The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Richard H Gelberman - One of the best experts on this subject based on the ideXlab platform.
-
the effect of modified locking methods and suture materials on zone ii flexor Tendon Repair an ex vivo study
PLOS ONE, 2018Co-Authors: Matthew J Silva, Stephen W Linderman, Stavros Thomopoulos, Susumu Yoneda, Hirotaka Okubo, Nozomu Kusano, Fuminori Kanaya, Richard H GelbermanAbstract:The failure rate of intrasynovial Tendon Repair is high due to substantial elongation at the Repair site and to the development of adhesions between the Tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of Repair. The Winters-Gelberman 8-strand Repair technique was modified by adding surface lock loops and by using Fiberwire suture material. Forty-eight canine flexor digitorum profundus Tendons were transected and Repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the Repairs. The surface locking Kessler technique improved Repair maximum load, load necessary to create a 2 mm Repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire suture improved maximum load, the load necessary to create a 2 mm Repair site gap, stiffness, and yield force compared to Supramid suture. Failure occurred by both suture pull out and by suture breakage in the modified Kessler, Supramid suture Repair group. Failure occurred consistently by suture breakage in the surface locking Kessler, Supramid suture Repair group. These results reveal that a novel locking Kessler Repair is significantly stronger than the current state-of-the art flexor Tendon suture Repair technique. The use of a surface locking Kessler technique with Fiberwire suture markedly improves the mechanical properties of intrasynovial Tendon Repair by reducing the risk of post-operative gapping and rupture.
-
effect of connective tissue growth factor delivered via porous sutures on the proliferative stage of intrasynovial Tendon Repair
Journal of Orthopaedic Research, 2018Co-Authors: Stephen W Linderman, Stavros Thomopoulos, Shelly E Sakiyamaelbert, Younan Xia, Hua Shen, Susumu Yoneda, Rohith Jayaram, Michael L Tanes, Richard H GelbermanAbstract:Recent growth factor, cell, and scaffold-based experimental interventions for intrasynovial flexor Tendon Repair have demonstrated therapeutic potential in rodent models. However, these approaches have not achieved consistent functional improvements in large animal trials due to deleterious inflammatory reactions to delivery materials and insufficient induction of targeted biological healing responses. In this study, we achieved porous suture-based sustained delivery of connective tissue growth factor (CTGF) into flexor Tendons in a clinically relevant canine model. Repairs with CTGF-laden sutures were mechanically competent and did not show any evidence of adhesions or other negative inflammatory reactions based on histology, gene expression, or proteomics analyses at 14 days following Repair. CTGF-laden sutures induced local cellular infiltration and a significant biological response immediately adjacent to the suture, including histological signs of angiogenesis and collagen deposition. There were no evident widespread biological effects throughout the Tendon substance. There were significant differences in gene expression of the macrophage marker CD163 and anti-apoptotic factor BCL2L1; however, these differences were not corroborated by proteomics analysis. In summary, this study provided encouraging evidence of sustained delivery of biologically active CTGF from porous sutures without signs of a negative inflammatory reaction. With the development of a safe and effective method for generating a positive local biological response, future studies can explore additional methods for enhancing intrasynovial Tendon Repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2052-2063, 2018.
-
enhanced zone ii flexor Tendon Repair through a new half hitch loop suture configuration
PLOS ONE, 2016Co-Authors: Ioannis Kormpakis, Stephen W Linderman, Stavros Thomopoulos, Richard H GelbermanAbstract:This study evaluated the impact of a new half hitch loop suture configuration on flexor Tendon Repair mechanics. Cadaver canine flexor digitorum profundus Tendons were Repaired with 4- or 8-strands, 4-0 or 3-0 suture, with and without half hitch loops. An additional group underwent Repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand Repairs by 21% when 4-0, and 33% when 3-0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand Repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand Repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved Repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor Tendon Repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period.
-
the effect of suture caliber and number of core suture strands on zone ii flexor Tendon Repair a study in human cadavers
Journal of Hand Surgery (European Volume), 2014Co-Authors: Daniel A Osei, Martin I Boyer, Stavros Thomopoulos, Jeffrey G Stepan, Ryan P Calfee, Ryan Potter, Richard H GelbermanAbstract:Purpose To compare the tensile properties of a 3-0, 4-strand flexor Tendon Repair with a 4-0, 4-strand Repair and a 4-0, 8-strand Repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in Tendon Repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus Tendons after zone II Repair with 1 of 3 techniques: a 3-0, 4-strand core Repair, a 4-0, 8-strand Repair, or a 4-0, 4-strand Repair. We compared results across suture caliber for the 2 sutures and across Tendon Repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand Repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand Repair than in the 3-0, 4-strand Repair. Conclusions In an ex vivo model, an 8-strand Repair using 4-0 suture was 43% stronger than a 4-strand Repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a Repair site has an important effect on time zero, ex vivo flexor Tendon Repair strength. Clinical relevance Surgeons should consider using techniques that prioritize multistrand core suture Repair over an increase in suture caliber.
-
controlled delivery of mesenchymal stem cells and growth factors using a nanofiber scaffold for Tendon Repair
Acta Biomaterialia, 2013Co-Authors: Cionne N Manning, Matthew J Silva, Richard H Gelberman, Andrea G Schwartz, Wenying Liu, Jingwei Xie, Necat Havlioglu, Shelly E Sakiyamaelbert, Younan Xia, Stavros ThomopoulosAbstract:Outcomes after Tendon Repair are often unsatisfactory, despite improvements in surgical techniques and rehabilitation methods. Recent studies aimed at enhancing Repair have targeted the paucicellular nature of Tendon for enhancing Repair; however, most approaches for delivering growth factors and cells have not been designed for dense connective tissues such as Tendon. Therefore, we developed a scaffold capable of delivering growth factors and cells in a surgically manageable form for Tendon Repair. Platelet-derived growth factor BB (PDGF-BB), along with adipose-derived mesenchymal stem cells (ASCs), were incorporated into a heparin/fibrin-based delivery system (HBDS). This hydrogel was then layered with an electrospun nanofiber poly(lactic-co-glycolic acid) (PLGA) backbone. The HBDS allowed for the concurrent delivery of PDGF-BB and ASCs in a controlled manner, while the PLGA backbone provided structural integrity for surgical handling and Tendon implantation. In vitro studies verified that the cells remained viable, and that sustained growth factor release was achieved. In vivo studies in a large animal Tendon model verified that the approach was clinically relevant, and that the cells remained viable in the Tendon Repair environment. Only a mild immunoresponse was seen at dissection, histologically, and at the mRNA level; fluorescently labeled ASCs and the scaffold were found at the Repair site 9days post-operatively; and increased total DNA was observed in ASC-treated Tendons. The novel layered scaffold has the potential for improving Tendon healing due to its ability to deliver both cells and growth factors simultaneously in a surgically convenient manner.
Thomas E Trumble - One of the best experts on this subject based on the ideXlab platform.
-
zone ii flexor Tendon Repair a randomized prospective trial of active place and hold therapy compared with passive motion therapy
Journal of Bone and Joint Surgery American Volume, 2010Co-Authors: Thomas E Trumble, Douglas P Hanel, Nicholas B Vedder, John G Seiler, Edward Diao, Sarah PettroneAbstract:Background: In order to improve digit motion after zone-II flexor Tendon Repair, rehabilitation programs have promoted either passive motion or active motion therapy. To our knowledge, no prospective randomized trial has compared the two techniques. Our objective was to compare the results of patients treated with an active therapy program and those treated with a passive motion protocol following zone-II flexor Tendon Repair. Methods: Between January 1996 and December 2002, 103 patients (119 digits) with zone-II flexor Tendon Repairs were randomized to either early active motion with place and hold or a passive motion protocol. Range of motion was measured at six, twelve, twenty-six, and fifty-two weeks following Repair. Dexterity tests were performed, and the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome questionnaire and a satisfaction score were completed at fifty-two weeks by ninety-three patients (106 injured digits). Results: At all time points, patients treated with the active motion program had greater interphalangeal joint motion. At the time of the final follow-up, the interphalangeal joint motion in the active place-and-hold group was a mean (and standard deviation) of 156° ± 25° compared with 128° ± 22° (p < 0.05) in the passive motion group. The active motion group had both significantly smaller flexion contractures and greater satisfaction scores (p < 0.05). We could identify no difference between the groups in terms of the DASH scores or dexterity tests. When the groups were stratified, those who were smokers or had a concomitant nerve injury or multiple digit injuries had less range of motion, larger flexion contractures, and decreased satisfaction scores compared with patients without these comorbidities. Treatment by a certified hand therapist resulted in better range of motion with smaller flexion contractures. Two digits in each group had Tendon ruptures following Repair. Conclusions: Active motion therapy provides greater active finger motion than passive motion therapy after zone-II flexor Tendon Repair without increasing the risk of Tendon rupture. Concomitant nerve injuries, multiple digit injuries, and a history of smoking negatively impact the final outcome of Tendon Repairs. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.
-
comparative biomechanic study of flexor Tendon Repair using fiberwire
Journal of Hand Surgery (European Volume), 2008Co-Authors: Thanapong Waitayawinyu, Paul A Martineau, Shai Luria, Douglas P Hanel, Thomas E TrumbleAbstract:Purpose FiberWire, an increasingly popular suture material, allows for strong flexor Tendon Repair that may allow early mobilization. This study was designed to evaluate the mechanical characteristics of FiberWire for flexor Tendon Repair and to identify the most effective Repair technique using this material. Methods Forty-nine human cadaver flexor Tendons were randomized and tested biomechanically using one of the following techniques of flexor Tendon Repair performed with 3-0 FiberWire: (1) modified Kessler, (2) modified Pennington, (3) 2-strand multiple grasping, (4) 2-strand multiple locking, (5) 2-strand double cross-locks, (6) Massachusetts General Hospital, and (7) 4-strand locked cruciate. The ultimate tensile strength, 2-mm gap resistance, and failure mode of the Repairs were evaluated. Results Knot unraveling was the most common failure mode of FiberWire Repair in 4 of the 7 techniques. Four-strand Repairs and locking Repairs provided significantly more strength than 2-strand Repairs and grasping Repairs. Multiple grasping and multiple locking Repairs with 2 knots were significantly weaker than single grasping and locking Repairs with a single knot. Four-strand locked cruciate Repairs were significantly stronger than the other techniques (mean ultimate tensile strength 107 N, 2-mm gap force 96 N). Two-strand double cross-locks Repairs were stronger than the other 2-strand Repairs (mean ultimate tensile strength 69 N, 2-mm gap force 53 N). Conclusions The strength of the FiberWire Repairs increased with locking Repair and with increased number of strands but was not influenced by increased number of locking and grasping stitches. Four-strand locked cruciate and 2-strand double cross-locks provided the greatest strength and likely are appropriate for future clinical use in, respectively, 4-strand and 2-strand Repairs. However, the poor knot-holding characteristics of FiberWire with the need of a greater number of knot throws may be of concern for surgeons using this product for flexor Tendon Repairs.
-
comparison of pullout button versus suture anchor for zone i flexor Tendon Repair
Journal of Hand Surgery (European Volume), 2006Co-Authors: Wren V Mccallister, Heidi C Ambrose, Leonid I Katolik, Thomas E TrumbleAbstract:Purpose To evaluate the clinical outcome after Repair of zone I flexor Tendon injuries using either the pullout button technique or suture anchors placed in the distal phalanx. Methods Between 1998 and 2002 we treated 26 consecutive zone I flexor Tendon injuries. Thirteen patients had Repairs from 1998 to 2000 using a modified pullout button technique (group A) and 13 patients had Repair using suture anchors placed in the distal phalanx (group B). Patient characteristics were similar for both groups. The same postoperative flexor Tendon rehabilitation protocol and follow-up schedule were used for both groups. Evaluation included range of motion, sensibility and grip strength, failure, complications, and return to work. The Student t test was used to determine significant differences. Results All patients completed 1 year of follow-up evaluation. There were 2 infections in group A that resolved with oral antibiotics and no infections in group B. There were no Tendon Repair failures and no repeat surgeries in either group. At final follow-up evaluation there were no statistically significant differences for the following end points: sensibility (Semmes-Weinstein monofilament testing and 2-point discrimination), active range of motion (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined motion), flexion contracture (at the proximal interphalangeal joint, distal interphalangeal joint, or their combined contracture), and grip strength (injured Tendon as a percent of the contralateral uninjured Tendon). The suture anchor group had a statistically significant improvement for time to return to work. Conclusions There was no significant difference in the clinical outcome after flexor Tendon Repair using either suture anchors or the pullout button technique. A significant improvement was found for time to return to work for Repairs using the suture anchor technique. Flexor Tendon Repair can be achieved using suture anchors placed in the distal phalanx, thereby avoiding the potential morbidity associated with the pullout button technique. Type of study/level of evidence Therapeutic, Level III.
Donald H Lalonde - One of the best experts on this subject based on the ideXlab platform.
-
wide awake flexor Tendon Repair and early Tendon mobilization in zones 1 and 2
Hand Clinics, 2013Co-Authors: Donald H Lalonde, Alison L MartinAbstract:The wide-awake approach to flexor Tendon Repair has decreased our rupture and tenolysis rates and permitted us to get consistently good results in cooperative patients. The wide-awake surgery allows the Repair of gaps of the surgical Repair site revealed with intraoperative active movement testing of the Repair We are now doing midrange active movement after primary Tendon Repair. After tenolysis, full-range active motion is possible even before skin closure. We no longer perform flexor Tendon Repair with the tourniquet, sedation, and muscle paralysis of general or block (Bier or axillary) anesthesia.
-
avoiding flexor Tendon Repair rupture with intraoperative total active movement examination
Plastic and Reconstructive Surgery, 2010Co-Authors: Amanda Higgins, Donald H Lalonde, Michael Bell, Daniel Mckee, Jan LalondeAbstract:Background: Wide-awake flexor Tendon Repair in tourniquet-free unsedated patients permits intraoperative Total Active Movement examination (iTAMe) of the freshly Repaired flexor Tendon. This technique has permitted the intraoperative observation of Tendon Repair gapping induced by active movement when the core suture is tied too loosely. The gap can be Repaired intraoperatively to decrease postoperative Tendon Repair rupture rates. The authors record their rupture rate in the first 15 years of experience with iTAMe. Methods: This was a retrospective chart review of 102 consecutive patients with wide-awake flexor Tendon Repair (no tourniquet, no sedation, and pure locally injected lidocaine with epinephrine anesthesia) in which iTAMe was performed by two hand surgeons in two Canadian cities between 1998 and 2008. Intraoperative gapping and postoperative rupture were analyzed. Results: The authors observed intraoperative bunching and gap formation with active movement in flexor Tendon Repair testing (iTAMe) in seven patients. In all seven cases, they redid the Repair and repeated iTAMe to confirm gapping was eliminated before closing the skin, and those seven patients did not rupture postoperatively. In 68 patients with known outcomes, four of 122 Tendons ruptured (Tendon rupture rate, 3.3 percent) in three of 68 patients (patient rupture rate, 4.4 percent). All three patients who ruptured had accidental jerk forced rupture. All those patients who did what we asked them did not rupture. Conclusions: Tendons can gap with active movement if the core suture is tied too loosely. Gapping can be recognized intraoperatively with iTAMe and Repaired to decrease postoperative rupture.
-
wide awake flexor Tendon Repair
Plastic and Reconstructive Surgery, 2009Co-Authors: Donald H LalondeAbstract:The wide-awake approach to hand surgery is performed with no sedation and no tourniquet. Only locally injected tumescent lidocaine and epinephrine are used for anesthesia and hemostasis. The confirmation that epinephrine hemostasis in the finger is safe1–5 has permitted the use of this technique, which has now become widespread in Canada. With exceptions that include hand surgery in small children, major trauma patients, and on those who are mentally challenged, more than 95 percent of all of the hand surgery in our center is now being performed with the wide-awake approach. With the possible exception of Tendon transfers,6 none of our hand operations have benefitted more from the advent of the wide-awake approach than flexor Tendon Repair. This videoplus presentation focuses on important technical aspects of wide-awake flexor Tendon Repair. It includes details of a zone 1 flexor Tendon Repair in a 16-year-old, from the injection of the local anesthetic to the 1-year postoperative result (see Video,SupplementalDigitalContent1,http://links. lww.com/A657 ).
Stavros Thomopoulos - One of the best experts on this subject based on the ideXlab platform.
-
the effect of modified locking methods and suture materials on zone ii flexor Tendon Repair an ex vivo study
PLOS ONE, 2018Co-Authors: Matthew J Silva, Stephen W Linderman, Stavros Thomopoulos, Susumu Yoneda, Hirotaka Okubo, Nozomu Kusano, Fuminori Kanaya, Richard H GelbermanAbstract:The failure rate of intrasynovial Tendon Repair is high due to substantial elongation at the Repair site and to the development of adhesions between the Tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of Repair. The Winters-Gelberman 8-strand Repair technique was modified by adding surface lock loops and by using Fiberwire suture material. Forty-eight canine flexor digitorum profundus Tendons were transected and Repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the Repairs. The surface locking Kessler technique improved Repair maximum load, load necessary to create a 2 mm Repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire suture improved maximum load, the load necessary to create a 2 mm Repair site gap, stiffness, and yield force compared to Supramid suture. Failure occurred by both suture pull out and by suture breakage in the modified Kessler, Supramid suture Repair group. Failure occurred consistently by suture breakage in the surface locking Kessler, Supramid suture Repair group. These results reveal that a novel locking Kessler Repair is significantly stronger than the current state-of-the art flexor Tendon suture Repair technique. The use of a surface locking Kessler technique with Fiberwire suture markedly improves the mechanical properties of intrasynovial Tendon Repair by reducing the risk of post-operative gapping and rupture.
-
effect of connective tissue growth factor delivered via porous sutures on the proliferative stage of intrasynovial Tendon Repair
Journal of Orthopaedic Research, 2018Co-Authors: Stephen W Linderman, Stavros Thomopoulos, Shelly E Sakiyamaelbert, Younan Xia, Hua Shen, Susumu Yoneda, Rohith Jayaram, Michael L Tanes, Richard H GelbermanAbstract:Recent growth factor, cell, and scaffold-based experimental interventions for intrasynovial flexor Tendon Repair have demonstrated therapeutic potential in rodent models. However, these approaches have not achieved consistent functional improvements in large animal trials due to deleterious inflammatory reactions to delivery materials and insufficient induction of targeted biological healing responses. In this study, we achieved porous suture-based sustained delivery of connective tissue growth factor (CTGF) into flexor Tendons in a clinically relevant canine model. Repairs with CTGF-laden sutures were mechanically competent and did not show any evidence of adhesions or other negative inflammatory reactions based on histology, gene expression, or proteomics analyses at 14 days following Repair. CTGF-laden sutures induced local cellular infiltration and a significant biological response immediately adjacent to the suture, including histological signs of angiogenesis and collagen deposition. There were no evident widespread biological effects throughout the Tendon substance. There were significant differences in gene expression of the macrophage marker CD163 and anti-apoptotic factor BCL2L1; however, these differences were not corroborated by proteomics analysis. In summary, this study provided encouraging evidence of sustained delivery of biologically active CTGF from porous sutures without signs of a negative inflammatory reaction. With the development of a safe and effective method for generating a positive local biological response, future studies can explore additional methods for enhancing intrasynovial Tendon Repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2052-2063, 2018.
-
enhanced zone ii flexor Tendon Repair through a new half hitch loop suture configuration
PLOS ONE, 2016Co-Authors: Ioannis Kormpakis, Stephen W Linderman, Stavros Thomopoulos, Richard H GelbermanAbstract:This study evaluated the impact of a new half hitch loop suture configuration on flexor Tendon Repair mechanics. Cadaver canine flexor digitorum profundus Tendons were Repaired with 4- or 8-strands, 4-0 or 3-0 suture, with and without half hitch loops. An additional group underwent Repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand Repairs by 21% when 4-0, and 33% when 3-0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand Repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand Repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved Repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor Tendon Repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period.
-
the effect of suture caliber and number of core suture strands on zone ii flexor Tendon Repair a study in human cadavers
Journal of Hand Surgery (European Volume), 2014Co-Authors: Daniel A Osei, Martin I Boyer, Stavros Thomopoulos, Jeffrey G Stepan, Ryan P Calfee, Ryan Potter, Richard H GelbermanAbstract:Purpose To compare the tensile properties of a 3-0, 4-strand flexor Tendon Repair with a 4-0, 4-strand Repair and a 4-0, 8-strand Repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in Tendon Repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus Tendons after zone II Repair with 1 of 3 techniques: a 3-0, 4-strand core Repair, a 4-0, 8-strand Repair, or a 4-0, 4-strand Repair. We compared results across suture caliber for the 2 sutures and across Tendon Repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand Repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand Repair than in the 3-0, 4-strand Repair. Conclusions In an ex vivo model, an 8-strand Repair using 4-0 suture was 43% stronger than a 4-strand Repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a Repair site has an important effect on time zero, ex vivo flexor Tendon Repair strength. Clinical relevance Surgeons should consider using techniques that prioritize multistrand core suture Repair over an increase in suture caliber.
-
controlled delivery of mesenchymal stem cells and growth factors using a nanofiber scaffold for Tendon Repair
Acta Biomaterialia, 2013Co-Authors: Cionne N Manning, Matthew J Silva, Richard H Gelberman, Andrea G Schwartz, Wenying Liu, Jingwei Xie, Necat Havlioglu, Shelly E Sakiyamaelbert, Younan Xia, Stavros ThomopoulosAbstract:Outcomes after Tendon Repair are often unsatisfactory, despite improvements in surgical techniques and rehabilitation methods. Recent studies aimed at enhancing Repair have targeted the paucicellular nature of Tendon for enhancing Repair; however, most approaches for delivering growth factors and cells have not been designed for dense connective tissues such as Tendon. Therefore, we developed a scaffold capable of delivering growth factors and cells in a surgically manageable form for Tendon Repair. Platelet-derived growth factor BB (PDGF-BB), along with adipose-derived mesenchymal stem cells (ASCs), were incorporated into a heparin/fibrin-based delivery system (HBDS). This hydrogel was then layered with an electrospun nanofiber poly(lactic-co-glycolic acid) (PLGA) backbone. The HBDS allowed for the concurrent delivery of PDGF-BB and ASCs in a controlled manner, while the PLGA backbone provided structural integrity for surgical handling and Tendon implantation. In vitro studies verified that the cells remained viable, and that sustained growth factor release was achieved. In vivo studies in a large animal Tendon model verified that the approach was clinically relevant, and that the cells remained viable in the Tendon Repair environment. Only a mild immunoresponse was seen at dissection, histologically, and at the mRNA level; fluorescently labeled ASCs and the scaffold were found at the Repair site 9days post-operatively; and increased total DNA was observed in ASC-treated Tendons. The novel layered scaffold has the potential for improving Tendon healing due to its ability to deliver both cells and growth factors simultaneously in a surgically convenient manner.
Jin Bo Tang - One of the best experts on this subject based on the ideXlab platform.
-
new developments are improving flexor Tendon Repair
Plastic and Reconstructive Surgery, 2018Co-Authors: Jin Bo TangAbstract:Summary:New developments in primary Tendon Repair in recent decades include stronger core Tendon Repair techniques, judicious and adequate venting of critical pulleys, followed by a combination of passive and active digital flexion and extension. During Repair, core sutures over the Tendon should ha
-
strong digital flexor Tendon Repair extension flexion test and early active flexion experience in 300 Tendons
Hand Clinics, 2017Co-Authors: Jin Bo Tang, Jun Qing, Ke Tong Gong, Xiang Zhou, Jing ChenAbstract:: Over the past 2 decades, Repair and rehabilitation methods of primary Repair of the digital flexor Tendon have changed. In this article, we outline interim results from ongoing investigations in several units. Surgeons in these units now perform digital flexor Tendon Repairs according to a treatment protocol. Before adopting the protocol, they had no history of Tendon-related research; they had not used any of the Repair and rehabilitation methods described in the protocol. The surgeons involved are junior or midlevel attending surgeons. At the end of this article, we outline current practice of digital flexor Tendon Repair in Asian countries.
-
Wide-Awake Primary Flexor Tendon Repair, Tenolysis, and Tendon Transfer.
Clinics in Orthopedic Surgery, 2015Co-Authors: Jin Bo TangAbstract:Tendon surgery is unique because it should ensure Tendon gliding after surgery. Tendon surgery now can be performed under local anesthesia without tourniquet, by injecting epinephrine mixed with lidocaine, to achieve vasoconstriction in the area of surgery. This method allows the Tendon to move actively during surgery to test Tendon function intraoperatively and to ensure the Tendon is properly Repaired before leaving the operating table. I applied this method to primary flexor Tendon Repair in zone 1 or 2, tenolysis, and Tendon transfer, and found this approach makes Tendon surgery easier and more reliable. This article describes the method that I have used for Tendon surgery.
-
release of the a4 pulley to facilitate zone ii flexor Tendon Repair
Journal of Hand Surgery (European Volume), 2014Co-Authors: Jin Bo TangAbstract:During primary or delayed primary Repair of the flexor digitorum profundus Tendon, surgeons often face difficulty in passing the retracted Tendon or Repaired Tendon under the dense, fibrous A4 pulley. The A4 pulley is the narrowest part of the flexor sheath, proximal to the terminal Tendon. Disrupted Tendon ends (or surgically Repaired Tendons) are usually swelling, making passage of the Tendons under this pulley difficult or even impossible. During Tendon Repair in the A4 pulley area, when the trauma is in the middle part of the middle phalanx and the A3 pulley is intact, the A4 pulley can be vented entirely to accommodate surgical Repair and facilitate gliding of the Repaired Tendon after surgery. Venting the pulley does not disturb Tendon function when the other major pulleys are intact and when the venting of the A4 pulley and adjacent sheath is limited to the middle half of the middle phalanx. Such venting is easily achieved through a palmar midline or lateral incision of the A4 pulley and its adjacent distal or/and proximal sheath, which helps ensure a more predictable recovery of digital flexion and extension.
-
current practice of primary flexor Tendon Repair a global view
Hand Clinics, 2013Co-Authors: Jin Bo Tang, Peter C Amadio, Chunfeng Zhao, Martin I Boyer, R Savage, Michael J Sandow, Steve K Lee, Scott W WolfeAbstract:In this article, a group of international leaders in Tendon surgery of the hand provide details of their current methods of primary flexor Tendon Repair. They are from recognized hand centers around the world, from which major contributions to the development of methods for flexor Tendon Repair have come over the past 2 decades. Changes made since the early 1990s regarding surgical methods and postoperative care for the flexor Tendon Repair are also discussed. Current practice methods used in the leading hand centers are summarized, and key points in providing the best possible clinical outcomes are outlined.
