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Nahttechniken für Beugesehnen der Hand

Suture techniques for flexor tendons of the hand

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Zusammenfassung

Hintergrund

Der Erfolg der Beugesehnennaht hängt von vielen Faktoren ab. Ein wichtiger Faktor ist dabei die Sehnennahttechnik, die bei Beugesehnen wesentlich aufwendiger und exakter ausgeführt werden muss als an allen anderen Sehnen des Körpers.

Fragestellung

Welche bedeutenden operationstechnischen Punkte müssen bei der Beugesehnennaht beachtet werden?

Methode

Die bedeutendsten technischen Details zur Beugesehnennaht aus der Literatur und der persönlichen Erfahrung werden zusammengestellt.

Ergebnisse

Es werden Details zur Kernnaht, zur Ringnaht, zur Reißfestigkeit, zum Nahtmaterial, zur Lückenbildung, zur Durchblutung der Sehne bei liegender Naht, zum Gleitverhalten und zur Sehnenstumpfanfrischung diskutiert.

Schlussfolgerungen

Die Beugesehnennaht muss sehr sorgfältig und gewebeschonend ausgeführt werden.

Abstract

Background

The success of the flexor tendon suture depends on many factors. An important factor is that the tendon suture technique that must be carried out for flexor tendons is considerably more complex and more precise than for all other tendons of the body.

Objectives

To discover important technical points that need to be considered during flexor tendon suturing.

Method

We compiled the most important technical details in flexor tendon suturing from the literature and from personal experience.

Results

Details on core suture, peripheral suture, the tensile strength, gapping, the circulation of sutured tendons, gliding resistance and excisions are discussed.

Conclusions

Flexor tendon suturing must be performed taking great care to conserve tissue.

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Literatur

  1. Amadio PC, Hunter JM, Jaeger SH, Wehbe MA, Schneider LH (1985) The effect of vincular injury on the results of flexor tendon surgery in zone 2. J Hand Surg 10A:626–632

    Article  Google Scholar 

  2. Becker H, Davidoff M (1977) Eliminating the gap in flexor tendon surgery. A new method of suture. Hand 9:306–311

    Article  CAS  PubMed  Google Scholar 

  3. Betz C, Schleicher P, Winkel R, Hoffmann R (2013) Biomechanische Untersuchung der Zugfestigkeit von Sehnennähten – blockierende Zwischenknoten erhöhen die Stabilität. Handchir Mikrochir Plast Chir 45:20–25

    Article  CAS  PubMed  Google Scholar 

  4. Boyes JH (1950) Flexor tendon grafts in the fingers and thumb. An evaluation of end results. J Bone Joint Surg 32A:489–499, 531

    Google Scholar 

  5. Bright DS, Urbaniak JS (1977) Direct measurements of flexor tendon tension during active passive digit motion and its application to flexor tendon surgery. Orthop Trans 1:4–5

    Google Scholar 

  6. Brug E (1997) Die primäre Versorgung von Beugesehnenverletzungen der Hand. Unfallchirurg 100: 602–612

  7. Buck-Gramcko D, Lanz U (1983) Verletzungen der Beugesehnen. In: Nigst H, Buck-Gramcko D, Millesi H (Hrsg) Handchirurgie, Bd II. Thieme, Stuttgart, S 28.1–28.33

    Google Scholar 

  8. Bunnell S (1918) Repair of tendons in the fingers and description of two new instruments. Surg Gynecol Obstet 26:103–110

    Google Scholar 

  9. Bunnell S (1944) Surgery of the hand. J.B. Lippincott, Philadelphia

    Google Scholar 

  10. Cullen KW, Tolhurst P, Lang D, Page RE (1989) Flexor tendon repair in zone 2 followed by controlled active mobilization. J Hand Surg 14B:392–395

    Article  Google Scholar 

  11. Diao E, Hariharan JS, Soejima O, Lotz JC (1996) Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg 21A:234–239

    Article  Google Scholar 

  12. Dowd MB, Figus A, Harris B, Southgate CM, Foster AJ, Elliot D (2006) The results of immediate re-repair of zone 1 and zone 2 primary flexor tendon repairs which rupture. J Hand Surg 31B:507–513

    Article  Google Scholar 

  13. Evans RB, Thomson DE (1993) The application of force to the healing tendon. J Hand Ther 6:266–284

    Article  CAS  PubMed  Google Scholar 

  14. Gelberman RH, Amiel D, Gonsalves M, Woo S, Akeson WH (1981) The influence of protected passive mobilization on the healing of flexor tendons: a biomechanical and microangiographic study. Hand 13:120–128

    Article  CAS  PubMed  Google Scholar 

  15. Gelberman RH, Boyer MI, Brodt MD, Winters SC, Silva MJ (1999) The effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons. J Bone Joint Surg 81A:975–982

    Google Scholar 

  16. Gelberman RH, Woo SL-Y, Lothringer R et al (1982) Effects of early intermittent passive mobilization on healing of canine flexor tendons. J Hand Surg 7A:170–175

    Article  Google Scholar 

  17. Geldmacher J (1991) Historische Entwicklung der Sehnenchirurgie. In: Geldmacher J, Köckerling F (Hrsg) Sehnenchirurgie. Urban & Schwarzenberg, München, S 3–14

    Google Scholar 

  18. Greenwald D, Shumway S, Allen C, Mass D (1994) Dynamic analysis of profundus tendon function. J Hand Surg 19A:626–635

    Article  Google Scholar 

  19. Harris SB, Harris D, Foster AJ, Elliot D (1999) The aetiology of acute rupture of flexor tendon repairs in zone 1 and 2 of the fingers during early mobilization. J Hand Surg 24B:275–280

    Article  Google Scholar 

  20. Hohmann G (1949) Hand und Arm. Ihre Erkrankungen und deren Behandlung. J.F. Bergmann, München

    Google Scholar 

  21. Hotokezaka S, Manske PR (1997) Differences between locking loops and grasping loops: effects on 2-strand core suture. J Hand Surg 22A:995–1003

    Article  Google Scholar 

  22. Iselin M (1933) Chirurgie de la main. Masson et Cie, Paris

  23. Kessler I (1973) The „grasping“ technique for tendon repair. Hand 5:253–255

    Article  CAS  PubMed  Google Scholar 

  24. Kirchmayr L (1917) Zur Technik der Sehnennaht. Zentralbl Chir 44:906–907

    Google Scholar 

  25. Kleinert HE, Kutz JE, Ashbell TS, Martinez E (1967) Primary repair of lacerated flexor tendons in „no man’s land“. J Bone Joint Surg 49A:577 (abstr.)

    Google Scholar 

  26. Kleinert HE, Kutz JE, Atasoy E, Stormo A (1973) Primary repair of flexor tendons. Orthop Clin North Am 4:865–876

    CAS  PubMed  Google Scholar 

  27. Koch SL, Mason ML (1933) Division of the nerves and tendons of the hand. Surg Gynecol Obstet 61:1–39

    Google Scholar 

  28. Komanduri M, Phillips CS, Mass DP (1996) Tensile strength of flexor tendon repairs in a dynamic cadaver model. J Hand Surg 21A:605–611

    Article  Google Scholar 

  29. Kubota H, Aoki M, Pruitt DL, Manske PR (1996) Mechanical properties of various circumferential tendon suture techniques. J Hand Surg 21B:474–480

    Article  Google Scholar 

  30. Langer MF, Surke C, Wieskötter B, Lötters E (2011) Prinzipien der Beugesehnenchirurgie. In: Towfigh H, Hierner R, Langer MF, Friedel R (Hrsg) Handchirurgie, Springer, Heidelberg

  31. Langer MF, Surke C, Wieskötter B (2013) Beugesehnenscheideninfektion der Finger und des Daumens. Obere Extremität 8:129–135

    Article  Google Scholar 

  32. Leddy JP (1993) Flexor tendon- acute injuries. In: Green DP (Hrsg) Operative hand surgery, 3. Aufl., Bd 2. Churchill Livingstone, New York, S 1823–1851

    Google Scholar 

  33. Lin GT, An KN, Amadio PC, Cooney WP (1988) Biomechanical studies of running suture for flexor tendons in dogs. J Hand Surg 13A:553–558

    Article  Google Scholar 

  34. Lindsay WK, Birch JR (1964) The fibroblast in flexor tendon healing. Plast Reconstr Surg 34:223–232

    Article  CAS  PubMed  Google Scholar 

  35. Lindsay WK, Thomson HG (1960) Digital flexor tendons: an experimental study. Br J Plast Surg 12:260–267

    Google Scholar 

  36. Lister GD, Kleinert HE, Kutz JE, Atasoy E (1977) Primary tendon repair followed by immediate controlled mobilization. J Hand Surg 2:441–451

    Article  CAS  Google Scholar 

  37. Malerich MM, Baird RA, McMaster W, Erickson JM (1987) Permissible limits of flexor digitorum profundus tendon advancement – an anatomic study. J Hand Surg 12A:30–33

    Article  Google Scholar 

  38. Manske PR (1988) Flexor tendon healing. J Hand Surg 13B:237–244

    Article  Google Scholar 

  39. Mason ML, Shearon CG (1932) Process of tendon repair: an experimental study of tendon suture and tendon graft. Arch Surg 25:616–691

    Article  Google Scholar 

  40. Nicoladoni C (1880) Ein Vorschlag zur Sehnennaht. Wien Med Wschr 30:1414–1417

    Google Scholar 

  41. Noguchi M, Seiler JG, Gelberman RH, Sofranko RA, Woo SL-Y (1993) In vitro biomechanical analysis of suture methods for flexor tendon repair. J Orthop Res 11:603–611

    Article  CAS  PubMed  Google Scholar 

  42. Norris SR, Ellis FD, Chen MI, Seiler JG III (1999) Flexor tendon suture methods: a quantitative analysis of suture material within the repair site. Orthopaedics 22:1–4

    Google Scholar 

  43. Pennington DG (1979) The locking loop suture. Plast Reconstr Surg 63:648–652

    Article  CAS  PubMed  Google Scholar 

  44. Pruitt DL, Manske PR (1996) The effect of suture knot location on tensile strength after flexor tendon repair. J Hand Surg 21A:969–973

    Article  Google Scholar 

  45. Pruitt DL, Manske PR, Fink B (1991) Cyclic stress analysis of flexor tendon repair. J Hand Surg 16A:701–707

    Article  Google Scholar 

  46. Pruitt DL, Tanaka H, Aoki M, Manske PR (1996) Cyclic stress testing after in vivo healing of canine flexor tendon lacerations. J Hand Surg 21A:974–977

    Article  Google Scholar 

  47. Pulvertaft RG (1956) Tendon grafts for flexor tendon injuries in the fingers and thumb. A study of technique and results. J Bone Joint Surg 38B:175–194

    Google Scholar 

  48. Reill P (1991) Die primäre Beugesehnennaht am Unterarm und an der Hand mit sofortiger Übungsbehandlung. Operat Orthop Traumatol 3:95–106

    Article  Google Scholar 

  49. Salomon A (1924) Klinische und experimentelle Untersuchungen über Heilung von Sehnenverletzungen, insbesondere innerhalb der Sehnenscheiden. Langenbecks Arch Klin Chir 129:397–430

    Google Scholar 

  50. Savage R (1985) In vitro studies of a new method of flexor tendon repair. J Hand Surg 10B:135–141

    Article  Google Scholar 

  51. Savage R, Risitano G (1989) Flexor tendon repair using a „six strand“ method of repair and early active mobilisation. J Hand Surg 14B:396–399

    Article  Google Scholar 

  52. Schuind F, Garcia-Elias M, Cooney WP III, An K-N (1992) Flexor tendon forces: in vivo measurements. J Hand Surg 17:291–298

    Article  CAS  Google Scholar 

  53. Shaieb MD, Singer DJ (1997) Tensile strength of various suture techniques. J Hand Surg 22B:764–767

    Article  Google Scholar 

  54. Silfverskiöld KL, Andersson CH (1993) Two new methods of tendon repair: an in vitro evaluation of tensile strength and gap formation. J Hand Surg 18A:58–65

    Article  Google Scholar 

  55. Silfverskiöld KL, May EJ (1994) Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active motion. J Hand Surg 19A:53–60

    Article  Google Scholar 

  56. Small JO, Brennen MD, Colville J (1989) Early active mobilisation following flexor tendon repair in zone 2. J Hand Surg 14B:383–391

    Article  Google Scholar 

  57. Strickland JW (1995) Flexor tendon injuries: I. Foundations of treatment. J Am Acad Orthop Surg 3:44–54

    PubMed  Google Scholar 

  58. Strickland JW, Gettle KH (1997) Flexor tendon repair. The Indianapolis method. In: Hunter JM, Schneider LH, Mackin EJ (Hrsg) Tendon and Nerve surgery in the hand. A third decade. Mosby St. Louis, S 353–361

    Google Scholar 

  59. Tang JB, Cao Y, Xie RG (2001) Effects of tenson direction on strength of tendon repair. J Hand Surg 26A:1105–1110

    Article  Google Scholar 

  60. Taras JS, Raphael JS, Marczyk SD, Bauerle W, Culp RW (1997) Evaluation of suture caliber in flexor tendon repait. Applications for active motion. In: Hunter JM, Schneider LH, Mackin EJ (Hrsg) Tendon and nerve surgery in the hand. A third decade. Mosby, St. Louis, S 314–319

    Google Scholar 

  61. Thurman RT, Trumble TE, Hanel DP, Tencer AF, Kiser PK (1998) Two-, four-, and sixstrand zone II flexor tendon repairs: an in situ biomechanical comparison using a cadaver model. J Hand Surg 23A:261–265

    Article  Google Scholar 

  62. Trail IA, Powell ES, Noble J (1989) An evaluation of suture materials used in tendon surgery. J Hand Surg 14B:422–427

    Article  Google Scholar 

  63. Trail IA, Powell ES, Noble J (1992) The mechanical strength of various suture techniques. J Hand Surg 17B:89–91

    Article  Google Scholar 

  64. Urbaniak JR, Cahill JD, Mortenson RA (1975) Tendon suture methods. Analysis of tensile strengths. AAOS symposium on tendon surgery in the hand. C.V. Mosby, St. Louis, S 70–80

    Google Scholar 

  65. Verdan C (1960) Primary repair of flexor tendons. J Bone Joint Surg 42A:647–657

    Google Scholar 

  66. Vigler M, Lee SK, Palti R, Williams JC, Kaminsky AJ, Posner MA, Hausman MR (2009) Biomechanical comparison of techniques to reduce the bulk of lacerated flexor tendon ends within digital sheaths of the porcine forelimb. J Hand Surg 34A:1653–1658

    Article  Google Scholar 

  67. Wada A, Kubota H, Hatanaka H, Hotokezaka S, Miura H, Iwamoto Y (2000) The mechanical properties of locking and grasping suture loop configurations in four-strand core suture techniques. J Hand Surg 25B:548–551

    Article  Google Scholar 

  68. Wade PJF, Wetherell RG, Amis AA (1989) Flexor tendon repair: significant gain in strength from Halsted peripheral suture technique. J Hand Surg 14B:232–235

    Article  Google Scholar 

  69. Winters SC, Gelberman RH, Woo SL-Y, Chan SS, Grewal R, Seiler JG (1998). The effects of multiple-strand suture methods on the strength and excursion of repaired intrasynovial flexor tendons: a biomechanical study in dogs. J Hand Surg 23A:97–104

    Article  Google Scholar 

  70. Winters SC, Seiler JG III, Woo SL-Y, Gelberman RH (1997) Suture methods for flexor tendon repair. A biomechanical analysis during the first six weeks following repair. Ann Chir Main 16:229–234

    CAS  Google Scholar 

  71. Witzel O (1887) Ueber Sehnenverletzung und ihre Behandlung. Samml Klin Vorträge 291:2647–2678

    Google Scholar 

  72. Wong JKF, Cerovac S, Ferguson MWJ, McGrouther DA (2006) The cellular effect of a single interrupted suture on tendon. J Hand Surg 31B:358–367

    Article  Google Scholar 

  73. Zechner W, Buck-Gramcko D, Lohmann H, Goth D, Stock W (1985) Überlegungen zur Verbesserung der Nahttechnik bei Beugesehnenverletzungen. Klinische und experimentelle Studie. Handchir. Mikrochir Plast Chir 17:8–13

    CAS  Google Scholar 

  74. Zhao C, Amadio PC, Zobitz ME, An K-N (2001) Gliding characteristics of tendon repair in canine flexor digitorum profundus tendons. J Orthop Res 19:580–586

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland

    M.F. Langer, S. Oeckenpöhler, C. Kösters, K. Herrmann & B. Wieskötter

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  1. M.F. Langer
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  2. S. Oeckenpöhler
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  3. C. Kösters
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  4. K. Herrmann
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  5. B. Wieskötter
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Correspondence to M.F. Langer.

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M. F. Langer, S. Oeckenpöhler, C. Kösters, K. Herrmann und B. Wieskötter geben an, dass kein Interessenkonflikt besteht.

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Langer, M., Oeckenpöhler, S., Kösters, C. et al. Nahttechniken für Beugesehnen der Hand. Orthopäde 44, 748–756 (2015). https://doi.org/10.1007/s00132-015-3153-5

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