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Microangiographic Comparison of the Effects of 3 Loop Pulley and 6 Strand Savage Tenorrhaphy Techniques on Equine Superficial Digital Flexor Tendon

Freeman, Kendra D., Barrett, Jennifer G., Youngstrom, Daniel W., White, Nathaniel A.
Veterinary surgery 2015 v.44 no.6 pp. 744-750
anesthesia, barium sulfate, forelimbs, formalin, horses, surgery, tendons
OBJECTIVE: The 6‐strand Savage (SSS) tenorrhaphy pattern is biomechanically superior to the commonly employed 3‐loop pulley (3LP); however, its effects on intrinsic tendon vasculature remain unknown. The objective of this study was to compare perfusion of intrinsic vasculature of the equine superficial digital flexor tendon (SDFT) after 3LP and SSS tenorrhaphies. We hypothesized that the SSS technique would significantly decrease vascular perfusion compared to the 3LP technique. STUDY DESIGN: Ex vivo, randomized, paired design. ANIMALS: Horses (n = 9) METHODS: Under general anesthesia, 9 pairs of forelimb SDFT were transected. Two tendons served as baseline control, the remainder had either SSS or 3LP tenorrhaphy performed. Horses were heparinized, euthanatized, and forelimbs perfused with barium sulfate solution were then fixed with formalin under tension. Tendons were transected every 5 mm and microangiographic images obtained. Microvascular analysis of sections proximal to, throughout, and distal to the tenorrhaphy was completed using a custom macro. Differences in vascular count were assessed using MANOVA. RESULTS: A significant reduction in the number of perfused vessels was seen for SSS compared with 3LP at 2 locations within the tenorrhaphy (P = .039 and P = .009). The SSS technique took on average 4.7 ± 0.9 times longer to place. CONCLUSIONS: The SSS technique causes an acute reduction in tendon perfusion compared to the 3LP, which may limit its clinical use. Further research is required to elucidate the clinical significance of this difference.