THE UNHAS TECHNIQUE FOR REPAIR TENDON

Over few decades we have seen numerous iterations of suture

repair methods for tendon. The pursuit of the ultimate repair has
led to many repair methods being described. The UNHAS
technique is one that closed to the ideal suture technique
including repair strength gapping resistance maintaining glide
reducing tendon damage minimising adhesion formation and
also provide easiness which can perform with conventional
suture material and less operating time.
Keywords! strength tendon repair unhas adhesion glide
History
"n tendon surgery many repair methods have been developed so as to cope
with cohesiveness gap formation and rupture in repair field. #urthermore active
or passive motion programs are modified to the repaired tendon in order to heal
the post$surgery results. %any techniques for tendon repair have been developed
over the years. Traditional suture techniques such as the &essler '()*+, &leinert
et al. '()*+, Tsuge et al. '()**, are widely used and the modifed &essler
technique is the current technique which preferred by many hand surgeons
'%c-arthy et al. ()). /apandrea et al. ()).,.
Ideal Suture
The ideal suture of tendon repair must consist !
(, "t should be strong enough that can allow immediate mobili0ation.
1, "t should an easy technique that allow the surgeon able to do a quic2 repair.
+, -heap "t can be perform using a conventional material.
3, "t produce less necrotic area smaller necrotic area is better
To achieve that purpose we currently develop a new technique.
Definition
UNHAS technique is a modified tendon repair technique adopted from
Tsuge method 'Tsuge et al. ()**,. "t is a core suture technique for tendon repair 1
strands with the 2not place on the volar surface of the tendon.
Te UNHAS Te!ni"ue
This suturing technique is a simple intra$tendon sutures parallel with the
tendon collagen fibers which carrying stress of the repair to the ends of the
tendon. The nodes at both ends guarantee appro4imation of ends tendon rupture
thus reducing the tendon gap formation so the tendon healing is guaranteed.
a, Suturing using nylon 3.5 starting from the surface of the tendon 'point
A, to a distance of *mm from the end of the tendon 'cut ends, and into the
tendon tissue and the needle out through the ends of the tendon 'point 6,.

b, Then across the laceration to the middle of the opposite side of the other
tendons 'point -, then out to the surface of the tendon 'point 7, with a distance of *
mm from the cut end.
c, Suturing is continued in the direction of point 8 and crossed into the inferior
side at point # when the needle is out pull the thread with the rest of the loop$
shaped at the base.
d, Here the needle went into the loop between points 7 and 8 form the 2not the
2not is lin2ed twice.
7m
7m
e, Once the 2not is tightened up it loo2s li2e a straight line between points 7
8 and #.
f, Then the needle enters again from point 9 penetrating tip 'cut end, at point H
and the bac2 entrance to the end 'cut end, opposite the first point and e4it at point A
'parallel point A,.
g, Here the two ends of the thread is tightened so that both ends of the tendons
meet 'end to end, then the needle entry and e4it to point & to point :
h, 7o surgical 2nots at point : to the end of the string at point A.
Stitches can be started from the distal or pro4imal side depending on the
circumstances at the time of suturing.
Te Study
This study including preliminary data for testing UNHAS technique on
chic2en 'rooster gallus domesticus, tendons consist of testing the strength the
gapping resistance the gliding resistance and the healing process.
#$ Stren%t & 'a((in% Resistan!e
9ap formation is one of the most frequent complications after tendon
repaired and postoperative rehabilitation. The gap is caused by stress arising either
by active or passive movement which e4ceeds the tolerance of suturing
technique. 9ap formation is critical for the surgeon and hand therapist in post$
operative rehabilitation.
The strength of the tendon reaches ;N during passive mobili0ation of the
wrist at )N with passive movement of the fingers and reached +.N with the
active movement of the fingers without resistance. Therefore the suturing
technique must be able to withstand at least 35N to resist gap formation. The safe
0one allows for active movement without resistance also need to be considered
appro4imately (.$+5N.
The Study to evaluated gapping force after tendon repaired using UNHAS
technique had been done.
The result revealed that there is a significant difference between Unhas
and 6unnell suture in the average value of gap forces after tendon repaired. The
average value of initial gap force in both methods was almost similar '<) N, but
the average value of 1 mm gap force of Unhas suture 'almost 15 N, was higher
compared to 6unnell suture.
The strength of .N to )N needed for passive mobili0ation on hand. "n our
study the initial average gap forces in the group Unhas technique was ).*;N and
the 6unnell technique is ).(;N. The power that causes initial gap has e4ceeded
the power of passive movement of the tendons of fingers. As e4pected this will
not formed a gap during passive mobili0ation under supervision.
Safe margins must be maintained by increasing the strength of the
connection technique gap resistance force of (.N$+5N and the gap that is formed
does not e4ceed 1 mm. UNHAS technique shown the average power that can
generate gap 1 mm is ()..3N. Safe enough to do early active motion. Similar to
6unnell technique the average power that can result in a gap of 1 mm is (.13N.
-onnecting loop configuration that is used to hold the tendons on both sides effect
the strength of the connection which loc2ing type is best because the loc2ing
loop technique increases the strength of resistance of suturing. This is what causes
the gap in technique UNHAS forces greater than 6unnell technique.
)$ 'lidin% Resistan!e
-linical reports shown that suturing technique is not enough to rely on the
strength of suture. =esistance to tendon gliding against the surrounding tissue is a
ma>or cause of gap formation and suture failure. 7ecreased resistance to tendon
gliding can be efficient in reducing suture failure.
The number of samples is (; samples. These samples were divided into
three groups group A was the control group 'no treatment, group 6 is the tendon
are sewn using Unhas techniques and group - was sutured tendon using the
6unnell technique.
Average 9liding resistance in the control group was 5.5)(3 ? 5.5.+@( N
the group Unhas technique is 5.1@++ ? 5.5.1(1 N the 6unnell technique was
5.35)@ ? 5.5*3(+ N.
/reviously stated that %odified &essler technique is a low friction repair
technique because it has an average gliding resistance of 5.1* ? 5.5. N. "n our
study we obtained UNHAS techniques have gliding resistance of 5.1@ ? 5.5. N
and that can be stated that UNHAS tecnique is a low friction repair techniques.
This is because the UNHAS technique is a simple suture technique and
atraumatic. As not to damage the surface of the tendon which can increase the
friction of the tendons. Unhas technique using a double$stranded and reinforced
with loc2ing suture at both ends which prevent the formation of bubbles in the gap
and produce small gliding resistance. 9liding with small resistance guarantee the
repaired tendon will pass the pulley easily during early mobili0ation.
*$ Healin% (ro!ess
An in vitro study have been conducted to determine healing process after
tendon repaired using UNHAS technique compared to bunnell technique. )
samples of rooster gallus dometicus was sacrificed at ; wee2s after tendon
repaired. Samples were histologically analy0ed.
Histological e4amination showed below that Unhas suture has more
granulation tissue and connective tissue than the 6unnell suture when compared
with normal tissue. Unhas suture showed faster tendon healing process than the
6unnell suture when compared with normal tissue.
Unhas suture considered to be strong enough to resist the movements of
early mobili0ation and less$intrusive tendon healing.
Con!lusion
Several preliminary studies had been done and we concluded that UNHAS
technique can fulfill the idea of ideal suture. Ae suggest to use UNHAS technique
especially in multiple tendon rupture and also can be used in 0one 1 laceration of
the hand.
Fi%+# Histologic appearance of tendon at ; wee2 post repaired using UNHAS
technique