Surgical repair of acute Achilles tendon rupture with an end-to-end tendon suture and tendon flap.

BACKGROUND: Achilles tendon ruptures are becoming more common. Complications after open or minimally invasive surgery are: recurrent rupture (2-8%), wound breakdown, deep infections, granuloma, and fistulas. The authors expose their experience with a personal technique. MATERIALS: In 8 patients with acute rupture of Achilles tendon the surgery was performed at least 25 days after trauma. Clinical exam and MR demonstrated in all case a total lesion of tendon. After a posterolateral skin incision the tendon stumps were debrided and suture in end-to-end fashion. A tendon flap was harvested from the proximal part of the tendon, in order to protect and reinforce the suture itself. A plaster cast was applied for 3 weeks and the patients started the rehabilitation protocol. RESULTS: After 4 months all patients returned to pre-injury daily activities. The mean follow up was 13 months (ranged between 6 and 24 months). No major complications occurred. CONCLUSION: The posterolateral skin incision, not above the tendon, preserves the vascularity of the soft tissues, allows identifying and not accidentally injuring the sural nerve, and prevents the cutaneous scar is overlapped the tendon. In this way is favoured physiological tendon sliding. The preparation of the flap tendon does not weaken the overall strength of the tendon and protects the tendon suture. The tension on sutured stumps is less than being spread over a larger area. In our sample of 8 patients the absence of short-and long-term complications and the rapid functional recovery after surgery suggest that the technique used is safe and effective.

Laboratory and FEA evaluation of dentin-to-composite bonding as a function adhesive layer thickness.

OBJECTIVE: The aim of this study was to test the hypothesis that microtensile bond strength values are inversely proportional to dentin-to-composite adhesive layer thickness through laboratory mechanical testing and finite element analysis. METHOD: Eighteen noncarious third molars were obtained, and occlusal enamel removed perpendicular to the tooth long axis. Two different adhesive systems were utilized as follows (n=3): (1) application of a single layer of Single Bond (3M ESPE Co.) and Clearfil SE Bond (Kuraray Co.) following the manufacturer's directions; (2) application of one layer of both adhesive systems followed by one additional layer; (3) application of one layer of both adhesive systems followed by two additional layers. A 4mm build up was fabricated in increments on each tooth sample (Z 100 composite, 3M ESPE). Section measurements were performed and specimens were separated into three adhesive thickness groups per material (40, 40-80 and 80-120 microm) for microtensile testing. The bond strength data (MPa) were analyzed by one-way ANOVA and Tukey test. Maximum principal stresses (MPS) were determined through FEA for three different adhesive layer thicknesses (20, 50 and 100 microm). RESULTS: The bond strength data obtained for Single Bond at 0-40 microm presented significantly higher values compared to higher adhesive layer thickness groups. There were no statistical differences among bond strength values for all Clearfil SE Bond adhesive layer thicknesses. FEA modeling indicated that MPS increased as adhesive layer increased. The hypothesis was accepted for the Single Bond only. SIGNIFICANCE: Correspondence (not tested statistically) between microtensile laboratory testing and FEA model was only observed for Single Bond as increased adhesive layer thickness did not reduce Clearfil SE Bond strength.