Chapter 9 Basic technique is a rectangular suture which has undergone numerous modifications after Kirchmayer’s first description in 1917. Fig. 9.1 (a) Original Kirchmayer/Kessler: Two sutures (two-strand) with knots buried in the tendon outside the suture line. A two-strand core suture with knots. In the suture line or burled in the tendon outside the suture line. lntratendinous knots may have better gliding properties, but have more suture material in the tendon gap. Theoretically, sutures should be placed insofar as possible at the volar aspect of the tendon to avoid disturbance of the dorsally situated vessels. Too much compression at the suture line should be avoided to prevent bulging of the tendon repair with subsequent impairment of gliding. (b–e) Modified Kessler: One or two sutures (two-strand) with intratendinous knots. Cross section demonstrates optimal position of core sutures. (f) Strickland’s “double grasp” modification of the Kirchmayer-Kessler technique (two-strand). (g) “Double grasp” technique with an additional rectangular mattress suture (four-strand). (h,i) Tsuge’s loop technique: Double loop (six-strand). (j) Pulvertaft technique: The tendon stumps are connected in a braided pattern—excellent tensile strength, allows early active mobilization. (k,l) Epitenon sutures: Epitenon sutures add considerable tensile strength to the tendon repair. They also smooth the contour of the tendon repair, thereby improving gliding properties. The two most commonly used patterns are running stitches (5–0) or interlocking sutures (5–0). A modification is a crisscross pattern that may increase tensile strength.
Techniques of Tendon Repair
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