Plast Reconstr Surg. 2022 Jun 8. doi: 10.1097/PRS.0000000000009321. Online ahead of print.
ABSTRACT
PURPOSE: The Pulvertaft weave continues as a staple technique for tendon coaptations. Many have proposed minor alterations to the original technique to improve its strength, though a lack of consensus exists. Our aim was to explore how the number of weaves and suture characteristics contribute to the overall strength of the coaptation.
METHODS: A comprehensive electronic search was conducted using PubMed, Cochrane Library, and Scopus. Criteria for inclusion consisted of cadaveric human or animal biomechanical studies evaluating ultimate failure load (Newtons, N) as well as number of weaves, suture characteristics, tendon source, and number of coaptations. Weaves with minimum averages of 75 N were deemed successful, and those with >120 N were considered high performing.
RESULTS: A total of 347 tendon transfers from 15 studies met inclusion criteria. Average strength by number of weaves was 36.4 N (n=52) for 1 weave; 54.2 N (n=58) for 2 weaves; 115.9 N (n=174) for 3 weaves; and 81.7 N (n=63) for 4 weaves. Statistical differences were observed between 1 and 2 weaves (p<0.0001); 2 and 3 weaves (p<0.0001); 3 and 4 weaves (p<0.003); and 2 and 4 weaves (p<0.0001). High performing tendon transfers utilized 3 weaves, 3-0 or 4-0 braided sutures, and figure-of-eight or mattress core sutures.
CONCLUSIONS: Contrary to the current dogma of ‘the more the better’, our findings show that Pulvertaft weave strength is optimized when 3 weaves are used to combine donor and recipient tendons. Braided sutures with either figure-of-eight or mattress sutures were associated with highest strength of repair.
PMID:35671455 | DOI:10.1097/PRS.0000000000009321
