1.Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture
Sadagatullah AN ; Raghu S ; Paiman M ; Ismail S ; Jusoh MH
Malaysian Orthopaedic Journal 2025;19(No. 2):1-8
Introduction: There are various methods used to repair
lacerated tendons. The minimum requirement for the best
results and lowest rupture rate is the four-strand repair
technique. The cruciate type of repair is among the most
popular methods available but is very technical and requires
expertise. An easier two-double-loop method for tendon
healing is suggested in this study. This study assessed the
biomechanical properties of two well-known tendon repair
techniques—the modified Kessler and cruciate
approaches—and two lesser-known double-loop techniques
for tensile strength, stiffness, and failure mode.
Materials and methods: Twenty-four adult chickens'
Achilles tendons were randomly divided into three groups
and sutured with a four-strand core suture using the fourstrand modified Kessler technique, the four-strand cruciate
technique, and the two-double-loop approach. Twenty-four
more adult chicken Achilles tendons were acquired, and they
were randomly assigned to the same three groups along with
an extra running epitendinous repair. A synthetic, nonabsorbable monofilament polypropylene suture was used for
all repairs.
Results: The four-strand modified Kessler, and the fourstrand cruciate procedures had the lowest mean ultimate
tensile strength, whereas the two double-loop techniques had
the strongest. The results were dramatically impacted by
using an epitendinous suture during test analysis.
Conclusion: The strongest and comparatively less
technically complex technique used in this investigation was
the two-double-loop, four-strand core suture method. The
significance of the extra strength that the epitendinous suture
gave was clear. Using this in a clinical setting is
recommended for hand flexor tendon injuries.
2.Variant Origin of the Left Vertebral Artery from a Vertebro-Subclavian Trunk Associated with an Unusual Branch Arising from the Brachiocephalic Trunk
Satheesha BN ; Sirasanagandla SR ; Surekha DS ; Deepthinath R ; Sudarshan S ; Raghu J
Journal of Surgical Academia 2014;4(1):73-75
Variant origin of the left vertebral artery (LVA) from the arch of aorta is well documented in the literature.
Involvement of complex sequential developmental steps in the aortic arch formation results in different patterns of
origin of LVA. Morphological variations in the LVA are thought to alter the cerebral hemodynamics and can cause
the cerebral dysfunction. Knowledge of the morphological variations of the LVA is useful while performing the head
and neck and thoracic surgeries. We here report one of the extremely rare patterns of the LVA origin, in a male
cadaver aged about 65 years. LVA and left subclavian artery (LSA) arose as a common vertebro-subclavian trunk
from the convexity of the aortic arch. Further, brachiocephalic trunk (BT) gave an unusual artery from its anterior
surface. This artery divided into thymic and tracheal branches. Variant origin of thymic branch may be crucial during
imaging and thymectomy procedures.
3.Unusual Path of Branches of Ilioinguinal Nerve: A Clinically Important Anatomic Variant
Satheesha BN ; Srinivasa RS ; Prakashchandra S ; Surekha DS ; Deepthinath R ; Raghu J ; Abhinitha P ; Jyothsna P
Journal of Surgical Academia 2014;4(2):59-61
Ilioinguinal nerve is a collateral branch of lumbar plexus. Its anatomical variations in relation to adjacent
musculoaponeurotic structures play a crucial role in the development of neuropathies associated with lower
abdominal surgeries. In this report, we present a rare case of unusual course and branches of the ilioinguinal nerve, in
a 55-year-old male cadaver. In the lateral part of inguinal canal ilioinguinal nerve gave three branches. Two of its
branches pierced the external oblique aponeurosis, about 6 cm above the pubic symphysis, to supply the skin of the
lower part of the anterior abdominal wall. Another branch pierced the conjoint tendon, in the medial part of the
inguinal canal about 2 cm above the superficial inguinal ring. Knowledge of unusual path of these branches may be
important to avoid injuries during the surgical repair of groin hernias. Further care should be taken while dealing
with the conjoint tendon in the Bassini procedure.
4.A Biomechanical Comparison of Intralaminar C7 Screw Constructs with and without Offset Connector Used for C6-7 Cervical Spine Immobilization : A Finite Element Study.
Muhammad QASIM ; Jae Taek HONG ; Raghu N NATARAJAN ; Howard S AN
Journal of Korean Neurosurgical Society 2013;53(6):331-336
OBJECTIVE: The offset connector can allow medial and lateral variability and facilitate intralaminar screw incorporation into the construct. The aim of this study was to compare the biomechanical characteristics of C7 intralaminar screw constructs with and without offset connector using a three dimensional finite element model of a C6-7 cervical spine segment. METHODS: Finite element models representing C7 intralaminar screw constructs with and without the offset connector were developed. Range of motion (ROM) and maximum von Mises stresses in the vertebra for the two techniques were compared under pure moments in flexion, extension, lateral bending and axial rotation. RESULTS: ROM for intralaminar screw construct with offset connector was less than the construct without the offset connector in the three principal directions. The maximum von Misses stress was observed in the C7 vertebra around the pedicle in both constructs. Maximum von Mises stress in the construct without offset connector was found to be 12-30% higher than the corresponding stresses in the construct with offset connector in the three principal directions. CONCLUSION: This study demonstrated that the intralaminar screw fixation with offset connector is better than the construct without offset connector in terms of biomechanical stability. Construct with the offset connector reduces the ROM of C6-7 segment more significantly compared to the construct without the offset connector and causes lower stresses around the C7 pedicle-vertebral body complex.
Biomechanics
;
Immobilization
;
Range of Motion, Articular
;
Spine


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