Flexor digitorum tendon injuries are challenging
conditions to manage to ensure optimal patient outcomes.
While several surgical approaches with high success rates
have been developed, there remains no gold standard for
suture technique for the repair of flexor tendon injuries.
In this study, we compared two distinct peripheral suture
methods on the strength of repaired tendons. Pig flexor
digitorum profundus tendons were used in biomechanical
studies and the biomechanical influence on tendon repair
of continuous running peripheral suture (CRPS) and
continuous locking peripheral suture (CLPS), were compared,
using stitch length ranging from 1mm to 5mm. In
CRPS, the 1mm stitch length group displayed the highest
maximum load and breaking power, which was 1.57 fold
higher than the 2mm stitch length group. Pairwise comparison
revealed that the 1 and 2mm groups were statistically
different from the 3, 4, and 5mm stitch length
groups while comparison among the latter groups was not
statistically significant. For CLPS, the 1mm group exhibited
consistently the highest maximum load strength and
breaking power, which was twice the strength displayed
by the 2mm group. Pairwise comparisons between groups
showed statistical significance. For future repairs of flexor
tendon injuries, 1mm stitch length is highly recommended
for simple peripheral suture.
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 Trybus M., Lorkowski J., Brongel L. and Hladki W., Causes and
consequences of hand injuries, Am J Surg, 2006, 192, 52-57.
 Chauhan A., Palmer B.A. and Merrell G.A., Flexor Tendon
Repairs: Techniques, Eponyms, and Evidence, J Hand Surg Am,
2014, 39, 1846-1853.
 Kim H.M., Nelson G., Thomopoulos S., Silva M.J., Das R. and
Gelberman R.H., Technical and biological modifications for
enhanced flexor tendon repair, J Hand Surg Am, 2010, 35,
1031-1037; quiz 1038.
 III J.G.S., FLEXOR TENDON REPAIR, Journal of the American
Society for Surgery of Hand, 2001, 1, 177-191.
 Ishida O. and Ikuta Y., Analysis of Tsuge’s procedure for the
treatment of radial nerve paralysis, Hand Surg, 2003, 8, 17-20.
 Defino H.L., Barbieri C.H., Goncalves R.P. and Paulin J.B.,
Studies on tendon healing. A comparison between suturing
techniques, J Hand Surg Br, 1986, 11, 444-450.
 Brown S.H., Hentzen E.R., Kwan A., Ward S.R., Friden J. and
Lieber R.L., Mechanical strength of the side-to-side versus
Pulvertaft weave tendon repair, J Hand Surg Am, 2010, 35,
 Bidic S.M., Varshney A., Ruff M.D. and Orenstein H.H.,
Biomechanical comparison of lasso, Pulvertaft weave, and
side-by-side tendon repairs, Plast Reconstr Surg, 2009, 124,
 Lister G.D., Kleinert H.E., Kutz J.E. and Atasoy E., Primary flexor
tendon repair followed by immediate controlled mobilization, J
Hand Surg Am, 1977, 2, 441-451.
 Wade P.J., Muir I.F. and Hutcheon L.L., Primary flexor tendon
repair: the mechanical limitations of the modified Kessler
technique, J Hand Surg Br, 1986, 11, 71-76.
 Lin G.T., An K.N., Amadio P.C. and Cooney W.P., 3rd,
Biomechanical studies of running suture for flexor tendon
repair in dogs, J Hand Surg Am, 1988, 13, 553-558.
 Diao E., Hariharan J.S., Soejima O. and Lotz J.C., Effect of
peripheral suture depth on strength of tendon repairs, J Hand
Surg Am, 1996, 21, 234-239.
 Bigdeli A.K., Kaczmarek I., Eifert S., Beiras-Fernandez A.,
Kober S., Nikolaou K., et al., Interrupted nitinol U-Clips
versus standard running suture for the central arterial
T-graft anastomosis: a prospective randomized study, Eur J
Cardiothorac Surg, 2011, 40, e93-97.
 Yotsumoto T., Miyamoto W. and Uchio Y., Novel approach to
repair of acute achilles tendon rupture: early recovery without
postoperative fixation or orthosis, Am J Sports Med, 2010, 38,
 Tang J.B., Wang B., Chen F., Pan C.Z. and Xie R.G.,
Biomechanical evaluation of flexor tendon repair techniques,
Clin Orthop Relat Res, 2001, 252-259.
 Cullen K.W., Tolhurst P., Lang D. and Page R.E., Flexor tendon
repair in zone 2 followed by controlled active mobilisation, J
Hand Surg Br, 1989, 14, 392-395.
 McCarthy D.M., Boardman N.D., 3rd, Tramaglini D.M.,
Sotereanos D.G. and Herndon J.H., Clinical management of
partially lacerated digital flexor tendons: a survey
hand surgeons, J Hand Surg Am, 1995, 20, 273-275.