Suture Material for Flexor Tendon Repair
For flexor tendon repair, use braided polyethylene (FiberWire/FiberLoop) suture material, as it provides superior tensile strength and biomechanical performance compared to traditional options like polypropylene or nylon. 1, 2, 3
Recommended Suture Material
Braided polyethylene (ultrahigh molecular weight polyethylene - UHMWPE) is the optimal choice for flexor tendon repair based on biomechanical evidence:
- Achieves ultimate tensile strength up to 145 N with modern repair techniques, significantly exceeding the threshold needed for early active rehabilitation 1
- Provides gap forces of 35-48 N, which is critical for preventing gap formation during early mobilization 2
- Demonstrates superior strength compared to polypropylene (145 N vs 80 N ultimate tensile strength in comparative studies) 1
- Outperforms traditional materials including monofilament nylon, polypropylene, and braided polyester in both stiffness and ultimate load capacity 3
Alternative Materials (Listed by Performance)
Second-Tier Options:
- Braided stainless steel wire: Provides strength comparable to braided polyethylene but is technically more challenging to work with 3
- Polytetrafluoroethylene (PTFE): Shows superior strength properties (73.41 N vs 49.90 N with polypropylene) when combined with epitendinous repair, though it requires multi-strand techniques to prevent cheese-wiring 4
Materials to Avoid:
- Monofilament nylon: Consistently produces the poorest mechanical performance in all outcome measures and should not be used for flexor tendon repair 3
- Standard polypropylene alone: Adequate but inferior to braided polyethylene options 1, 3
Suture Size Recommendations
- Core suture: 3-0 or 4-0 braided polyethylene for multi-strand techniques 1, 2
- Epitendinous/circumferential suture: 5-0 or 6-0 material 4, 5
Critical Technical Considerations
Failure modes vary by material and technique:
- Braided polyethylene typically fails 50% by suture breakage and 50% by pullout when using locking configurations 2
- PTFE requires epitendinous reinforcement to prevent cheese-wiring through tendon tissue 4
- All repairs using locking loops tend to fail at the locking loop site, making suture material strength paramount 3
For robotic or minimally invasive approaches, PTFE suture may be preferred over polypropylene as it ties more easily with robotic instruments or knot pushers 6
Common Pitfalls to Avoid
- Do not use monofilament nylon for flexor tendon repair under any circumstances 3
- Avoid relying on 2-strand techniques with PTFE, as they cannot bear the biomechanical demands despite the material's superior strength 4
- Do not assume all braided sutures are equivalent—braided polyester (Ethibond) is significantly weaker than braided polyethylene (FiberWire) 3