Wrist Level Tendon Repairs Utilizing a Novel Tendon Stapler Device: An Efficiency and Biomechanical Study.

BACKGROUND: A novel tendon stapler device (TSD) was recently developed and FDA-approved to improve the strength and consistency of primary tendon repairs. We hypothesized this TSD would demonstrate faster and superior biomechanical properties compared to a standard suture coaptation. We also hypothesized that the TSD biomechanical properties would be consistent across participants with differing tendon repair experience. METHODS: Participants included a novice, intermediate, and expert in tendon repairs. Timed comparisons were performed in flexor zones IV-V and extensor zones VI-VII on human cadaver arms. Suture repairs were performed with a modified Kessler with a horizontal mattress. TSD repairs were performed on the matched donor arms. Biomechanical testing included 2-mm gap force, ultimate failure load, and mode of failure. RESULTS: In total, 228 tendon coaptations from 12 donor arms were performed and analyzed. TSD coaptations were three times faster and withstood nearly 50% higher forces on the 2-mm gap testing and roughly 30% higher forces on ultimate failure testing. These findings did not change when the repair times were analyzed by individual participants. The suture coaptations failed from suture pull-through, suture breakage, and knot failure. The TSD coaptation failures only occurred from device pull-through. CONCLUSION: The TSD produces significantly faster and stronger primary tendon coaptations compared to a standard 4-strand core suture repair in human donor arms. These findings also demonstrated minimal variability among participants with differing tendon repair experience. Although further investigation is needed, this device has potential to revolutionize tendon repairs.

Learning Curve of Wrist-level Tendon Repairs Using a Novel Tendon Stapler versus Traditional Suture Methods.

Numerous effective techniques for primary tendon coaptations exist. However, these techniques are complex and require a substantial amount of training to become proficient. Recently, a novel tendon stapler device (TSD) was developed that could potentially diminish the discrepancies among surgeons of varying levels of training. We hypothesized that the TSD would be easier to learn and would demonstrate improved learning curve efficiencies across participants of differing tendon repair experience compared with traditional suture methods. Participants included a novice, intermediate, and expert in tendon repairs. Comparisons were performed on wrist-level flexors and extensors from human donor arms. The suture repairs were performed with a modified Kessler with a horizontal mattress and were performed in one session on two donor arms by each participant. In a second session, each participant performed the TSD repairs on the matched, contralateral donor arms. Scatterplots fitted with Loess curves, one-way analysis of variance, Tukey pairwise comparisons, two-sided independent samples t test, and Fisher exact test were used to analyze findings. Results of our study showed that TSD repair times did not vary significantly by experience level. Suture repairs reached a stable "learned" level around repair #30, whereas the TSD repairs showed a more efficient curve that stabilized around repair #23. The TSD required less educational time, demonstrated a more efficient learning curve, and showed less variability across participants and repair order. Overall, the TSD is easy to adopt and may carry positive implications for surgeons and patients.

Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies.

BACKGROUND: The Pulvertaft weave technique (PT) is frequently used during tendon repairs and transfers. However, this technique is associated with limitations. In this systematic review and meta-analysis, quantitative and qualitative analyses were performed on in vitro, biomechanical studies that compared the PT with alternative techniques. METHODS: Articles included for qualitative and/or qualitative analysis were identified following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included in the meta-analysis were analyzed either as continuous data with inverse variance and random effects or as dichotomous data using a Mantel-Haenszel analysis assuming random effects to calculate an odds ratio. RESULTS: A comprehensive electronic search yielded 8 studies meeting inclusion criteria for meta-analysis. Two studies with a total of 65 tendon coaptations demonstrated no significant difference in strength between the PT and traditional side-to-side (STS) techniques (P = .92). Two studies with a total of 43 tendon coaptations showed that the STS with 1 weave has a higher yield strength than the PT (P = .03). Two studies with a total of 62 tendon repairs demonstrated no significant difference in strength between the PT and the step-cut (SC) techniques (P = .70). The final 2 studies included 46 tendon repairs and demonstrated that the wrap around (WA) technique has a higher yield strength than the PT (P < .001). CONCLUSIONS: The STS, SC, and WA techniques are preferred for improving tendon form. The STS and WA techniques have superior yield strengths than the PT, and the SC technique withstands similar stress to failure as the PT.

Optimizing the Pulvertaft Weave Technique: A Comprehensive Systematic Review of Comparative Biomechanical Studies.

BACKGROUND: The Pulvertaft weave continues as a staple technique for tendon coaptations. Many have proposed minor alterations to the original technique to improve its strength, although a lack of consensus exists. The authors' aim was to explore how the number of weaves and suture characteristics contribute to the overall strength of the coaptation. METHODS: A comprehensive electronic search was conducted using the PubMed, Cochrane Library, and Scopus databases. Criteria for inclusion consisted of cadaveric human or animal biomechanical studies evaluating ultimate failure load (in newtons) and the number of weaves, suture characteristics, tendon source, and number of coaptations. Weaves with minimum averages of 75 N were deemed successful, and those with greater than 120 N were considered high performing. RESULTS: A total of 347 tendon coaptations from 15 studies met inclusion criteria. Average strength by number of weaves was 36.4 N ( n = 52) for one weave, 54.2 N ( n = 58) for two weaves, 115.9 N ( n = 174) for three weaves, and 81.7 N ( n = 63) for four weaves. Statistical differences were observed between one and two weaves ( p < 0.0001); two and three weaves ( p < 0.0001); three and four weaves ( p < 0.003); and two and four weaves ( p < 0.0001). High-performing tendon transfers used three weaves, 3-0 or 4-0 braided sutures, and figure-of-eight or mattress core sutures. CONCLUSIONS: Contrary to the current dogma of "the more the better," the authors' findings show that Pulvertaft weave strength is optimized when three weaves are used to combine donor and recipient tendons. Braided sutures with either figure-of-eight or mattress sutures were associated with the highest strength of repair.

Temporal trends in trunk flexor endurance and intra-abdominal pressure in postpartum women.

Objectives: To describe change in trunk flexor endurance and intra-abdominal pressure (IAP) associated with trunk flexor assessment and explore factors associated with change in trunk flexor endurance during the first postpartum year.Design: Ancillary analysis of an ongoing prospective cohort study.Methods: Participants (N = 282) were primiparous women delivered vaginally. They completed trunk flexor endurance testing while assessing IAP, body habitus measures (body mass index, waist circumference, and body composition), and questionnaires 5-10 weeks and 11-15 months postpartum. We investigated change in trunk flexor endurance by quartile of improvement and factors associated with improvement (Q4 vs. Q1-Q3) using multivariable models, adjusted for baseline endurance.Results: Mean age was 28 ± 5 years. The median (IQR) trunk flexor hold time increased from early to late postpartum (129/IQR = 68, 217 vs 148/IQR = 80, 265 seconds, p = .01) and mean (SD) IAP decreased (55/SD = 13 vs 48/SD = 14 cmH20, p < .0001). The most improved group (Q4) increased endurance time by 176 seconds (95% CI = 103, 254), were less likely to be Hispanic, more likely to be older, more educated, and have lower measures of body habitus than women in Q1-Q3. Conclusion: Trunk flexor endurance increased and IAP decreased over one year postpartum. Lower body habitus and higher age early postpartum predicted greatest improvement in trunk flexor endurance at 1 year.

Restoring Form and Function to the Partial Hand Amputee: Prosthetic Options from the Fingertip to the Palm.

Partial hand amputations are the most common upper extremity amputations and affect individuals across a spectrum of socioeconomic and geographic backgrounds. Prosthetic devices can provide straightforward solutions to the devastating aesthetic, functional, psychological, and social deficits caused by these injuries. However, because of the recent development of multiple partial hand prosthetic devices, many hand providers remain unaware of their applicability in practice. This article highlights the various classes of partial hand prostheses currently available, including passive functional, body-powered, and externally powered options. Familiarity with these partial hand prostheses will better enable providers to care for partial hand amputees.

Stem Cells Regenerating the Craniofacial Skeleton: Current State-Of-The-Art and Future Directions.

The craniofacial region comprises the most complex and intricate anatomical structures in the human body. As a result of developmental defects, traumatic injury, or neoplastic tissue formation, the functional and aesthetic intricacies of the face and cranium are often disrupted. While reconstructive techniques have long been innovated in this field, there are crucial limitations to the surgical restoration of craniomaxillofacial form and function. Fortunately, the rise of regenerative medicine and surgery has expanded the possibilities for patients affected with hard and soft tissue deficits, allowing for the controlled engineering and regeneration of patient-specific defects. In particular, stem cell therapy has emerged in recent years as an adjuvant treatment for the targeted regeneration of craniomaxillofacial structures. This review outlines the current state of the art in stem cell therapies utilized for the engineered restoration and regeneration of skeletal defects in the craniofacial region.