%0 Journal Article
%T Flexor Tendon Injuries in the Hand: A UK Survey of Repair Techniques and Suture Materials¡ªAre We Following the Evidence?
%A W. B. J. Rudge
%A M. James
%J ISRN Plastic Surgery
%D 2014
%R 10.1155/2014/687128
%X Introduction. Injuries to the hand are common, and poor functional outcomes can have significant long-term consequences affecting both work and social activities. Good outcomes following flexor tendon lacerations in the hand are dependent on a sound surgical repair allowing early active mobilisation. Materials and Methods. We reviewed the literature regarding the choice of suture material and repair technique. We then carried out a nationwide postal survey of plastic surgery hand units to assess the level of compliance with the evidence. Results. Fifty-four units were surveyed. The response rate was 72%, with the most popular core suture being Prolene (64%) and the most popular technique being the Kessler repair (36%). Discussion. Current evidence advocates a multistrand repair using Ethibond. We found that the majority of units are not following the evidence. We suggest the use of evidence-based departmental guidelines to improve the practice and outcomes following these common injuries. 1. Introduction Injuries to the hand are common, accounting for around one-fifth of all presentations to the emergency department in most hospitals and costing over 100,000,000 per year in the United Kingdom to treat [1]. Of these patients around 1-2% have tendon lacerations [2], more commonly on the flexor aspect. Strickland [3] described the characteristics of an ideal primary flexor tendon repair:(i)easily placed in tendon;(ii)secure knots;(iii)smooth junctions;(iv)minimal gapping;(v)minimal interference with tendon vascularity;(vi)sufficient strength throughout healing to permit application of early motion stress. Early active mobilisation has been shown to be important in terms of preventing the formation of adhesions [4], stimulating tendon healing [5], and improving functional outcome [6, 7]. Immediately after a tendon repair, the tendon itself will contribute nothing to the strength of the repair, which is therefore entirely dependent on the suture material and the technique used, as well as meticulous surgical technique and careful tissue handling. Suture material and technique are thus crucial to the survival of the repair. We have examined the evidence related to different suture materials and the different techniques for tendon repair and compared this with current practice in plastic surgery hand units within the United Kingdom and the Republic of Ireland. 2. Current Evidence 2.1. Suture The ideal core suture material should have high tensile strength, be inextensible, cause no tissue reaction, and be easy to handle and knot [8]. Stainless steel fulfils
%U http://www.hindawi.com/journals/isrn.plastic.surgery/2014/687128/