A re-exploration of the use of barbed sutures in flexor tendon repairs.

Flexor tendon repairs continue to improve thanks to advancements in suture material and technique. The role of barbed sutures in flexor tendon repairs has been previously investigated, but with the advent of a new material, interest in their use has been rekindled. We hypothesized that the use of modern barbed sutures will have comparable maximum tensile strength and 2-mm gapping strength to that of conventional sutures, allowing their use to theoretically decrease adhesions and tissue damage in flexor tendon repairs. Flexor tendon repairs were performed on a cadaver model using either 3-0 Ethibond (Ethicon, Inc, Somerville, New Jersey) (Kessler repair) or 2-0 Quill sutures (Angiotech, Vancouver, British Columbia, Canada ) (Kessler-Bunnell repair) and were biomechanically tested. The mode of failure for the Ethibond sutures was suture pullout 2 times and knot failure 18 of 20 times, while the Quill sutures failed entirely by pullout. Maximum load to failure was 34.7+/-5.4 N and 29.6+/-3.6 N for Ethibond and Quill, respectively. This was found to be statistically significant (P=.001). Tensile load at 2-mm gapping was 22.8+/-6.3 N and 22.2+/-4.0 N for Ethibond and Quill, respectively. No statistical significance was found (P=.723). This study helps substantiate the possible role of modern barbed sutures in flexor tendon repair. Additional biomechanical studies will need to be performed to further assess the use of barbed sutures in flexor tendon repair.