The effect of core suture geometry on the mechanical interaction with the epitenon suture in terms of gap prevention, failure strength and mode of failure was investigated in a flexor tendon repair model. A total of 48 porcine flexor tendons were repaired using three techniques with distinct core suture geometry: single Kessler; double Kessler; and cruciate repair. Cyclic linear testing was carried out with and without a simple running epitenon suture. At failure load the epitenon suture reduced gapping by 87% in the double Kessler, 42% in the single Kessler and 15% in cruciate repairs. It increased the strengths of the repairs by 58%, 33% and 24%, respectively. Kessler repairs failed mainly by suture rupture, with and without epitenon suture, but cruciate repairs failed mainly by suture pull-out. The epitenon suture did not have a significant mechanical effect on the three repairs. Rather, its effect varied with the core suture geometry. The greatest effect occurred with double Kessler repairs.

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Journal of Hand Surgery (European Volume)
Erasmus MC: University Medical Center Rotterdam

de Wit, T, Walbeehm, E.T, Hovius, S.E.R, & McGrouther, D.A. (2013). The mechanical interaction between three geometric types of nylon core suture and a running epitenon suture in repair of porcine flexor tendons. Journal of Hand Surgery (European Volume), 38(7), 788–794. doi:10.1177/1753193413484876