[Improvement of suture technic in flexor tendon injuries. Clinical and experimental study]

Multiple causes for the rupture of sutured tendons have been reported. At the time of exploration, loosening of the knot and breakage of the suture have been found to explain failure. A knot with four throws is frequently mentioned in various series as the smallest secure knot which can be made when employing a braided polyester suture material. Experiments have shown that the distance between the ends of the tendons affects the healing process and the tensile strength of the injured tendons. In order to avoid increasing the gap between the sutured ends of the tendons with the thick knot, it can be placed away from the cut surface of the tendons and displaced into the proximal or distal end of the tendons with a small additional incision. Through a longitudinal incision, the suture is easily passed in a criss cross fashion through the tendon and the knot can be buried in the tendon. This technique assures a very delicate and exact coaptation of the tendon ends. Almost 100% of the tendons remain intact during the healing phase. According to this experience, the risk of tendon rupture is reduced as a result of an increase in the tensile strength of the suture and the displacement of the knot away from the cut surface of the tendon.