Flexor Tendon Repairs: The Impact of Fiberwire on Grasping and Locking Core Sutures

• Published in: The Journal of hand surgery (American ed.) Vol. 32; no. 5; pp. 591 - 596
• Main Authors: Miller, Brian, MD, Dodds, Seth D., MD, deMars, Adam, BA, Zagoreas, Niko, MD, Waitayawinyu, Thanapong, MD, Trumble, Thomas E., MD
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-05-2007; Elsevier; Elsevier Science Ltd
• Subjects: Biological and medical sciences; biomechanics; Biomechanics. Biorheology; Cadaver; Diseases of the osteoarticular system; Equipment Failure Analysis; Fiberwire suture; Finger Injuries - surgery; flexor tendon; Fundamental and applied biological sciences. Psychology; Humans; Materials Testing; Medical sciences; Orthopedic surgery; Orthopedics; Polyethylene; Polyethylene Terephthalates; Random Allocation; repair; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Sutures; Tendon Injuries - surgery; tendon laceration; Tensile Strength; Tissues, organs and organisms biophysics; zone II; repair; zone II; biomechanics; Fiberwire suture; flexor tendon; tendon laceration; Laceration; Finger; Biomechanics; Orthopedics; Flexor muscle; Repair; Suture; Tendon; Locking
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2007.03.003

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).