Fibrin glue augmentation for flexor tendon repair increases friction compared with epitendinous suture

N Michael Xu, Philip J Brown, Johannes F Plate, Omar F Nazir, George S Gluck, Joel D Stitzel, Zhongyu Li
Journal of Hand Surgery 2013, 38 (12): 2329-34

PURPOSE: To compare the gliding resistance, repair gapping, and ultimate strength of a common suture construct with a modified construct with fibrin glue augmentation.

METHODS: Twelve human cadaveric flexor digitorum profundus tendons were transected and repaired with a 4-strand core suture. Specimens were divided into 2 groups and augmented with epitendinous suture (n = 6) or fibrin glue (n = 6). We compared gliding resistance, 2-mm gapping, and ultimate strength of the repaired tendon between groups.

RESULTS: The linear stiffness, force to produce a 2-mm gap, and ultimate failure were similar in both repair methods. However, the 4-strand suture repair with fibrin glue augmentation displayed significantly higher gliding resistance compared with the 4-strand suture with a running epitendinous suture.

CONCLUSIONS: The significantly increased gliding resistance associated with fibrin glue raises questions regarding the use of this material for flexor tendon repair augmentation.

CLINICAL RELEVANCE: In a human cadaveric study, fibrin glue augmentation to zone II flexor tendon repairs significantly increased friction in the tendon sheath compared with an epitendinous suture.

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