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Marangi GF, Gratteri M, Savani L, Porso D, Cimmino A, Arcari L, Romano FD, Segreto F, Mirra C, Persichetti P. Correction of Rectus Abdominis Diastasis: A Prospective Comparative Study Between a New Suturable Polypropylene Mesh vs Polypropylene Standard Suture Plication. Aesthet Surg J 2024; 44:633-640. [PMID: 38243919 DOI: 10.1093/asj/sjae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Duramesh (Mesh Suture Inc., Chicago, IL) is a new suturing concept, combining the principles of mesh with the precision, flexibility, and versatility of a suture, suitable also for abdominal rectus diastasis (ARD) correction. OBJECTIVES This prospective research aimed to compare mesh with the standard polypropylene suture plication for rectus diastasis repair with regard to safety (infection, seroma, hematoma, surgical wound dehiscence, and fistula rates and hospital stay); effectiveness (ARD recurrence by ultrasound sonography, palpability of the muscular suture, surgical time, and postoperative pain evaluation); and satisfaction of the patients based on the BODY-Q, a patient-reported outcome measure. METHODS Sixty-five of the initial 70 patients who underwent rectus diastasis repair with a 6-month follow-up were randomly divided into 2 groups, comprising 33 patients treated with Duramesh and 32 patients treated with standard 0 polypropylene suture plication. Data regarding infection, seroma, hematoma, surgical wound dehiscence, and fistula rates; hospital stay; ARD recurrence; palpability of the muscular suture; surgical time; postoperative pain evaluation (measured by visual analog scale, or VAS); and the BODY-Q were analyzed by Prism 9 (GraphPad Software Inc., San Diego, CA). RESULTS No significant differences were reported between the 2 groups with regard to infection, seroma, hematoma, surgical wound dehiscence, and fistula rates and hospital stay. The mesh decreased the time required to perform plication compared with standard polypropylene detached sutures. No statistically significant differences were found with respect to the VAS and BODY-Q data. CONCLUSIONS Duramesh 0 application for rectus diastasis repair is safe and effective without compromising aesthetic improvement when compared with standard 0 polypropylene plication. LEVEL OF EVIDENCE: 2
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Sarac BA, Hackenberger P, Janis JE. Mesh Strip Repair for Midline Ventral Hernias: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5643. [PMID: 38510330 PMCID: PMC10954048 DOI: 10.1097/gox.0000000000005643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 01/16/2024] [Indexed: 03/22/2024]
Abstract
Background Polypropylene mesh strip repair is a novel method of hernia closure. Currently, there is limited representation in the literature regarding both the reproducibility of this method and its outcomes. The present study sought to analyze a second institution's experience with fascial closure using the mesh strip technique with long-term follow-up. Methods A retrospective review of all patients undergoing abdominal wall reconstruction by the senior author was performed. Patients undergoing midline ventral hernia repair with mesh strip only fascial closure and greater than 1 year follow-up were including for analysis. Demographic data; operative details; and outcomes, specifically presence and timing of hernia recurrence, were recorded. Results Eighteen patients met inclusion criteria. Average follow-up was 860 ± 307 days. Nine patients (50%) had recurrence of their hernia after repair. Average time to recurrence was 602 ± 406 days, with the earliest recurrence occurring at 126 days postoperatively. Seven patients (39%) underwent concurrent anterior component separation (four unilateral, three bilateral), of which there were three recurrences, all occurring in patients with bilateral anterior component separation. Conclusions The mesh strip repair is a novel technique that shows uncertain reproducibility of outcomes, specifically with concurrent component separation techniques. With the recent Food and Drug Administration approval of a mesh suture, further multi-institutional analysis will allow for better characterization of the outcomes and indications for this technique.
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Affiliation(s)
- Benjamin A. Sarac
- From The Ohio State University Department of Plastic and Reconstructive Surgery, Columbus, Ohio
| | - Paige Hackenberger
- Northwestern University Division of Plastic and Reconstructive Surgery, Chicago, Ill
| | - Jeffrey E. Janis
- From The Ohio State University Department of Plastic and Reconstructive Surgery, Columbus, Ohio
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Wang Y, Qian L, Liu ZF, Chen W, Shen X, Wu JN, Yang WX, Wang XH, Wang J, Xu YW. Safety and efficacy of ultrasonography of tension after zone II flexor tendon repair: A randomized controlled trial. J Hand Ther 2023; 36:786-795. [PMID: 37598094 DOI: 10.1016/j.jht.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Primary flexor tendon repairs of lacerations in zone II of the hand are fraught with problems. Traditionally, exercise (active and passive), orthoses, and physical agents are common interventions for the rehabilitation of patients experiencing these issues. One area of focus in this field is how to safely utilize tension to lengthen gliding distance following zone II injury. Finding effective solutions in this area is a key priority for improving patient outcomes and quality of life. PURPOSE To identify the optimal immobilization position that meets safety standards for tension and is the most efficient, and consequently, to validate our clinical effectiveness. STUDY DESIGN A cross-sectional study was adopted for the first part of the research (Research 1). A prospective, parallel, 2-group, randomized trial was conducted with concealed allocation and single blinding in the second part of the research (Research 2). METHODS A total of 60 healthy adults were recruited to select the best-fit protective immobilization position in Research 1, which was confirmed by tendon tension (via Young's modulus) and excursion (via gliding distance). We then randomly assigned 45 patients after zone II flexor tendon repair into two groups in Research 2 to compare functional outcomes. The control group underwent the conventional modified Duran protocol with early passive motion, while the experimental group received the protocol (optimized by Research 1) with early active motion. Ultrasonography was used to measure the tension and excursion of the flexor tendons. The outcomes measured at 16 weeks post-repair included total active motion, strength, the Disabilities of the Arm, Shoulder and Hand, and Strickland scores. RESULTS Three participants were unable to participate in Research 2 due to medical issues and poor attendance. The investigation found that the safe tendon threshold was 345.09 ± 87.74 kPa for partial active digital motion among the 60 participants. The optimal immobilization position requires the wrist to be neutral with a flexion angle of 30° at the metacarpophalangeal joint. The grip strengths (p = 0.012), ratio of grip strength (p = 0.015), the Disabilities of the Arm, Shoulder and Hand (p = 0.036), and total active motion (p = 0.023) differed significantly between the two groups. CONCLUSIONS Protective immobilization of the wrist in a neutral flexion position and with the metacarpophalangeal joint flexed at 30° can secure the repaired flexor tendon safely and efficiently. The effects of an early active motion protocol may improve the grip strength and upper limb mobility of individuals after zone II flexor tendon repair. CLINICAL TRIAL REGISTRATION ChiCTR2000030592.
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Affiliation(s)
- Ying Wang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Lei Qian
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Zhen-Feng Liu
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Wei Chen
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xia Shen
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Jia-Ni Wu
- Sports Rehabilitation, Soochow University, Suzhou, China
| | - Wei-Xiang Yang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xin-Hao Wang
- Department of Rehabilitation and Health Care, Wuxi Vocational and Technology College: Wuxi Institute of Technology, Wuxi, China
| | - Jun Wang
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| | - Yan-Wen Xu
- Department of Rehabilitation, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
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Xu SW, Wu YF. Effect of loading speed on gap resistance and tensile strength of flexor tendon repair under cyclic loading test. J Biomech 2023; 158:111749. [PMID: 37562275 DOI: 10.1016/j.jbiomech.2023.111749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 05/08/2023] [Accepted: 07/31/2023] [Indexed: 08/12/2023]
Abstract
Postoperative digit motion is important for the functional recovery of injured tendons. To date, it is unknown whether the loading speed impacts the biomechanical properties of a repaired tendon. This study investigated the effect of loading speed on the gap resistance and tensile strength of tendon repairs. One hundred porcine flexor tendons were repaired with two core sutures, 4-strand modified Kessler and double Q, and cyclically loaded at the speeds of 10, 40, 80, 160, and 320 mm/min. The number of tendons that formed an initial or 2 mm gap at the repair site during cyclic loading, stiffness at the 1st and 20th loading cycles, gap size between tendon ends when cyclic loading ended, and the ultimate strength were recorded. Under the lowest loading speed, the tendons repaired with the 4-strand modified Kessler suture developed significantly larger gaps and smaller stiffness than those with a greater loading speed. The loading speed did not affect the maximum strength of both tendon repairs. The findings suggest that very slow motion promotes gap formation of tendon repair with inferior gap resistance. The rate corresponds to regular hand action or the tendon core suture possessing a strong gap resistance increases the safety margin during early active finger movement. Our findings help to guide the exercise regimens after tendon surgery.
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Affiliation(s)
- Si Wei Xu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China; Medical School, Nantong University, Nantong, Jiangsu, China
| | - Ya Fang Wu
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
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Kobeniak MM, Pronina OM. MORPHOFUNCTIONAL CHARACTERISTICS OF THE CRYPTS STRUCTURAL COMPONENTS OF THE CECUM PERIVULNAR AREA BY USING DESMOSIN SURGICAL THREAD. BULLETIN OF PROBLEMS BIOLOGY AND MEDICINE 2023. [DOI: 10.29254/2077-4214-2022-4-167-296-301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Janes LE, Mioton LM, Fracol ME, Ko JH. An In Vivo Comparison: Novel Mesh Suture Versus Traditional Suture-Based Repair in a Rabbit Tendon Model. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:32-39. [PMID: 35415598 PMCID: PMC8991626 DOI: 10.1016/j.jhsg.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Despite advancements in surgical techniques, suture pull-though and rupture continue to limit the early range of motion and functional rehabilitation after flexor tendon repairs. The aim of this study was to evaluate a suturable mesh compared with a commonly used braided suture in an in vivo rabbit intrasynovial tendon model. Methods Twenty-four New Zealand female rabbits (3-4 kg) were injected with 2 units/kg botulinum toxin evenly distributed into 4 sites in the left calf. After 1 week, the animals underwent surgical tenotomy of the flexor digitorum tendon and were randomized to repair with either 2-0 Duramesh suturable mesh or to 2-0 Fiberwire using a 2-strand modified Kessler and 6-0 polypropylene running epitendinous suture. Rabbits were killed at 2, 4, and 9 weeks after surgery. Results Grouping across time points, 58.3% (7 of 12) of Duramesh repairs were found to be intact for the explant compared with 16.7% (2 of 12) of Fiberwire repairs (P = .09). At 2 weeks, the mean Duramesh repairs were significantly stronger than the Fiberwire repairs with a mean failure load of 50.7 ± 12.7 N compared to 14.8 ± 18.3 N (P = .02). The load supported by the Duramesh repairs at 2 weeks (mean 50.7 ± 12.7 N) was similar to the load supported by both Fiberwire (52.2 ± 13.6 N) and Duramesh (57.6 ± 22.3 N) at 4 weeks. The strength of repair between Fiberwire and Duramesh at 4 weeks and 9 weeks was not significantly different. Conclusions The 2-strand tendon repair with suturable mesh achieved significantly greater strength at 2 weeks than the conventional suture material. Future studies should evaluate the strength of repair prior to 2 weeks to determine the strength curve for this novel suture material. Clinical Relevance This study evaluates the utility of a novel suturable mesh for flexor tendon repair in an in vivo rabbit model compared with conventional suture material.
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Affiliation(s)
- Lindsay E. Janes
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren M. Mioton
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan E. Fracol
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jason H. Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
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Gillis JA, Athens CM, Rhee PC. Biomechanical Comparison of Tendon Coaptation Methods With a Meshed Suture Construct. J Hand Surg Am 2021; 46:343.e1-343.e10. [PMID: 33279324 DOI: 10.1016/j.jhsa.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/29/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Tendon-to-tendon attachment constructs for tendon reconstructions or transfers need to be secure in order to allow early mobilization after surgery. The purpose of this study was to biomechanically compare 2 common constructs secured with a novel mesh suture versus a nonabsorbable braided suture. METHODS We used 100 cadaveric tendons to create 5 different tendon coaptation constructs (a to e) (10 coaptations per group): (a) Pulvertaft weave with a braided suture (PTe); (b) mesh suture (PTm); (c) single-pass, side-to-side (SP-STS) coaptation with 30-mm overlap using a mesh suture (SP-STS-30m); (d) SP-STS 50-mm overlap with a mesh suture (SP-STS-50m); and (e) SP-STS with 30-mm tendon overlap using a braided suture (SP-STS-30e). The tensile strength, bulk, gliding resistance, and failure type were compared. RESULTS There was no difference between the various tendon constructs and the suture type in terms of coaptation bulk. All SP-STS constructs with mesh suture had higher peak gliding resistance than any of the PT constructs regardless of suture type. Compared with the PT constructs, the SP-STS constructs with mesh or braided suture had a higher peak load, peak load normalized to repair length, and stiffness. Within each tendon coaptation construct group, Pulvertaft or SP-STS, the suture type did not affect any of the investigated parameters. CONCLUSIONS The SP-STS constructs are significantly stronger and stiffer than the PT constructs. The SP-STS with mesh suture exhibited greater gliding resistance than the PT constructs and may result in greater gliding resistance through physiological tissue planes. However, the use of a mesh suture did not affect strength, bulk, gliding resistance, or failure type when compared within a construct group. CLINICAL RELEVANCE The use of SP-STS constructs for tendon coaptations produces a stronger and stiffer construct than the PT weave; however, the use of a mesh suture may not provide any benefit over a braided suture.
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Affiliation(s)
- Joshua Allan Gillis
- Division of Plastic and Reconstructive Surgery, Roth-McFarlane Hand and Upper Limb Centre, London, Ontario, Canada; Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester MN
| | - Christian M Athens
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester MN; Department of Orthopedic Surgery, Aultman Hospital, Canton, OH
| | - Peter C Rhee
- Division of Hand Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester MN.
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Abstract
The field of hand surgery continues to evolve in new and exciting directions. Advances in diagnosis and management for common complaints and complex injuries allow higher-level care, while still being cognizant of the cost of health care delivery. Indications and protocols for past paradigm shifts, such as volar locked plating for distal radial fractures, continue to be honed, and the outcomes seen for modern flexor tendon repairs are impressive. Open questions remain, but promising results for scaphoid nonunion surgery and peripheral nerve reconstruction with processed allograft will continue to shed light on these unsolved problems.
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Affiliation(s)
- Travis A Doering
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA.
| | - Benjamin M Mauck
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
| | - James H Calandruccio
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic, 1211 Union Avenue, Suite 500, Memphis, TN 38104, USA
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Wang Z, Long Z, Li H, Lu H, Gingery A, Amadio PC, Moran SL, Zhao C. A biomechanical comparison of a mesh suture to a polyblend suture in a porcine tendon model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:450. [PMID: 33850847 PMCID: PMC8039690 DOI: 10.21037/atm-20-1065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background The suture-tendon interface turned out to be the weak point of a repaired rotator cuff. A double rip-stop (DRS) technique was developed to enhance the strength of the suture-tendon interface. The first aim of this study was to compare the suture-tendon interface strength between mesh suture and the No. 2 FiberWire (FW), which is commonly used in the clinic. The second aim was to compare the biomechanical properties of rotator cuff repair between mesh suture and No. 2 FiberWire using a typical suture-bridge (SB) and DRS techniques. Methods Eighteen porcine subscapularis tendon (SST) was randomly assigned to the Mesh-tendon group and FiberWire-tendon group. A single suture loop was passed through the SST with a Mesh suture or FiberWire. Thirty-two infraspinatus tendons (ISTs) were randomly assigned to four groups: SB-Mesh group: SB technique with Mesh suture, SB-FW group: SB technique with FiberWire, DRS-Mesh group: DRS technique with Mesh suture, and DRS-FW group: DRS technique with FiberWire. All repaired specimens were underwent failure testing. Failure modes, load to create a 3-mm gap, failure load, and stiffness were compared. Results There were no significant differences between the Mesh-tendon group and FiberWire-tendon group regarding the failure load, stiffness, and ultimate stress. When the same technique was used, the rotator cuff repaired with a mesh suture had the similar load to create a 3-mm gap, failure load, and stiffness compared with FiberWire. When the same suture was used, the DRS technique had a significantly higher load to create a 3-mm gap formation and failure load compared with the SB technique. Conclusions The repair failure strength and stiffness using the mesh suture were similar to the FiberWire suture regardless of the repair techniques. However, the repair strength in the DRS technique was significantly stronger than the SB technique when the same suture material was used.
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Affiliation(s)
- Zhanwen Wang
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Zeling Long
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hong Li
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Anne Gingery
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Peter C Amadio
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chunfeng Zhao
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Affiliation(s)
- Christopher J. Dy
- Department of Orthopaedic Surgery, and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri,Email address:
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Suturable mesh better resists early laparotomy failure in a cyclic ball-burst model. Hernia 2020; 24:559-565. [DOI: 10.1007/s10029-020-02133-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/27/2020] [Indexed: 12/30/2022]
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