![[ Visit Client Website ]](images/banner.gif)
Introduction
Barbed sutures have a growing number of applications in plastic surgery from body contouring to facelifts. Several flexor tendon repair methods have been described using barbed devices yet these have resulted in exposed barbs on the tendon surface which would damage the intricate pulley system in-vivo. We have previously described a barbed technique for flexor tenorraphy without exposed barbs1 (Figure 1). The purpose of this study was to test our novel barbed method using three commercially available barbed devices against a traditional polyester braided repair technique.
Materials and Methods
Eighty porcine tendons were randomly assigned to one of the four repair groups. The tendons were then transected and repaired. The cross sectional area at the repair site was measured before and after repair. Biomechanical testing was carried out using a tensiometer and data recorded included ultimate strength, 2mm gap formation force and mode of failure.
Results
The V-Loc device performed the best out of the barbed devices in relation to ultimate strength and 2mm gap formation force. In terms of ultimate strength, there was no significant difference between the Ethibond (90.4 ± 11.01 N) and the V-Loc device (88.16 ± 8.3 N). Following repair, the percentage increase in cross-sectional area at the repair site was significantly less in the three barbed groups compared to the traditional polyester repair group.
Conclusion
We have demonstrated that the V-Loc barbed device has a comparable tensile strength to a traditional suture for flexor tendon repairs. The V-Loc performed the best out of the barbed sutures due to the larger barbs secondary to the dual angle cut in the barb manufacture. Furthermore, following repair, the barbed device had a significantly reduced increase in cross-sectional area compared to the polyester repair group. If used in vivo, this would improve tendon gliding in zone II and lead to less gapping and tendon rupture. Barbed sutures may represent the future of flexor tendon repairs but further study is definitely warranted.
References
1. Joyce CW, Sugrue C, Chan JC, Delgado L, Zeugolis D, Carroll SM, Kelly JL.
A barbed suture repair for flexor tendons: a novel technique with no exposed barbs. Plast Reconstr Surg Glob Open. 2014 7;2:e237
Figure 1. The barbed repair technique. The arrows represent the direction of the suture passage.
