Evaluating adhesion reduction efficacy of type I/III collagen membrane and collagen-GAG resorbable matrix in primary flexor tendon repair in a chicken model

Background

Reduction of peritendinous adhesions after injury and repair has been the subject of extensive prior investigation. The application of a circumferential barrier at the repair site may limit the quantity of peritendinous adhesions while preserving the tendon’s innate ability to heal. The authors compare the effectiveness of a type I/III collagen membrane and a collagen-glycosaminoglycan (GAG) resorbable matrix in reducing tendon adhesions in an experimental chicken model of a “zone II” tendon laceration and repair.

Methods

In Leghorn chickens, flexor tendons were sharply divided using a scalpel and underwent repair in a standard fashion (54 total repairs). The sites were treated with a type I/III collagen membrane, collagen-GAG resorbable matrix, or saline in a randomized fashion. After 3 weeks, qualitative and semiquantitative histological analysis was performed to evaluate the “extent of peritendinous adhesions” and “nature of tendon healing.” The data was evaluated with chi-square analysis and unpaired Student’s t test.

Results

For both collagen materials, there was a statistically significant improvement in the degree of both extent of peritendinous adhesions and nature of tendon healing relative to the control group. There was no significant difference seen between the two materials. There was one tendon rupture observed in each treatment group. Surgical handling characteristics were subjectively favored for type I/III collagen membrane over the collagen-GAG resorbable matrix.

Conclusion

The ideal method of reducing clinically significant tendon adhesions after injury remains elusive. Both materials in this study demonstrate promise in reducing tendon adhesions after flexor tendon repair without impeding tendon healing in this model.     

Laceration of tibialis anterior tendon complicating a closed tibial fracture: A case report

Traumatic laceration of the tibialis anterior tendon complicating a closed tibial shaft fracture is a rare injury pattern. Only 3 such cases have been reported to date in the English literature and all were missed on initial examination. A case of a 17-year-old motorcyclist with an acute laceration of the tibialis anterior tendon resulting from a closed oblique tibial shaft fracture is presented. The tendon laceration was suspected preoperatively because of the patient's inability to actively dorsiflex his ankle joint and the existence of a palpable gap in the soft tissues over the anterolateral aspect of his tibia. Tibialis anterior tendon repair was performed simultaneously with fracture fixation. The role of careful physical examination is stressed so that this rare injury combination will not be missed.     

Trigger finger following partial flexor tendon laceration: Magnetic resonance imaging-assisted diagnosis

IntroductionPost-traumatic trigger finger is considerably rarer than normal trigger finger. The diagnosis is usually made on a clinical basis. This can be obscured; however, by concurrent pathological conditions. We report a case of post-traumatic trigger finger in which diagnosis was aided by magnetic resonance imaging (MRI).Presentation of caseOur patient is a 32-year-old male who had a previous laceration with a subsequent surgery for infectious tenosynovitis. The MRI showed the impinging tendon tag. Surgical excision of the tag successfully solved the case.DiscussionThe use of imaging studies for the diagnosis of post-traumatic trigger finger has been previously reported, the authors described a variation on the contour of the pulley system. The full lacerated tendon tag can be seen on our patient's MRI.ConclusionOn this case, the use of MRI was a useful aid for the differential diagnosis of post-traumattic trigger finger.     

Postcoital Vaginal Laceration in a Patient Presenting with Signs of Small Bowel Perforation: Report of a Case

Postcoital vaginal rupture or tear is a well-known entity to the gynecologist, albeit unusual; however, such cases are rarely encountered by the general surgeon. The index case is reported to highlight the rare situation wherein a middle-aged woman underwent laparotomy for a suspected small bowel perforation, which revealed a vaginal tear as the cause of pneumoperitoneum. This case emphasizes the importance of taking a gynecological history and performing a gynecological examination when the clinical diagnosis is uncertain. Received: December 27, 1999 / Accepted: September 26, 2000     

Partial flexor digitorum profundus lacerations

The management of partially lacerated flexor tendons remains controversial. Some have advocated repair of a partially severed tendon to restore gliding function, whereas others have recommended foregoing tenorrhaphy because of the negative impact of repair on the tensile strength of the tendon. Studies in several laboratories have suggested that tendons with up to 60% cross-sectional area involvement may be strong enough to withstand an early active mobilization regimen without rupture. In addition, tenorrhaphy does not significantly improve gliding function in tendons with up to 70% laceration. For these reasons, we recommend tenorrhaphy only for those tendons with greater than 60% laceration of cross-sectional area or those that trigger. Meticulous surgical technique and early protected mobilization provide the best chance for an optimal result.     

Flexor tendon repairs: the impact of fiberwire on grasping and locking core sutures

PURPOSE: Immediate surgical repair and early mobilization are essential in preventing adhesion formation and finger stiffness. A new polyethylene-based, braided suture material, Fiberwire (Arthrex, Naples, FL), touting increased strength, presents the potential for stronger repairs and, therefore, earlier active motion after surgery with a greater safety margin. The purpose of this biomechanic study was to investigate the differences in gap formation, tensile strength, and mode of failure for 2 distinct repair techniques using nylon, Ethibond (Ethicon, Somerville, NJ), and Fiberwire. METHODS: Human cadaver flexor tendons were harvested and repaired in a randomized fashion with either the Strickland or Massachusetts General Hospital (MGH) repairs using either nylon, Ethibond, or Fiberwire. Twelve tendons per group were repaired for each combination of material and method. During load-to-failure testing, 2-mm gap force and maximum tensile strength were statistically analyzed. RESULTS: Strickland repairs failed by suture pull-out in 74% of repairs, whereas 99% of the MGH repairs failed by suture breakage. For MGH repairs, Fiberwire suture provided significantly more tensile strength than Ethibond and nylon. For Strickland repairs, where the mode of failure was more often by suture pull-out rather than breakage, differences between type of suture were not significant. When comparing repair techniques using Fiberwire, the MGH repair was significantly stronger than the Strickland repair. CONCLUSIONS: Biomechanic testing shows that Fiberwire outperforms both Ethibond and nylon suture when using a locked flexor tendon repair suture (MGH repair) but not when using a grasping-type, nonlocking repair (Strickland repair).     

A brief review of extensor tendon injuries specific to the pediatric patient

Extensor tendon injuries in the pediatric population require careful evaluation and treatment. This article focuses on the differences in injury type and treatment of pediatric versus adult extensor tendon injuries. A detailed history and physical examination is crucial in the management of extensor tendon injuries of the young patient. Treatment of pediatric extensor tendon injuries depends largely on the site of injury. A majority of these injuries may be treated with splinting or primary repair. Treatment methods that require high compliance must be adjusted for the young child.     

Partial laceration of the flexor tendon as an unusual cause of trigger finger

Abstract

We present two cases of trigger finger caused by partial laceration of a flexor tendon. Both patients had preceding skin injury and required operative treatment with resection of the lacerated portion of the tendon and incision of the A1 pulley. We describe keys to the diagnosis of this type of lesion.     

Risk factors for obstetrical anal sphincter lacerations

The objective of this study was to identify the rate of anal sphincter lacerations in a large population-based database and analyze risk factors associated with this condition. Data were obtained from Pennsylvania Healthcare Cost Containment Council (PHC4) regarding all cases of obstetrical third and fourth degree perineal lacerations that occurred during a 2-year period from January 1990 to December 1991. Modifiable risk factors associated with this condition were analyzed, specifically episiotomy, forceps-assisted vaginal delivery, forceps with episiotomy, vacuum-assisted vaginal delivery, and vacuum with episiotomy. There were a total of 168,337 deliveries in 1990 and 165,051 deliveries in 1991 in Pennsylvania. Twenty-two percent (n=74,881) of the deliveries were by cesarean section and were excluded from analysis. Among the remaining 258,507 deliveries, there were 18,888 (7.3%) third and fourth degree lacerations. Instrumental vaginal delivery, particularly with use of episiotomy, increased the risk of laceration significantly [forceps odds ratio (OR): 3.84, forceps with episiotomy OR: 3.89, vacuum OR: 2.58, vacuum with episiotomy OR: 2.93]. Episiotomy on the whole was associated with a threefold increase in the risk of sphincter tears. However, episiotomy in the absence of instrumental delivery seems to be protective with an OR of 0.9 [95% confidence interval (CI): 0.88–0.93]. Instrumental vaginal delivery, particularly forceps delivery, appears to be an important risk factor for anal sphincter tears. The risk previously attributed to episiotomy is probably due to its association with instrumental vaginal delivery. Forceps delivery is associated with higher occurrence of anal sphincter injury compared to vacuum delivery.     

糜蛋白酶防止肌腱粘连的实验研究

目的 探讨糜蛋白酶对肌腱粘连的影响.方法 将36只健康白色纯种来享鸡,随机平均分成实验组和对照组.均以右侧第3趾为实验对象,切断趾深屈肌腱后采用改良Kessler法缝合.实验组向鞘管内滴注4 000 U/mL的糜蛋白酶1 mL,对照组采用生理盐水滴注.术后第2周、4周、6周处死动物,收集两组右侧缝合的趾深屈肌腱,分别进行大体观察,生物力学检测,组织学观察.结果 实验组肌腱粘连程度较对照组明显减轻,在肌腱修复术后第4周和第6周肌腱的最大载荷也明显增强,差异有统计学意义(P＜0.05).结论 糜蛋白酶有防止肌腱粘连的作用.