gms | German Medical Science

Objectives/Interrogation: Surgical repair of muscle belly lacerations remains a challenge for surgeons treating extremity trauma. We have previously described a technique for repair of mid-substance muscle belly lacerations using an orthogonally placed "anchor suture" to augment purchase in the muscle belly [1]. The purpose of study was to evaluate the integrity of this repair against that of a standard modified Kessler repair and an intact control specimen.

Methods: Fifteen hindleg specimens from fresh-frozen adolescent pigs were divided into 3 proportionate groups: an intact control group, a modified Kessler repair group (MK), and an anchor suture repair group (AS). Five specimens underwent repair with the modified Kessler technique. Each repair comprised of six Kessler constructs, producing twelve strands across the repair site. Another five specimens were repaired with the anchor suture (AS) technique as previously described by the authors [1]. A total of six anchor sutures were placed in the repaired specimens with a total of twelve strands crossing the repair site. The proximal and distal bony attachments of each muscle-tendon unit were secured in a custom-made cylindrical polymethylmethacrylate fixation apparatus which was then mounted on a robotic manipulator with a six-degree-of-freedom load cell to determine the tensile load through the muscle. Specimens were subsequently loaded to failure. Pattern of failure, strain, and ultimate tensile strength were determined for each specimen.

Results and Conclusions: Suture pullout was the principle mode of failure in each group. The ultimate tensile strength of the control group was found to be 608.1±107.9 N. This was significantly (p<0.05) higher than the pullout strength of the MK and AS groups. The pullout strength of the AS group was 143.1±36.7 N, about twice that of the MK group who pullout strength was 69.8±16.4 N (p=0.11).

The Anchor suture proved to be a superior method of repair with ultimate tensile strength roughly twice that of the of the Kessler repair. The improved performance of the anchor suture may be due to the simple fact that more epimysium is incorporated into the repair. Similarly, the perpendicular orientation of each anchor suture allows for the recruitment of more muscle tissue per suture. To conclude, the anchor suture technique is a viable and robust option for repair of mid-substance muscle belly lacerations.