Dr. Gluck and his colleagues, from Wake Forest University Baptist Medical Center, recently published their research on flexor tendon repair in the hand in the December 2013 edition of The Journal of Hand Surgery. Many flexor tendon repair research articles focus on suture configuration and strength. This is an important variable in tendon repair, but friction and gliding of the tendon through the sheath after repair are also important factors that contribute to patient outcomes. A good repair will fail, no matter how strong it is, without optimization of tendon gliding and reduction of friction. These are the factors that make flexor tendon repair in the hand such a delicate procedure.
Fibrin glue is used to augment nerve repairs in surgery, but it has also been considered for use in flexor tendon repairs to help strengthen the repair and improve gliding. It has also be used to try to reduce scarring and adhesions at the repair site that can ultimately lead to worse outcomes and the need for additional surgery. This concept was put to the test in this published research article entitled “Fibrin Glue Augmentation for Flexor Tendon Repair Increases Friction Compared With Epitendinous Suture.”
This was a soft tissue study, performed in the lab, comparing fibrin glue to additional suturing. A special, custom-built, testing construct was designed to evaluate gliding and friction in the tendons after cutting and then repairing them. Dr. Gluck and his colleagues were able to demonstrate that fibrin glue is actually not as good as using the current standard technique of suture augmentation. Hand surgeons and other Orthopedic surgeons are always looking for ways to improve patient outcomes. As the study demonstrates, however, fibrin glue does not seem to provide any benefit when performing flexor tendon repairs in the hand.
Drs. Vahey and Gluck develop their practice protocols using the latest evidence-based, peer-reviewed literature whenever possible. This provides their patients with treatment that is not only cutting-edge, but also cost-effective and proven to work.
The Journal of Hand Surgery is one of the leading, peer-reviewed research journals for hand and upper extremity surgeons in the United States, as well as throughout the world.