Number of suture throws and its impact on the biomechanical properties of the four-strand cruciate locked flexor tendon repair with FiberWire.

FiberWire is a popular suture in flexor tendon repair that allows for early mobilization, but its poor knot-holding properties have raised concerns over the potential effects on tendon healing and strength. We examined how the number of knot throws affects the 2 mm gap force, ultimate tensile strength, and mode of failure in a four-strand cruciate locked tendon repair in porcine flexor tendons in order to elucidate the optimal number of suture throws. There was no effect on the 2 mm gap force with increasing knot throws, but there was a significant increase in ultimate tensile strength. A minimum of six-knot throws prevents unravelling, whereas five out of 10 of repairs unravelled with less than six throws.

Evaluation of simple and looped suture and new material for flexor tendon repair.

Flexor tendon repair strength is proportional to the number of suture strands crossing the repair site but it is not clear if each strand needs to result from a separate pass through the tendon. We examined whether one throw of looped suture across a repair site equals two separate throws of suture and whether fewer passes with stronger material such as Fiberwire is equivalent to more passes with a comparatively weaker material such as Supramid. When evaluating the repairs for force required to generate a 2 mm gap and for gap formed at the instant prior to failure, looped suture cannot substitute for two separate passes of suture (Supramid Kessler looped vs. separate passes, 14 N vs. 35 N and 8.8 mm vs. 4.1 mm, respectively; Fiberwire Kessler looped vs. separate passes, 25 N vs. 43 N and 7.6 mm vs. 4.6 mm, respectively; all p<0.05). Two-stranded Fiberwire Kessler repair equalled four-stranded cruciate repair with Supramid for all tested parameters (force at 2 mm gap: 17 N vs. 22 N, respectively; force at failure: 42 N vs. 46 N; and gap formed prior to instant of failure: 6.9 mm vs. 5.6 mm; all p>0.05).

The clinical significance of the palmaris longus tendon in the pathophysiology of carpal tunnel syndrome.

Carpal tunnel syndrome is associated with increased intracarpal canal pressure. The effect of tendon loading on intracarpal canal pressures is documented in biomechanical studies. Palmaris longus loading in wrist extension induces the greatest absolute increase in intracarpal canal pressure. Despite this fact, the palmaris longus is not yet a proven independent risk factor for the development of carpal tunnel syndrome. The purpose of this prospective clinical study was to assess and quantify the association between the presence of a palmaris longus tendon and carpal tunnel syndrome. Thirty-six carpal tunnel subjects with bilateral disease were compared with 36 controls. Each subject was clinically examined for the presence of the palmaris longus tendon. The prevalence of palmaris longus agenesis was significantly lower in the carpal tunnel group. The palmaris longus tendon is a strong independent risk factor for carpal tunnel syndrome.

A prolonged case of Mycobacterium marinum flexor tenosynovitis: radiographic and histological correlation, and review of the literature.

We report on a 30-year-old man with prolonged Mycobacterium marinum flexor tenosynovitis. Due to low clinical suspicion, diagnosis was not made until 8 years after initial presentation. The history and magnetic resonance and tissue examination findings are consistent with mycobacterial tenosynovitis. These findings are presented, together with a review of the literature.

The impact of prior intra-abdominal surgery on laparoscopic cholecystectomy.

The presence of abdominal wall scarring and intra-abdominal adhesions following prior abdominal surgery has been proposed as a relative contraindication to the performance of laparoscopic cholecystectomy. The impact of prior abdominal surgery on the management of symptomatic gall bladder disease was retrospectively reviewed. Three groups were evaluated: open, laparoscopic, and laparoscopic converted to open cholecystectomy. Clinical factors analyzed included lengths of operative time, postoperative hospitalization stay, medical risk (ASA Classification), and postoperative complications. In addition, factors contributing to the conversion from a laparoscopic to open procedure were evaluated to determine the impact of prior surgery on conversion. The records of 504 consecutive patients undergoing open and laparoscopic cholecystectomy were reviewed. Individuals having additional intra-abdominal procedures were excluded. A total of 175 patients were identified who had prior abdominal surgery and underwent a cholecystectomy. In patients requiring cholecystectomy who have had prior abdominal surgery, the following observations can be made regarding laparoscopic cholecystectomy: 1) The operative time is less compared to open cholecystectomy. 2) The advantage of a shorter postoperative stay is realized. 3) The conversion rate (7/158) is low. Five of the seven conversions were due to the dense adhesion that prevented safe needle/trocar placement. 4) The complication rate is not increased. 5) The successful completion rate of laparoscopic cholecystectomy following prior intra-abdominal surgery (95.6%) is high.