V-LOC 3-0 non-absorbable sutures Standard tendon repair techniques employed Post-op care: Standard flexor / extensor tendon repair protocol

by Hand OT.

Results

7

8

3

Tendon repair / reconstruction

Tendon transferFlexor tendon repairExtensor tendon repair

Results – Nature of surgery

Pt No.

Surgery Type ComplicationsAdhesions Rupture

1 Trapeziectomy and APL suspensioplasty

Tendon transfer Nil Nil

2 PL to APB Camitz Transfer Tendon Transfer Nil Nil3 FDS repair (MF) Flexor repair Nil Nil

FDP repair (MF) Flexor repair Nil Nil4 EPL repair Extensor repair Nil Nil5 Trapeziectomy and APL

suspensioplastyTendon transfer Nil Nil

6 PL to APB Camitz Transfer Tendon transfer Nil Nil7 APB to EPL graft Tendon transfer Nil Nil8 Trapeziectomy and APL

suspensioplastyTendon transfer Nil Nil

Results – Nature of surgery

Pt No.

Surgery Type ComplicationsAdhesions Rupture

9 FPL repair Flexor repair Nil Nil

10 FDP repair (MF) Flexor repair Nil NilFDP repair (LF) Flexor repair Nil Nil

11 EIP to EPL tendon graft Tendon transfer12 EPL repair Extensor repair Nil Nil13 EPL repair Extensor repair Nil Nil

14 FDP repair Flexor repair Nil Nil15 FDP repair (LF) Flexor repair Nil Nil

FDS repair (LF) Flexor repair Nil Nil

Results – Pt #10

LF FDP rupture LF FDP Post-repair

MF FDP rupture MF FDP post-repair

Results

Results

Discussion

Barbed suture repair described since 1960s1

Advantages: 1. Barbs provide multiple anchoring points, uniform

distribution of tissue-holding forces2. Knotless suturing

1 McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. Preliminary report. J Bone Joint Surg 1967;49B:440–447.

Source:http://mms.businesswire.com/bwapps/mediaserver/ViewMedia?mgid=229832&vid=5

Discussion

24 studies identified in MEDLINE, EMBASE, Google Scholar 2 meta-analysis, 21 biomechanical studies, 1 in-vivo study (chickens) No in-vivo study with human subjects.

Discussion

Studies showing biomechanically comparable, if not superior results in barbed sutures. Greater or equivalent load to failure1,2

Smaller cross-sectional area3

Friction between exposed barbs and flexor tendon sheath4. Adhesions

1 Joyce CW, Whately KE, Chan JC, Murphy M, O’Brien FJ, Carroll SM. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur Vol. 2014;39:40–5

2 Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg. 2009;124: 1551–8.

3 McClellan WT, Schessler MJ, Ruch DS, Levin LS, Goldner RD. A　 knotless flexor tendon repair technique using a bidirectional barbed　 suture: an ex vivo comparison of three methods. Plast Reconstr Surg.　 2011;128:322e–7e

4 Oded BA, J Kargel, B Mailey. The Effect of Barbed Suture Tendon Repair on Work of Flexion. J Hand Surg Am. 2015;40(5):969-974

Limitations

Retrospective study Small sample size No comparison between barbed suture and traditional

sutures in our study

Conclusion

Early outcomes of using barbed sutures for tendon repair and reconstruction in the hand favourable.

Viable alternative to traditional sutures Advantages – less suture material and faster repair. Further studies required to ascertain long term results

Prospective study to compare barbed sutures and traditional sutures.

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