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Barbed Sutures and Tendon Repair—a Review

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HAND

Abstract

Introduction

Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair.

Methods

Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations.

Results

Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:

  1. 1.

    Maximum load to failure

  2. 2.

    Mode of failure

  3. 3.

    Load to 2-mm gap

  4. 4.

    Change in cross-sectional area

  5. 5.

    Type of repair

Conclusions

Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the non-uniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.

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References

  1. Ansari U, Lawson RD, Peterson JL, Appleyard RC, Tonkin MA. Effect of partial versus complete circumferential repair on flexor tendon strength in cadavers. J Hand Surg. 2009;34:1771–6.

    Article  Google Scholar 

  2. Aoki M, Manske PR, Pruitt DL, Larson BJ. Work of flexion after tendon repair with various suture methods. A human cadaveric study. J Hand Surg. 1995;20:310–3.

    Article  CAS  Google Scholar 

  3. Barrie KA, Wolfe SW, Shean C, Shenbagamurthi D, Slade 3rd JF, Panjabi MM. A biomechanical comparison of multistrand flexor tendon repairs using an in situ testing model. J Hand Surg. 2000;25:499–506.

    Article  CAS  Google Scholar 

  4. Cannon NM, Strickland JW. Therapy following flexor tendon surgery. Hand Clin. 1985;1:147–65.

    CAS  PubMed  Google Scholar 

  5. Caulfield RH, Maleki-Tabrizi A, Patel H, Coldham F, Mee S, Nanchahal J. Comparison of zones 1 to 4 flexor tendon repairs using absorbable and unabsorbable four-strand core sutures. J Hand Surg Eur Vol. 2008;33:412–7.

    Article  CAS  PubMed  Google Scholar 

  6. Coert JH, Uchiyama S, Amadio PC, Berglund LJ, An KN. Flexor tendon-pulley interaction after tendon repair. A biomechanical study. J Hand Surg. 1995;20:573–7.

    Article  CAS  Google Scholar 

  7. Cooney WP, Weidman K, Malo D, Wood MB. Management of acute flexor tendon injury in the hand. Instr Course Lect. 1985;34:373–81.

    CAS  PubMed  Google Scholar 

  8. Gussous YM, Zhao C, Amadio PC, An KN. The resurgence of barbed suture and connecting devices for use in flexor tendon tenorrhaphy. Hand. 2011;6:268–75.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Hirpara KM, Sullivan PJ, O’Sullivan ME. A new barbed device for repair of flexor tendons. J Bone Joint Surg Br Vol. 2010;92:1165–70.

    Article  CAS  Google Scholar 

  10. Ingle NP, King MW. Optimizing the tissue anchoring performance of barbed sutures in skin and tendon tissues. J Biomech. 2010;43:302–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ingle NP, King MW, Zikry MA. Finite element analysis of barbed sutures in skin and tendon tissues. J Biomech. 2010;43:879–86.

    Article  CAS  PubMed  Google Scholar 

  12. Jennings ER, Mansberger Jr AR, Smith Jr EP, Yeager GH. A new technique in primary tendon repair. Surg Gynecol Obstet. 1952;95:597–600.

    CAS  PubMed  Google Scholar 

  13. Joyce CW, Whately KE, Chan JC, Murphy M, O’Brien FJ, Carroll SM. Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair. J Hand Surg Eur Vol. 2014;39:40–5.

    Article  CAS  PubMed  Google Scholar 

  14. Khanna A, Gougoulias N, Maffulli N. Modalities in prevention of flexor tendon adhesion in the hand: what have we achieved so far? Acta Orthop Belg. 2009;75:433–44.

    PubMed  Google Scholar 

  15. Kim PT, Aoki M, Tokita F, Ishii S. Tensile strength of cross-stitch epitenon suture. J Hand Surg. 1996;21:821–3.

    Article  CAS  Google Scholar 

  16. Kim JC, Lee YK, Lim BS, Rhee SH, Yang HC. Comparison of tensile and knot security properties of surgical sutures. J Mater Sci Mater Med. 2007;18:2363–9.

    Article  CAS  PubMed  Google Scholar 

  17. Kubota H, Aoki M, Pruitt DL, Manske PR. Mechanical properties of various circumferential tendon suture techniques. J Hand Surg. 1996;21:474–80.

    Article  CAS  Google Scholar 

  18. Lin TE, Lakhiani C, Lee MR, Saint-Cyr M, Sammer DM. Biomechanical analysis of knotless flexor tendon repair using large-diameter unidirection barbed suture. Hand. 2013;8:315–9.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Marin Braun F, Foucher G, Buch Jaeger N, Sammut D. [Repair of the flexor digitorum profundus and the flexor pollicis longus by the “rope down” technique. Results in a series of 77 cases]. Ann Hand Upper Limb Surg. 1991;10:13–21.

    CAS  Google Scholar 

  20. Marrero-Amadeo IC, Chauhan A, Warden SJ, Merrell GA. Flexor tendon repair with a knotless barbed suture: a comparative biomechanical study. J Hand Surg. 2011;36:1204–8.

    Article  Google Scholar 

  21. McClellan WT, Schessler MJ, Ruch DS, Levin LS, Goldner RD. A knotless flexor tendon repair technique using a bidirectional barbed suture: an ex vivo comparison of three methods. Plast Reconstr Surg. 2011;128:322e–7e.

    Article  CAS  PubMed  Google Scholar 

  22. McKenzie AR. An experimental multiple barbed suture for the long flexor tendons of the palm and fingers. Preliminary report. J Bone Joint Surg Br Vol. 1967;49:440–7.

    CAS  Google Scholar 

  23. Miller B, Dodds SD, de Mars A, Zagoreas N, Waitayawinyu T, Trumble TE. Flexor tendon repairs: the impact of fiberwire on grasping and locking core sutures. J Hand Surg. 2007;32:591–6.

    Article  Google Scholar 

  24. Momose T, Amadio PC, Zhao C, Zobitz ME, Couvreur PJ, An KN. Suture techniques with high breaking strength and low gliding resistance: experiments in the dog flexor digitorum profundus tendon. Acta Orthop Scand. 2001;72:635–41.

    Article  CAS  PubMed  Google Scholar 

  25. Momose T, Amadio PC, Zhao C, Zobitz ME, An KN. The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons. J Biomed Mater Res. 2000;53:806–11.

    Article  CAS  PubMed  Google Scholar 

  26. Moriya T, Zhao C, An KN, Amadio PC. The effect of epitendinous suture technique on gliding resistance during cyclic motion after flexor tendon repair: a cadaveric study. J Hand Surg. 2010;35:552–8.

    Article  Google Scholar 

  27. Murtha AP, Kaplan AL, Paglia MJ, Mills BB, Feldstein ML, Ruff GL. Evaluation of a novel technique for wound closure using a barbed suture. Plast Reconstr Surg. 2006;117:1769–80.

    Article  CAS  PubMed  Google Scholar 

  28. O’Broin ES, Earley MJ, Smyth H, Hooper AC. Absorbable sutures in tendon repair. A comparison of PDS with prolene in rabbit tendon repair. J Hand Surg. 1995;20:505–8.

    Article  Google Scholar 

  29. Parikh PM, Davison SP, Higgins JP. Barbed suture tenorrhaphy: an ex vivo biomechanical analysis. Plast Reconstr Surg. 2009;124:1551–8.

    Article  CAS  PubMed  Google Scholar 

  30. Peltz TS, Haddad R, Scougall PJ, Gianoutsos MP, Bertollo N, Walsh WR. Performance of a knotless four-strand flexor tendon repair with a unidirectional barbed suture device: a dynamic ex vivo comparison. The Journal of hand surgery, European volume 2014;39:30-9.

  31. Peltz TS, Scougall P, Oliver RS, Glanoutsos MP, Bertollo N, Walsh W. The knotless tendon repair with a resorbable unidirectional barbed suture device: an in vivo comparison in the turkey foot. J Hand Surg. 2013;38:e33–4.

    Article  Google Scholar 

  32. Pruitt DL, Aoki M, Manske PR. Effect of suture knot location on tensile strength after flexor tendon repair. J Hand Surg. 1996;21:969–73.

    Article  CAS  Google Scholar 

  33. Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK. Two-, four-, and six-strand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg. 1998;23:261–5.

    Article  CAS  Google Scholar 

  34. Trail IA, Powell ES, Noble J. An evaluation of suture materials used in tendon surgery. J Hand Surg. 1989;14:422–7.

    Article  CAS  Google Scholar 

  35. Trocchia AM, Aho HN, Sobol G. A re-exploration of the use of barbed sutures in flexor tendon repairs. Orthopedics 2009;32.

  36. Viinikainen A, Goransson H, Huovinen K, Kellomaki M, Rokkanen P. A comparative analysis of the biomechanical behaviour of five flexor tendon core sutures. J Hand Surg. 2004;29:536–43.

    Article  CAS  Google Scholar 

  37. Waitayawinyu T, Martineau PA, Luria S, Hanel DP, Trumble TE. Comparative biomechanic study of flexor tendon repair using FiberWire. J Hand Surg. 2008;33:701–8.

    Article  Google Scholar 

  38. Winters SC, Gelberman RH, Woo SL, Chan SS, Grewal R, Seiler 3rd JG. The effects of multiple-strand suture methods on the strength and excursion of repaired intrasynovial flexor tendons: a biomechanical study in dogs. J Hand Surg. 1998;23:97–104.

    Article  CAS  Google Scholar 

  39. Zeplin PH, Zahn RK, Meffert RH, Schmidt K. Biomechanical evaluation of flexor tendon repair using barbed suture material: a comparative ex vivo study. J Hand Surg. 2011;36:446–9.

    Article  Google Scholar 

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Conflict of Interest

AS declares that he has no conflict of interest.

MR declares that she has no conflict of interest.

AA declares that he has no conflict of interest.

Statement of Human and Animal Rights

This article does not contain any studies with human or animal subjects.

Statement of Informed Consent

Informed consent is not necessary in this study as it is a review of the available literature on the topic.

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Authors and Affiliations

  1. Plastic and Reconstructive Surgery, Yale University School of Medicine, 3rd Floor, Boardman Building, 330 Cedar Street, New Haven, CT, 06520, USA

    Ajul Shah, Megan Rowlands & Alexander Au

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  1. Ajul Shah
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  2. Megan Rowlands
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Correspondence to Ajul Shah.

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Shah, A., Rowlands, M. & Au, A. Barbed Sutures and Tendon Repair—a Review. HAND 10, 6–15 (2015). https://doi.org/10.1007/s11552-014-9669-z

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