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Use of P4HB Membrane as a Barrier against Adhesion Formation after Flexor Tendon Repair in a Chicken Model
Meredith Larsen, MD; Randy Bindra, MD; Sherri Yong, MD; Loyola University Medical Center
Loyola University Medical Center, Maywood, IL, USA

Introduction: Peritendinous adhesions plague zone II flexor tendon repairs despite advances in surgical repair and rehabilitation. The aim of this study was to evaluate the effectiveness of a biodegradable polymer film of poly-4-hydroxybutyrate (P4HB) in prevention of adhesions after flexor tendon repair in an in-vivo chicken model.

Materials and Methods: Zone II FDP lacerations of the 2nd and 4thdigits of fifteen White Leghorn chickens were surgically repaired. After randomization, half of the repairs were wrapped with a P4HB film (experimental group, n = 15) with the rest serving as controls (n = 15). After four weeks, specimens from each group were evaluated for breaking strength (n = 5), digital work of flexion (WOF), and internal gliding resistance (n = 5). Five repair sites from each group were assessed histologically for peritendinous adhesions, tendon healing and inflammatory response. An additional 15 uninjured FDP tendons underwent identical evaluations as the normal control (Fig. 1).

Results: The mean peak breaking strength was 14.64 N in the experimental and 6.97 N in the control group (p = 0.23). The mean WOF was 108.43 N-mm in the experimental group and 69.77 N-mm in the control group (p = 0.43). The mean internal gliding resistance was 91.18% of the total WOF in the experimental group and 98.72% in the control group (p = 0.24). The mean Bhavsar and Tang adhesion severity grades were significantly less in the experimental group (2.10 and 2.20) compared to the control group (4.50 and 5.70, p < 0.01). The mean tendon healing grade was significantly less in experimental group (2.50) than in the control group (3.80, p < 0.01), as seen in Fig. 2. The repair site inflammation was mild to moderate in severity and chronic in nature in both groups.

Conclusions: Wrapping zone II FDP tendon repairs with P4HB film resulted in fewer visible peritendinous adhesions and more mature tendon healing compared to controls. The film did not adversely affect repair site strength, WOF or incite additional inflammatory response. P4HB may be clinically useful as a physical barrier to reduce adhesions after flexor tendon repair.

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