Review Question - QID 5713

Epitendinous suture repair of the cut edges is all that is necessary to prevent gap formation.

Most surgeons repair lacerations of = 50% if there is triggering and nonrepair for 50-60% lacerations without triggering. Although lacerations of up to 75% are capable of handling early, non-resisted active mobilization, most hand surgeons will repair 75% partial lacerations.

Haddad et al. compared repair vs nonrepair of 75% lacerated sheep flexor tendons. They found that peripheral or peripheral + core repairs reduced gap formation (= 1mm at 500 cycles) but there was no difference in gap formation between these 2 groups. Nonrepaired tendons had gap formation early (100 cycles). They concluded that gapping is reduced with a peripheral repair (with or without core suture).

Illustration A demonstrates epitendinous suture techniques, whereas Illustration B demonstrates core suture techniques.

Incorrect Answers:
Answer 1: Gap formation occurs rapidly with no repair.
Answer 2: Core suture repairs do not provide adequate apposition at the cut edge to prevent gapping.
Answer 4: For partial lacerations, there is no advantage to circumferential epitendinous sutures compared with epitendinous sutures at the lacerated edge alone.
Answer 5: The addition of core sutures increases bulk of the repair and is unnecessary to prevent gapping. In the study above by Haddad et al., there was no difference between core+epitendinous and epitendinous alone for partial lacerations.