Tendon Suture

Tendons are relatively avascular structures and heal by the in growth of connective tissue from the epitenon.

Indications

• traumatic injury to tendons
• as part of another procedure

Assessment

• Wounds in the vicinity of a tendon, assume tendon injury until it is shown to be intact on clinical examination
• If no action is demonstrated and there is doubt, explore the wound 

Technique

• Prepare the skin
• Apply a tourniquet
• Explore the wound and extend it if necessary
• If the wound is suitable for primary closure proceed to repair the tendons
• When several tendons are divided make sure that the cut ends are correctly paired
• Draw the cut ends together, flex or extend the neighbouring joints if necessary
• Use a monofilament non-absorbable suture (i.e: prolene) and apply a modified Kessler stitch (see fig.)

Modified Kessler Stitch

• Approximate the tendon ends till they just meet
• Complete the knot with at least 6 throws
• Cut the knot flush
• Complete the repair with a simple running suture of 6/0 prolene
• Release the tourniquet and secure haemostasis
• Apply a padded plaster to relieve tension on suture lines and remove after 3 weeks in the upper limb and 6 weeks in the lower limb