Experimental tenorrhaphy with the use of microsurgical tendon holder
https://doi.org/10.52581/1814-1471/82/03
Abstract
Objective. Damage to the tendons of the extremities is one of the most frequent injuries of the human musculoskeletal system. Tenorrhaphy, aimed at restoring their integrity, is a technically complex surgical intervention, including access with the release of the ends of the tendons, their retention and repeated interception during suturing with a thread. During surgery, the tendon inevitably undergoes additional trauma from compression by surgical instruments. As a result, there is a violation of the ultrastructure, blood supply and weakening of the ends of the sutured tendon. In turn, this prevents accurate adaptation and causes deformation in the seam area, promotes thread eruption. At the same time, tendon regeneration proceeds with a pronounced scar-adhesive process, sliding properties are violated, tenogenic contractures are formed.
Purpose of the study. To evaluate the effect of the tendon capture and retention method during tenorrhaphy on the microanatomic structure of the tendon.
Material and methods. A new instrument for performing tenorrhaphy is proposed. 12 experimental tenorrhaphies were performed on the tendons of the limbs of people amputated for medical reasons, using tweezers and an original tendon holder, followed by histotopographic examination of stitched tendon samples.
Results and discussion. In the course of the study, it was found that the method of capturing and holding the tendon during tenoraphy has a significant impact on its anatomical structure. When holding tendons with tweezers, violations of the tendon structure and damage to its membranes were observed. The tendons held during the operation with the help of a tendon holder were distinguished by the preservation of the macromicroanatomic structure of the tendon itself and the surrounding tissues.
Conclusion. The use of a microsurgical tendon holder makes it possible to ensure the safety of the macromicroscopic structure of the tendon, the anatomicity and precision of the tenoraphy, in comparison with traditional methods of tendon retention.
About the Authors
A. M. Gurianov
Orenburg State Medical University
Russian Federation
Russian Federation
Andrey M. Gurianov, Cand. Med. sci., Associate Professor, head of the Department of Traumatology and Orthopedics
6, Sovetskaya st., Orenburg, 460000
I. I. Kagan
Orenburg State Medical University
Russian Federation
Russian Federation
Ilya I. Kagan, Dr. Med. sci., Professor, the Department of Operative Surgery and Clinical Anatomy named after S. S. Mikhailov
6, Sovetskaya st., Orenburg, 460000
V. I. Studenov
Orenburg State Medical University
Russian Federation
Russian Federation
Vladimir I. Studenov, Assistant, the Department of Traumatology and Orthopedics
6, Sovetskaya st., Orenburg, 460000
V. V. Ivlev
Orenburg State Medical University
Russian Federation
Russian Federation
Vladislav V. Ivlev, Assistant, the Department of Operative Surgery and Clinical Anatomy named after S. S. Mikhailov
6, Sovetskaya st., Orenburg, 460000
References
1. Kilic B., Zekioğlu A., Serdar Yücel A. Flexor tendon injuries and treatment results of 67 patients. Pak J Biol Sci. 2015 Jan;18(1):32-6. doi: 10.3923/pjbs.2015.32.36
2. Samodai V.G., Magomedov R.M., Magomedov R.M. Hirurgiya povrezhdeniy suhozhiliy sgibateley paltsev kisti (obzor literatury) [The surgery of the flexor tendon injuries of hand (literature review). Kafedra travmatologii i ortopedii – The Department of Traumatology and Orthopedics. 2021;1(43):42-52 (In Russ.).
3. Nakonechnyi D.G., Kiseleva A.N. Evolyutsiya hirurgicheskogo shva pri vosstanovlenii povrezhdennyh sukhozhiliy sgibateley paltsev kisti [Evolution of surgical suture in case of repairing the damaged flexor tendons of the fingers]. Vestnik hirurgii im. I.I. Grekova– I.I. Grekov Bulletin of Surgery. 2018$177(6):91-95 (In Russ.).
4. Muradov M.I., Mukhammedkerim K.B., Baiguzeva A.A., et al. Meneye travmatichnyye dostupy v mikrokhirurgii travm sukhozhiliy sgibateley paltsev kisti [Less traumatic approaches of flexor tendon injuries of hand fingers in microsurgery]. Vestnik khirurgii Kazakhstana – Bulletin of Surgery in Kazakhstan. 2018;3(56):25-28. (In Russ.).
5. Warwick D., Dunn R. Hand Surgery (Oxford Specialist Handbooks Series in Surgery) / Oxford University Press. 2nd Ed. 2018. 736 р.
6. Khor W., Langer M., Wong R., et al. Improving outcomes in tendon repair: A critical look at the evidence for flexor tendon repair and rehabilitation. Plast Reconstr Surg. 2016 Dec;138(6):1045e–1058e. doi: 10.1097/PRS.0000000000002769
7. Baranov O.N., Salov I.A., Maslyakov V.V., Korshunova G.A. Mikrohirurgicheskiy shov suhozhiliya sgibateley paltsev kisti i perifericheskih nervov pri ostroy travme [Microsurgical suture of the flexor tendon of the fingers of the hand and peripheral nerves in acute trauma]. Annaly plasticheskoy, rekonstruktivnoy i esteticheskoy khirurgii – Annals of Plastic, Reconstructive and Aesthetic Surgery. 2018;4:55. (In Russ.).
8. Guriyanov A.M., Safronov A.A., Ivlev V.V., Kagan I.I., Kim V.I. Mikrohirurgicheskiy tendoderzhatel dlya vypolneniya suhozhilnogo shva. Patent RF na poleznuyu model №177222 ot 13.02.2018 [Microsurgical tendonholder for fulfilment of tendon suture. Patent RF for useful model No. 177222 dated 13.02.2018] (In Russ.).
9. Guriyanov A.M., Safronov A.A., Kagan I.I., Kim V.I., Ivlev V.V., Roganov D.A., Bogdanov I.S., Studenov V.I. Sposob mikrohirurgicheskogo shva suhozhiliya. Patent RF na izobreteniye №2698439 ot 26.08.2019 [Method of microsurgical tendon suture. Patent RF for the invention № 2698439 dated 26.08.2019] (In Russ.).
10. Amlang M., Christiani P., Heinz P., Zwipp H. Percutaneous technique for Achilles tendon repair with the Dresden Instruments. Article in German. Unfallchirurg. 2015 Jul;108(7):529-36. doi: 10.1007/s00113-005-0938-8.
11. Munz G., Poggetti A., Cenci L., et al. Up to five-week delay in primary repair of zone 2 flexor tendon injuries: outcomes and complications. J Hand Surg Eur. 2021 Oct; 46(8):818-824. doi: 10.1177/17531934211024435 Epub 2021 Jun 18.
12. Manegold S., Tsitsilonis S., Schumann J., et al. Functional outcome and complication rate after percutaneous suture of fresh Achilles tendon ruptures with the Dresden instrument. J Orthop Traumatol. 2018 Sep 18;19(1):19. doi: 10.1186/s10195-018-0511-1.
13. Chmielnicki M., Prokop A., Zwipp H. Percutaneous Suture of the Achilles Tendon with the Dresden Instruments. Article in German. Z Orthop Unfall. 2016 Jun;154(3):303-305. doi: 10.1055/s-0042-104513 Epub 2016 Jun 28.
14. Yang B., Liu Y., Kan S., et al. Outcomes and complications of percutaneous versus open repair of acute Achilles tendon rupture: A meta-analysis. Int J Surg. 2017 Apr;40:178-186. doi: 10.1016/j.ijsu.2017.03.021
15. Zolotov A.S., Isokov S.Kh., Isokova A.Kh. Optimalnaya igla dlya shva suhozhiliy: traditsionnaya rezhushchaya ili obratno-rezhushchaya? Eksperimentalnoye issledovaniye [The Optimal Surgical Needle for Tendon Suture: Cutting Edge or Reverse Cutting Edge?]. Travmatologiya i ortopediya Rossii – Traumatology and Orthopedics of Russia. 2021;27(2):75-80. (In Russ.).
16. Zinchenko A.V., Chernyakova Yu.M. Nereshennyye voprosy hirurgicheskogo vosstanovleniya suhozhiliy sgibateley paltsev kisti [Unresolved issues of surgical restoration of the flexor tendons of the fingers of the hand]. Meditsinskiye novosti – Medical news. 2018;7(286):7-13. (In Russ.).
17. Patrikeev D.V., Ivanchak A.V., Zyablov G.I., Krivoshchekov E.P. Ustroystvo dlya fiksatsii sukhozhiliya: Patent RF na poleznuyu model №2004120314 ot 27.11.2004 [A device for fixing the tendon. RF patent for utility model. Application No. 2004120314/22 dated 07.07.2004] (In Russ.).
Review
For citations:
Gurianov A.M., Kagan I.I., Studenov V.I., Ivlev V.V. Experimental tenorrhaphy with the use of microsurgical tendon holder. Issues of Reconstructive and Plastic Surgery. 2022;25(3):22-29. (In Russ.) https://doi.org/10.52581/1814-1471/82/03
Views:
486
Email this article 