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BioMed Research International
Volume 2016 (2016), Article ID 4063137, 6 pages
Research Article

Four-Strand Core Suture Improves Flexor Tendon Repair Compared to Two-Strand Technique in a Rabbit Model

1Abteilung für Unfall-, Hand- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik Rostock, Schillingallee 35, 18055 Rostock, Germany
2Rudolf-Zenker-Institut für Experimentelle Chirurgie und Zentrale Versuchstierhaltung, Universitätsmedizin Rostock, Schillingallee 69a, 18057 Rostock, Germany

Received 29 April 2016; Revised 8 June 2016; Accepted 9 June 2016

Academic Editor: Magali Cucchiarini

Copyright © 2016 Alice Wichelhaus et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction. This study was designed to investigate the influence of the amount of suture material on the formation of peritendinous adhesions of intrasynovial flexor tendon repairs. Materials and Methods. In 14 rabbits, the flexor tendons of the third and the fourth digit of the right hind leg were cut and repaired using a 2- or 4-strand core suture technique. The repaired tendons were harvested after three and eight weeks. The range of motion of the affected toes was measured and the tendons were processed histologically. The distance between the transected tendon ends, the changes in the peritendinous space, and cellular and extracellular inflammatory reaction were quantified by different staining. Results. A 4-strand core suture resulted in significantly less gap formation. The 2-strand core suture showed a tendency to less adhesion formation. Doubling of the intratendinous suture material was accompanied by an initial increase in leukocyte infiltration and showed a greater amount of formation of myofibroblasts. From the third to the eighth week after flexor tendon repair, both the cellular and the extracellular inflammation decreased significantly. Conclusion. A 4-strand core suture repair leads to a significantly better tendon healing process with less diastasis between the sutured tendon ends despite initially pronounced inflammatory response.