A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture.

PURPOSE: To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture. METHODS: Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded. RESULTS: Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N). CONCLUSIONS: We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study. CLINICAL RELEVANCE: In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair.

High-pressure cement injection injury of the hand: a case report.

Modern equipment allows injection of substances at much higher pressures than previously. We describe a high-pressure cement injection injury to the hand and how its management differs from other injection injuries. This injury was treated by the established standard for this surgical wound: immediate debridement. The wound had the same mechanism, pathology, bacteriology, and treatment as other similar wounds. Prognosis after high-pressure injection injuries, however, also depends on the substance injected. Treatment for cement injection injuries differs because of the unique properties of cement. Immediate intervention is necessary for decompression and minimization of chemical burn. Removing the final few fragments of cement after they have hardened may decrease the number of debridements and soft tissue destruction. Serial x-rays can be used to guide debridements, but if serial x-ray films are not obtained, a final x-ray is mandatory to ensure removal of all cement.