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Comparison of modified Kessler and Yotsumoto-Dona suture: A biomechanical study on porcine tendons.
MedLine Citation:
PMID:  22931133     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract There is a need for a strong suture technique that allows early active mobilisation after repair of flexor tendons, but the best method has not yet been found. The aim of this study was to compare the modified Kessler suture biomechanically with a newer, two-strand suture. Eighteen porcine tendons were cut and repaired according to either the grasping modified Kessler suture or the combined side-locking loop technique (Yotsumoto) and interlocking horizontal mattress suture (Dona). The specimens were tested linearly to failure. The 2 mm gap force, yield force, ultimate force, stiffness, energy to yield, and energy to failure were all significantly higher (p value = 0.005, 0.003, <0.001, 0.001, 0.004, and 0.001, respectively) in the Yotsumoto-Dona group (median values (IQR): 30.9 (28.1-39.5) N, 82.7 (64.9-114.1) N, 82.7 (76.6-114.1) N, 12.5 (10-14.5) N/mm, 0.45 (0.2-0.5) J, and 0.45 (0.35-0.5) J) than in the modified Kessler group (25.8 (12.2-28.1) N, 35 (24.6-54.4) N, 50.9 (34.4-55.1) N, 7 (5.8-91) N/mm, 0.09 (0.06-0.18) J, and 0.21 (0.18-0.28) J). All Yotsumoto-Dona specimens had a yield force exceeding 35 N, while in the Kessler group only four did. The early yielding rate was 6/9 and 2/9 in the modified Kessler and the Yotsumoto-Dona groups, respectively (p = 0.15). Most of the core sutures failed by breakage, but three Yotsumoto knots loosened. All the simple running and six of the Dona epitendinous sutures failed predominantly by pulling-out, and by breakage at the intersections in three of the latter. The relatively easy two-strand Yotsumoto-Dona suture is likely to withstand the loads of active finger flexion, whereas the modified Kessler suture is probably not.
Authors:
István Z Rigó; Jan-Ragnar Haugstvedt; Per Ludvigsen; Magne Røkkum
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-30
Journal Detail:
Title:  Journal of plastic surgery and hand surgery     Volume:  -     ISSN:  2000-6764     ISO Abbreviation:  J Plast Surg Hand Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101534130     Medline TA:  J Plast Surg Hand Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Orthopaedic Surgery, Oslo University Hospital , Oslo , Norway.
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