Biomechanical comparison of double grasping repair versus cross-locked cruciate flexor tendon repair.

PURPOSE: This study was conducted to compare the in vitro biomechanical properties of tensile strength and gap resistance of a double grasping loop (DGL) flexor tendon repair with the established four-strand cross-locked cruciate (CLC) flexor tendon repair, both with an interlocking horizontal mattress (IHM) epitendinous suture. The hypothesis is that the DGL-IHM method which utilizes two looped core sutures, grasping and locking loops, and a single intralesional knot will have greater strength and increased gap resistance than the CLC-IHM method. METHODS: Forty porcine tendons were evenly assigned to either the DGL-IHM or CLC-IHM group. The tendon repair strength, 2-mm gap force and load to failure, was measured under a constant rate of distraction. The stiffness of tendon repair was calculated and the method of repair failure was analyzed. RESULTS: The CLC-IHM group exhibited a statistically significant greater resistance to gapping, a statistically significant higher load to 2-mm gapping (62.0 N), and load to failure (99.7 N) than the DGL-IHM group (37.1 N and 75.1 N, respectively). Ninety percent of CLC-IHM failures were a result of knot failure whereas 30 % of the DGL-IHM group exhibited knot failure. CONCLUSIONS: This study demonstrates that the CLC-IHM flexor tendon repair method better resists gapping and has a greater tensile strength compared to the experimental DGL-IHM method. The authors believe that while the DGL-IHM provides double the number of sutures at the repair site per needle pass, this configuration does not adequately secure the loop suture to the tendon, resulting in a high percentage of suture pullout and inability to tolerate loads as high as those of the CLC-IHM group.

Necrotizing soft tissue infections of the upper extremity: a case series.

Four cases of necrotizing soft tissue infections of the upper extremity are presented. Each involved minor wounds to the hand that gradually progressed to fulminant infection. Two of the patients reported a history of alcohol abuse. One patient had psychiatric illness that led to delay in recognizing the infection and seeking intervention. The causative organism in all cases was group A beta hemolytic streptococcus. Fortunately, none of the patients suffered loss of the affected extremity, although long-term function is limited. The necrotizing soft tissue infection encountered in these cases represents a less severe presentation than classic necrotizing fasciitis. Necrotizing soft tissue infections are properly recognized as a spectrum of disease and can, as in these cases, follow a prolonged progression with limited systemic involvement. The current literature regarding diagnosis and treatment of necrotizing soft tissue infections is reviewed.