Surgical repair of traumatic rupture of superficial and deep digital flexor tendon in a 7 year old working mule with complicated skin injury

A 7 year old working mule,with the history of traumatic injury on left hind limb,was presented to TVCC within 6-7 hours of injury with open complicated skin wound. Physical and clinical examination revealed rupture of superficial and deep digital flexor tendons with relative soft tissue and skin damage. The case was diagnosed as traumatic flexor tendon rupture and posted for surgical correction by Bunnell-Mayer suturing technique. Anaesthesia was induced using Xylazine (1.1 mg/kg) and Ketamine (2.2 mg/kg) combination and maintained with thiopental sodium (500 mg) under lateral recumbency. Polyglactin-910 (#2) suture was preferred for tenorrhaphy because of higher tensile and functional strength. Post-operativeimmobilization was achieved by fiber-glass full limb cast. Animal showed lameness for the first post-operative week,and then slowly reduced. During the cast removal at 6thweek post-operatively, there was exuberant granulation tissue formation, which was removed by using cauterization.Thedressing of wound was continued with proper debridement and antibiotictill the re-establishment of damaged tissue

Propriedades mecânicas de dois padrões de sutura e dois tipos de fios aplicados às tenorrafias dos equinos / Tenorrhaphy in horses: comparison of the mechanical properties of two different suture patterns and suture materials

As lesões traumáticas dos membros que resultam em secções tendíneas são problemas comuns na clínica equina. Diversas complicações têm sido associadas à reparação dos tendões nessa espécie. O objetivo do presente trabalho foi avaliar biomecanicamente dois padrões de sutura e dois diferentes materiais aplicados às tenorrafias. Vinte e quatro peças de tendão flexor digital profundo de equinos foram seccionadas e suturadas em padrão locking loop duplo (grupo 1, com polipropileno; grupo 2, com poliglactina) ou em padrão locking loop simples associado à sutura de epitendão (grupo 3, com polipropileno; grupo 4, com poliglactina). Os corpos de prova foram submetidos a ensaios mecânicos de tração, em que se determinaram valores de força mínima, força máxima e pico de força, além do afastamento observado entre os cotos durante o pico máximo de força. Para avaliação dos resultados, foram utilizados os métodos ANOVA e os não paramétricos de Kruskal-Wallis e Mann-Whitney (P<0,05). Os maiores valores de força máxima foram documentados no grupo 3. Os valores de força mínima foram maiores nos grupos 3 e 4 que nos grupos 1 e 2, mas não diferiram significativamente entre os grupos 3 e 4. Os valores de pico de força foram maiores nos grupos 1 e 2 que no grupo 4, mas não diferiram significativamente no grupo 3. O afastamento foi maior nos grupos 1 e 2 quando comparados aos grupos 3 e 4. O padrão locking loop simples, com sutura de epitendão, atingiu maior resistência quando avaliado afastamento de até 3 milímetros entre os cotos tendíneos, sendo considerado padrão de escolha para aplicação clínica, tendo em vista os resultados obtidos neste trabalho.(AU)

Traumatic distal limb injuries resulting in tendon rupture are common in equine practice. Several complications have been associated with tendon repair in horses. The aim of this study was to compare the biomechanical properties of two tenorrhaphy techniques using two different suture materials. Twenty-four equine deep digital flexor tendon specimens were transected and sutured with the double locking loop pattern (polypropylene, group 1; polyglactin, group 2) or the single locking loop pattern with peripheral epitendon suture (polypropylene, group 3; polyglactin, group 4). Specimens were submitted to mechanical strain testing. Maximum, minimum and peak strain, and maximum, minimum and peak gap formation were evaluated. ANOVA and the non-parametric Kruskal-Wallis and Mann-Whitney tests were used (P<0.05). Higher maximum strength values were documented in group 3. Minimum strength values were higher in groups 3 and 4 than 1 and 2, but did not differ significantly between groups 3 and 4. Peak strength values were higher in groups 1 and 2 than 4, but did not differ significantly from group 3. Gap formation was greater in groups 1 and 2 than 3 and 4. The single locking loop pattern with epitendon suture performed with polypropylene had greater resilience, yielded lesser gap formation (3 mm) and is the pattern of choice for clinical application based on the results of this study.(AU)

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

PURPOSE: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. METHODS: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. RESULTS: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. CONCLUSION: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.

Thermographic and histological analysis of rabbit different tenorrhaphies techniques (4 and 6 strands) after early active mobilization / Análise termográfica e histológica de diferentes técnicas de tenorrafias (4 e 6 passadas) em coelhos após a mobilização ativa precoce

Introduction This research is based on the results of the surgeries of tenorraphy, which have been improved due to the association between strong and not voluminous sutures and physiotherapic protocols, which preconize the early active motion to the postoperative period. Objective To evaluate the healing process in vivo in different types of tenorraphies. Methods Thirty-six rabbits that underwent early active motion after tenorraphy. The sample was constituted of 3 groups of 12, in accordance with the 3 different types of suture (Brasil, Indiana and Tsai). Results On the 15th and 30th days after the surgery, thermographic and histological analyses revealed similar results that all groups showed similar behaviors in the same time of surgical repair, just differentiating between the periods. On the 30th day analysis were observed that collagen fibers being more exuberant thickening, thus being able to offer higher tensile strength to the tendon. Conclusion That suggests early active motion may be increased gradually to around the 30th day taking this as clinical relevance. .

Introdução Esta pesquisa é baseada nos resultados das cirurgias de tenorrafia, as quais têm evoluído em virtude da associação de suturas fortes e não volumosas e protocolos fisioterápicos, os quais preconizam mobilização ativa precoce no período pós-operatório. Objetivo Avaliar o processo de cicatrização in vivo em diferentes tipos de tenorrafias. Método Trinta e seis coelhos foram submetidos a mobilidade ativa precoce após tenorrafia. A amostra foi constituída por 3 grupos de 12, de acordo com os 3 tipos de sutura utilizados (Brasil, Indiana e Tsai). Resultados No 15º e 30º dia após a cirurgia, as análises termográficas e histológicas revelaram resultados similares evidenciando que todos os grupos apresentaram comportamentos semelhantes no mesmo tempo do reparo cirúrgico, diferenciando-se apenas entre os períodos. No trigésimo dia os estudos evidenciaram que as fibras de colágeno mostravam um exuberante afilamento, sendo assim, capazes de oferecer maior resistência tensil ao tendão. Conclusão Isto sugere que o movimento ativo precoce pode ser gradativamente aumentado em torno do trigésimo dia, o que é de grande relevância clínica. .

Surgical Treatment of Peroneus Longus Tendon Rupture after Ostectomy of Peroneus Tubercle of Calcaneus: A Case Report / 대한족부족관절학회지

We experienced a patient in whom rupture of the peroneus longus tendon occurred after ostectomy of the peroneus tubercle of the calcaneus. Acute rupture of the peroneus tendon can be managed by end-to-end anastomosis, while neglected cases can be treated by tenodesis, tendon transfer, or tendon graft. In the current patient, the tendon ends were mildly retracted, yielding a small gap. We successfully repaired the retracted tendon ends after lengthening by Z-plasty.

The Effect of Alloderm on Prevention of Adhesions following Tenorrhaphy in the Rabbits

PURPOSE: Peritendinous adhesion is one of the most notorious complication after the flexor tendon injury. In this study, Alloderm(R)(LifeCell Corp., Branchburg, N.J.), which is the decellularized human dermal analogue with its intact native basement membrane components, was used for the prevention of peritendinous adhesions following flexor tendon repair. METHODS: Thirty New Zealand white male rabbits were divided equally into 3 groups. In all groups, the flexor digitorum profundus of the third finger of the right back foot was cut totally and repaired by modified Kessler suture technique. Following tendon repair, Alloderm(R) was wrapt around the repaired tendon in the first group and sodium hyaluronate gel was sprayed to the operation field in the second group. In the control group, no external material was applied. The right back foot were immobilized for 6 weeks to optimize the formation of adhesion ingrowth. After death, the third finger that repaired tendons and sheaths was removed en bloc. We checked range of motion. and studied histologically for all groups. RESULTS: The experimental groups had better range of motion than the control group. We checked that the range of motion was 73.5 degrees in Alloderm(R) group, 55.9 degrees in the hyaluronic acid group, and 38.3 degrees in the control group. in the histological study, the experimental group had less adhesions compared with the control group. CONCLUSION: This study concludes that Alloderm(R) can decrease peritendinous adhesions following flexor tendon repairs in rabbits. We think the method could be used in clinical cases.

Effect of Amniotic Membrane Transplantation and Heparin on Tissue Adhesion in Flexor Tenorrhaphy of Chicken / 대한정형외과연구학회지

PURPOSE: The role of the amniotic membrane with or without heparin was investigated with regard to the prevention of adhesion formation following flexor tenorrhaphy of chicken. MATERIALS AND METHODS: We classified twelve chickens into four groups of three chickens. In group A, the flexor tendon was partially cut and the tendon was repaired. In group B, The repaired tendon was covered with heparin. In group C, the repaired tendon was covered with amniotic membrane. In group D, the repaired tendon was covered with amniotic membrane and heparin. Histologic and gross findings of the repaired tendon were evaluated at postoperative 3, 6 and 9 weeks. RESULTS: In group D, there were less inflammatory cell infiltration and fibroblasts proliferation in all stages. At postoperative 9 weeks of all groups, there were less inflammation and fibroblasts proliferation than those in postoperative 3 and 6 weeks. CONCLUSION: The use of amniotic membrane transplantation and heparin is effective in the prevention of inflammation and adhesion formation following flexor tenorrhaphy of chicken.

Effect of Amniotic Membrane Transplantation and Heparin on Tissue Adhesion in Flexor Tenorrhaphy of Chicken / 대한정형외과연구학회지

PURPOSE: The role of the amniotic membrane with or without heparin was investigated with regard to the prevention of adhesion formation following flexor tenorrhaphy of chicken. MATERIALS AND METHODS: We classified twelve chickens into four groups of three chickens. In group A, the flexor tendon was partially cut and the tendon was repaired. In group B, The repaired tendon was covered with heparin. In group C, the repaired tendon was covered with amniotic membrane. In group D, the repaired tendon was covered with amniotic membrane and heparin. Histologic and gross findings of the repaired tendon were evaluated at postoperative 3, 6 and 9 weeks. RESULTS: In group D, there were less inflammatory cell infiltration and fibroblasts proliferation in all stages. At postoperative 9 weeks of all groups, there were less inflammation and fibroblasts proliferation than those in postoperative 3 and 6 weeks. CONCLUSION: The use of amniotic membrane transplantation and heparin is effective in the prevention of inflammation and adhesion formation following flexor tenorrhaphy of chicken.

Effect of Amniotic Membrane Transplantation on Tissue Adhesion in Flexor Tenorrhaphy of Chicken / 대한정형외과학회잡지

PURPOSE: The role of the amniotic membrane with or without radiation was investigated with regard to preventing adhesion after flexor tenorrhaphy of chicken. MATERIALS AND METHODS: Nine chicken were divided into three groups. The second flexor tendon of the chicken was operated on. In group A, the flexor tendon was excised and one half and the tendon was repaired. In group B, the repaired tendon was covered with an amniotic membrane. In group C, the repaired tendon was covered with a lyophilised and 25 kGy irradiated amniotic membrane. The gross and histology findings on the level of inflammation and fibrosis of the repaired tendon were evaluated at 3, 6 and 9 weeks after surgery. RESULTS: Group C had the least inflammatory cell infiltration and fibroblast proliferation at any time. CONCLUSION: The use of radiated amniotic membrane was effective in preventing inflammation and adhesion after flexor tenorrhaphy in chickens.