Flexor tenorrhaphy using absorbable suture materials

Abstract

Background: Nonabsorbable sutures are favorable for repairing flexor tendons. However, absorbable sutures have performed favorably in an animal model.

Methods: Two-strand sutures using the interlocking modified Kessler method with polydioxanone absorbable sutures 4-0 were used to repair completely ruptured flexor tendons in 55 fingers from 41 consecutive patients. The medical records of average 42 follow up weeks were analyzed retrospectively. The data analyzed using the chi-squared test, and Fisher's exact test was used for postoperative complications. The results were compared with those of other studies.

Results: Among the index, middle, ring, and little fingers were injured in 9, 17, 16, and 13 fingers, respectively. The injury levels varied from zone 1 to 5. Of the 55 digits in our study, there were 26 (47%) isolated flexor digitorum profundus (FDP) injuries and 29 (53%) combined FDP and with flexor digitorum superficialis injuries. Pulley repair was also conducted. Concomitant injuries of blood vessels and nerves were found in 17 patients (23 fingers); nerve injuries occurred in 5 patients (10 fingers). Two patients had ruptures (3.6%), and one patient had two adhesions (3.6%). Using the original Strickland criteria, all the patients were assessed to be excellent or good. Also, fibrosis and long-term foreign body tissue reactions such as stitch granuloma were less likely occurred in our study. Compared to the Cullen's report that used nonabsorbable sutures, there was no significant difference in the rupture or adhesion rates.

Conclusions: Therefore, this study suggests that appropriate absorbable core sutures can be used safely for flexor tendon repairs.

Keywords: Hand; Polydioxanone; Rupture; Tendon Injuries.

Fig. 1

Preoperative view A 33-year-old woman suffered soft tissue damage on the volar and ulnar aspect of the left ring finger. The complete rupture of the flexor digitorum profundus tendon was observed.

Fig. 2

Postoperative views (A) Assessment of the postoperative tendon function six months after the surgery. The functional outcome was excellent according to the Strickland system, although mild flexion limitation on the distal interphalangeal joint was observed. (B) Full extension without postoperative extension lag.

Fig. 3

Preoperative view A 43-year-old man suffered soft tissue damage on the proximal interphalangeal joint to the fingertip of the left middle finger to the volar and ulnar region. The complete rupture of the flexor digitorum profundus tendon was observed.

Fig. 4

Postoperative views (A) Assessment of postoperative tendon function three months after the surgery. (B) Excellent total active range of motion. Full extension without postoperative extension lag.