{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T02:28:57Z","timestamp":1777170537615,"version":"3.51.4"},"reference-count":19,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T00:00:00Z","timestamp":1648425600000},"content-version":"vor","delay-in-days":1062,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T00:00:00Z","timestamp":1553644800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:p>\n          Background  The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model.<\/jats:p><jats:p>\n          Methods  The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded.<\/jats:p><jats:p>\n          Results  The maximum tensile strength until failure was 44.6\u00b14.3 N in group 1, 35.7\u00b15.2 N in group 2, and 56.7\u00b117.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P&lt;0.05). Furthermore, the barbed sutures showed the shortest repair time (P&lt;0.05).<\/jats:p><jats:p>\n          Conclusions  This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.<\/jats:p>","DOI":"10.5999\/aps.2018.00962","type":"journal-article","created":{"date-parts":[[2019,3,27]],"date-time":"2019-03-27T04:40:56Z","timestamp":1553661656000},"page":"228-234","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis"],"prefix":"10.1055","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-1649","authenticated-orcid":false,"given":"\u00d6zlem","family":"\u00c7olak","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Okmeydani Training and Research Hospital, \u0130stanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1761-3324","authenticated-orcid":false,"given":"Y\u00fcksel","family":"Kankaya","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9744-0007","authenticated-orcid":false,"given":"Nezih","family":"Sungur","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2966-6618","authenticated-orcid":false,"given":"Kadri","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ayd\u0131n State Hospital, Ayd\u0131n, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7730-7225","authenticated-orcid":false,"given":"Koray","family":"G\u00fcrsoy","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6646-5252","authenticated-orcid":false,"given":"Kemal","family":"\u015eerbet\u00e7i","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, \u0130zmir Democracy University, \u0130zmir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9873-1183","authenticated-orcid":false,"given":"U\u011fur","family":"Ko\u00e7er","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,3,28]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1097\/PRS.0b013e3181babb77","article-title":"Barbed suture tenorrhaphy: an ex vivo biomechanical analysis","volume":"124","author":"PM Parikh","year":"2009","journal-title":"Plast Reconstr Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1177\/1558944715626928","article-title":"Comparison of barbed sutures in porcine flexor tenorrhaphy","volume":"11","author":"A Sull","year":"2016","journal-title":"Hand"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1055\/s-0037-1606628","article-title":"In vitro comparison of two barbed suture configurations for flexor tendon repair","volume":"9","author":"JL Engel","year":"2017","journal-title":"J Hand Microsurg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1093\/asj\/sju012","article-title":"Barbed sutures and wound complications in plastic surgery: an analysis of outcomes","volume":"35","author":"R Cortez","year":"2015","journal-title":"Aesthet Surg J"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"666e","DOI":"10.1097\/PRS.0000000000002573","article-title":"Biomechanical analysis of barbed suture in flexor tendon repair versus conventional method: systematic review and meta-analysis","volume":"138","author":"JY Shin","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1177\/145749690809700410","article-title":"Primary flexor tendon repair techniques","volume":"97","author":"A Viinikainen","year":"2008","journal-title":"Scand J Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1177\/1558944717701238","article-title":"Comparing biomechanical properties, repair times, and value of common core flexor tendon repairs","volume":"13","author":"A Chauhan","year":"2018","journal-title":"Hand"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/j.jhsa.2015.04.009","article-title":"A mechanical evaluation of zone II flexor tendon repair using a knotless barbed suture versus a traditional braided suture","volume":"40","author":"AN Nayak","year":"2015","journal-title":"J Hand Surg Am"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jhsa.2005.09.006","article-title":"Influence of core suture purchase length on strength of four-strand tendon repairs","volume":"31","author":"Y Cao","year":"2006","journal-title":"J Hand Surg Am"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1097\/00003086-200105000-00033","article-title":"Biomechanical evaluation of flexor tendon repair techniques","author":"JB Tang","year":"2001","journal-title":"Clin Orthop Relat Res"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1016\/j.jhsa.2011.04.003","article-title":"Flexor tendon repair with a knotless barbed suture: a comparative biomechanical study","volume":"36","author":"IC Marrero-Amadeo","year":"2011","journal-title":"J Hand Surg Am"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10195-014-0333-8","article-title":"Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model","volume":"16","author":"A Clemente","year":"2015","journal-title":"J Orthop Traumatol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1177\/1753193416631440","article-title":"A knotless bidirectional-barbed tendon repair is inferior to conventional 4-strand repairs in cyclic loading","volume":"41","author":"FP O\u2019Brien 3rd","year":"2016","journal-title":"J Hand Surg Eur Vol"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/1753193413476607","article-title":"Performance of a knotless four-strand flexor tendon repair with a unidirectional barbed suture device: a dynamic ex vivo comparison","volume":"39","author":"TS Peltz","year":"2014","journal-title":"J Hand Surg Eur Vol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1177\/1753193413487470","article-title":"Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair","volume":"39","author":"CW Joyce","year":"2014","journal-title":"J Hand Surg Eur Vol"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"e237","DOI":"10.1097\/GOX.0000000000000203","article-title":"A barbed suture repair for flexor tendons: a novel technique with no exposed barbs","volume":"2","author":"CW Joyce","year":"2014","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1016\/j.jhsa.2005.05.011","article-title":"Core suture purchase affects strength of tendon repairs","volume":"30","author":"JB Tang","year":"2005","journal-title":"J Hand Surg Am"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhsu.2003.50074","article-title":"The effect of increased peripheral suture purchase on the strength of flexor tendon repairs","volume":"28","author":"GA Merrell","year":"2003","journal-title":"J Hand Surg Am"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jss.2017.03.035","article-title":"Turkey model for flexor tendon research: in vitro comparison of human, canine, turkey, and chicken tendons","volume":"216","author":"A Kadar","year":"2017","journal-title":"J Surg Res"}],"container-title":["Archives of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/e-aps.org\/upload\/pdf\/aps-2018-00962.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/e-aps.org\/journal\/view.php?doi=10.5999\/aps.2018.00962","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.5999\/aps.2018.00962.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,18]],"date-time":"2024-01-18T09:04:58Z","timestamp":1705568698000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.5999\/aps.2018.00962"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5]]},"references-count":19,"journal-issue":{"issue":"03","published-online":{"date-parts":[[2022,3,28]]},"published-print":{"date-parts":[[2019,5]]}},"URL":"https:\/\/doi.org\/10.5999\/aps.2018.00962","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2234-6163","2234-6171"],"issn-type":[{"value":"2234-6163","type":"print"},{"value":"2234-6171","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5]]},"assertion":[{"value":"2018-08-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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