Optimization of the Parameters of an Intra-Tendinous Barb Suture for Finger Flexor Tendon Repair in Zone II

Joseph Bakhach*, Elsa Bakhach, Bachar Chaya and Reem Karameh

Received: August 14, 2018;   Published: August 23, 2018

DOI: 10.26717/BJSTR.2018.08.001642

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Abstract

Aim: The ideal flexor tendon repair should be a simple procedure and should provide enough strength to the tendon in order to ensure a good anatomical stumps connection. The surgery must be performed without impairing either the tendon shape or the gliding process, particularly in zone II. Many experimental attempts have been made by using a barbed suture in the repair of the finger flexors focusing particularly on the mechanical properties of the suture. All the devices previously used had either a circular cross-sectional area or were designed to be used on the skin and subcutaneous tissues. The aim of our research is to define the anatomical properties of the digital flexor system in order to set the ideal shape and dimensions for a barb wire, that can be used for the digital flexor tendon repair.

Methods: Twenty-four hands from fresh cadavers were dissected exposing the different finger flexor systems. The length of the different annular pulleys and the distance from the distal insertion of each pulley to the distal insertion of the Flexor Digitorum Profondus (FDP) were both recorded. In addition, the width, heights and cross-sectional diameter of all the FDP tendons were documented.

Results: The cross-sectional shape of the FDP tendon in zone II is elliptical. We have postulated that the wire device should have an elliptical shape in order for it to better conform with the tendon. The different measurements of the cross-sectional diameters – radioulnar (a) and dorsovolar (b) - of the FDP tendon of the different fingers have demonstrated that the mean ratio a/b is usually 1.5. Thus, the mechanical investigations should address wires with a mean cross-sectional area ratio of 1.5, 2, 3 and 4.

Conclusion: These anatomical studies revealed that the best shape of an intra-tendinous barb wire device should be elliptical rather than the available circular ones. From an anatomical perspective, the optimal cross-sectional area of the wire should be 1.5 but the final cross-sectional area ratio should be adapted according to the results of the mechanical testing results.

Keywords: Flexor Tendon; Hand; Suture; Finger; Sheath; Pulley; Barb; Intra Tendinous; Zone Ranges; Flexor Digital

Abstract | Introduction | Material and Methods | Results | Discussion | Conclusion | Declarations | Data Source and Availability | References |