Relationship between the suture materials used in extensor tendon injuries and reoperations
Year 2021,
Volume: 46 Issue: 4, 1394 - 1400, 30.12.2021
Melih Bağır
,
Akif Mirioğlu
,
Buğra Kundakçı
,
Ömer Biçer
,
Cenk Özkan
Abstract
Purpose: The aim of our study was to compare the absorbable and non-absorbable suture materials used in hand extensor tendon repairs in terms of reoperations related to suture reaction-irritation.
Materials and Methods: Patients who admitted to our institute with extensor tendon injury of the hand and underwent surgical repair were evaluated retrospectively. Patients who met the inclusion criteria were divided into two groups according to the suture materials as absorbable suture (AS) (polydioxanone) group and non-absorbable suture (NAS) (polypropylene) group. Age, gender, side, and necessity of suture reaction related surgery were compared between groups. Repaired tendons and injury levels were enrolled for both groups. Cases with reoperation due to the suture reactions were assessed.
Results: There were 250 tendons of 172 patients met the inclusion criteria. One hundred and three (59.9%) patients were in NAS group and 69 (40.1%) were in AS group. Distribution of age, gender, and side were similar in both groups. There were 31 cases required suture related reoperation during follow-up. 29 (93.5 %) patients were in NAS group and 2 (%6.5) were in AS group. %74.2 of the cases were seen at zone 5 and 6 level, and frequently after the repair of extensor tendons of 2nd and 3rd digits.
Conclusion: We have found that NAS (polypropylene) suture use for extensor tendon repair increased the suture related reoperation risk. Hence, we thought that AS use for extensor tendon repair can be more appropriate since the soft tissue coverage is relatively weaker than the flexor site.
References
- 1. Bağır M, Eskandari MM. Longitudinal extensibility of the dorsal skin of the hand. J Hand Surg Eur Vol. 2019;44:1013-1018.
- 2. Yoon AP, Chung KC. Management of Acute Extensor Tendon Injuries. Clin Plast Surg. 2019;46:383-391.
- 3. Patillo D, Rayan GM. Open extensor tendon injuries: an epidemiologic study. Hand Surg. 2012;17:37-42.
- 4. Hanz KR, Saint-Cyr M, Semmler MJ, Rohrich RJ. Extensor tendon injuries: acute management and secondary reconstruction. Plast Reconstr Surg. 2008;121:109-120.
- 5. Lee SK, Dubey A, Kim BH, Zingman A, Landa J, Paksima N. A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique. J Hand Surg Am. 2010;35:19-23.
- 6. Desai MJ, Wanner JP, Lee DH, Gauger EM. Failed Extensor Tendon Repairs: Extensor Tenolysis and Reconstruction. J Am Acad Orthop Surg. 2019;27:563-574.
- 7. Esenyel CZ, Demirhan M, Kiliçoğlu O, Adanir O, Bilgiç B, Güzel O, et al. Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model. Acta Orthop Traumatol Turc. 2009;43:366-72.
- 8. Bekler HI, Beyzadeoğlu T, Gökçe A, Servet E. Aseptic drainage associated with polyglactine sutures used for repair of Achilles tendon ruptures. Acta Orthop Traumatol Turc. 2008;42:135-8.
- 9. Al-Qattan MM, Kfoury H. A Delayed Allergic Reaction to Polypropylene Suture Used in Flexor Tendon Repair: Case Report. J Hand Surg Am. 2015;40:1377-81.
- 10. Ollivere BJ, Bosman HA, Bearcroft PW, Robinson AH. Foreign body granulomatous reaction associated with polyethelene 'Fiberwire(®)' suture material used in Achilles tendon repair. Foot Ankle Surg. 2014;20:27-9.
- 11. Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am. 1983;8:794-8.
- 12. Amirtharajah M, Lattanza L. Open extensor tendon injuries. J Hand Surg Am. 2015;40:391-398.
- 13. Colzani G, Tos P, Battiston B, Merolla G, Porcellini G, Artiaco S. Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review. J Hand Microsurg. 2016;8:2-12.
- 14. Newport ML, Pollack GR, Williams CD. Biomechanical characteristics of suture techniques in extensor zone IV. J Hand Surg Am. 1995;20:650-6.
- 15. Mehdinasab SA, Pipelzadeh MR, Sarrafan N. Results of primary extensor tendon repair of the hand with respect to the zone of injury. Arch Trauma Res. 2012;1:131-4.
- 16. Teymoortash A, Fasunla JA, Pfützner W, Steinbach-Hundt S. Nasal tip abscess due to adverse skin reaction to Prolene: an unusual long term complication of rhinoplasty. J Laryngol Otol. 2013;127:76-9.
- 17. Skrypuch OW, Willis NR. Giant papillary conjunctivitis from an exposed prolene suture. Can J Ophthalmol. 1986;21:189-92.
- 18. Chung HS, Feder RS, Weston BC, Bryar PJ. Suture reaction masquerading as a conjunctival malignancy. Can J Ophthalmol. 2006;41:207-9.
- 19. Pabari A, Iyer S, Branford OA, Armstrong AP. Palmar granuloma following flexor tendon repair using Ticron: a case for absorbable suture material? J Plast Reconstr Aesthet Surg. 2011;64:409-11.
Elin ekstensör tendon onarımlarında kullanılan sütür materyallerinin reoperasyonlar ile ilişkisi
Year 2021,
Volume: 46 Issue: 4, 1394 - 1400, 30.12.2021
Melih Bağır
,
Akif Mirioğlu
,
Buğra Kundakçı
,
Ömer Biçer
,
Cenk Özkan
Abstract
Amaç: Çalışmamızın amacı, elde ekstensör tendon onarımlarında kullanılan emilebilen ve emilemeyen sütür materyallerinin sütür reaksiyonu-irritasyonu ile ilişkili reoperasyonlar açısından karşılaştırılmasıdır.
Gereç ve Yöntem: Çalışmamızda elde akut ekstensör tendon kesisi nedeniyle tendon onarımı yapılan hastalar retrospektif olarak değerlendirildi. Çalışma kriterlerine uyan hastalar, kullanılan sütür materyaline göre absorbabl sütür (AS) (polidiakson) ve nonabsorbabl sütür (NAS) (polipropilen) olarak iki gruba ayrıldı. Her iki grup yaş, cinsiyet, taraf ve sütür reaksiyonu ilişkili reoperasyon açısından karşılaştırıldı. Ayrıca her iki grupta tamir edilen tendonlar ve tamir bölgeleri değerlendirildi. Sütür reaksiyonu gelişen olguların, tamir edilen tendon ve tamir bölgesine göre dağılımı değerlendirildi.
Bulgular: Çalışmada 172 hastanın 250 ekstensör tendon tamiri değerlendirildi. Hastaların, 103(%59.9)’ü NAS, 69(%40.1)’u AS grubunda yer aldı. Her iki grup yaş, cinsiyet ve taraf açısından benzerdi. Sütür reaksiyonu sebepli reoperasyon uygulanan toplam 31 olgunun 29(%93.5)’unda NAS, 2(%6.5)’sinde AS kullanılmıştı. Sütür reaksiyonu gelişen olguların % 74.2’sinin Zon 5 ve 6’da yer aldığı ve sıklıkla 2 ve 3. parmak ekstensör tendon onarımlarından sonra geliştiği tespit edildi.
Sonuç: Çalışmamızda ekstensör tendon onarımlarında NAS (polipropilen) kullanımının sütür reaksiyonu nedeniyle reoperasyon sayısını arttırdığını tespit ettik. Dolayısıyla yumuşak doku desteği açısından fleksör bölgeye göre zayıf olan el dorsalindeki ekstensör tendon onarımlarında AS ile onarımın daha uygun olduğunu düşünmekteyiz.
References
- 1. Bağır M, Eskandari MM. Longitudinal extensibility of the dorsal skin of the hand. J Hand Surg Eur Vol. 2019;44:1013-1018.
- 2. Yoon AP, Chung KC. Management of Acute Extensor Tendon Injuries. Clin Plast Surg. 2019;46:383-391.
- 3. Patillo D, Rayan GM. Open extensor tendon injuries: an epidemiologic study. Hand Surg. 2012;17:37-42.
- 4. Hanz KR, Saint-Cyr M, Semmler MJ, Rohrich RJ. Extensor tendon injuries: acute management and secondary reconstruction. Plast Reconstr Surg. 2008;121:109-120.
- 5. Lee SK, Dubey A, Kim BH, Zingman A, Landa J, Paksima N. A biomechanical study of extensor tendon repair methods: introduction to the running-interlocking horizontal mattress extensor tendon repair technique. J Hand Surg Am. 2010;35:19-23.
- 6. Desai MJ, Wanner JP, Lee DH, Gauger EM. Failed Extensor Tendon Repairs: Extensor Tenolysis and Reconstruction. J Am Acad Orthop Surg. 2019;27:563-574.
- 7. Esenyel CZ, Demirhan M, Kiliçoğlu O, Adanir O, Bilgiç B, Güzel O, et al. Evaluation of soft tissue reactions to three nonabsorbable suture materials in a rabbit model. Acta Orthop Traumatol Turc. 2009;43:366-72.
- 8. Bekler HI, Beyzadeoğlu T, Gökçe A, Servet E. Aseptic drainage associated with polyglactine sutures used for repair of Achilles tendon ruptures. Acta Orthop Traumatol Turc. 2008;42:135-8.
- 9. Al-Qattan MM, Kfoury H. A Delayed Allergic Reaction to Polypropylene Suture Used in Flexor Tendon Repair: Case Report. J Hand Surg Am. 2015;40:1377-81.
- 10. Ollivere BJ, Bosman HA, Bearcroft PW, Robinson AH. Foreign body granulomatous reaction associated with polyethelene 'Fiberwire(®)' suture material used in Achilles tendon repair. Foot Ankle Surg. 2014;20:27-9.
- 11. Kleinert HE, Verdan C. Report of the Committee on Tendon Injuries (International Federation of Societies for Surgery of the Hand). J Hand Surg Am. 1983;8:794-8.
- 12. Amirtharajah M, Lattanza L. Open extensor tendon injuries. J Hand Surg Am. 2015;40:391-398.
- 13. Colzani G, Tos P, Battiston B, Merolla G, Porcellini G, Artiaco S. Traumatic Extensor Tendon Injuries to the Hand: Clinical Anatomy, Biomechanics, and Surgical Procedure Review. J Hand Microsurg. 2016;8:2-12.
- 14. Newport ML, Pollack GR, Williams CD. Biomechanical characteristics of suture techniques in extensor zone IV. J Hand Surg Am. 1995;20:650-6.
- 15. Mehdinasab SA, Pipelzadeh MR, Sarrafan N. Results of primary extensor tendon repair of the hand with respect to the zone of injury. Arch Trauma Res. 2012;1:131-4.
- 16. Teymoortash A, Fasunla JA, Pfützner W, Steinbach-Hundt S. Nasal tip abscess due to adverse skin reaction to Prolene: an unusual long term complication of rhinoplasty. J Laryngol Otol. 2013;127:76-9.
- 17. Skrypuch OW, Willis NR. Giant papillary conjunctivitis from an exposed prolene suture. Can J Ophthalmol. 1986;21:189-92.
- 18. Chung HS, Feder RS, Weston BC, Bryar PJ. Suture reaction masquerading as a conjunctival malignancy. Can J Ophthalmol. 2006;41:207-9.
- 19. Pabari A, Iyer S, Branford OA, Armstrong AP. Palmar granuloma following flexor tendon repair using Ticron: a case for absorbable suture material? J Plast Reconstr Aesthet Surg. 2011;64:409-11.