2. Formation of tendon connection gap with Kessler Modification KM
technique Based on Table 5.5 can be known
that of all samples that exist in the treatment group Kessler modification
techniques KM most of the gap formed on the load to 600 grams and a small
portion is formed on the load to 400 grams.
According to Rizal 2010 that the increased of tendon connections gap,
provide poor clinical outcome. At tendon grafting, the formation of gap has
effect on adhesion formation in the tendon, so it will affect the function of
tendon gliding.
This Kessler Modification KM suture technique, according to the
researchers is too many punctures suture that surrounds the tendon rupture
so that allow the occurence of re- rupture, in addition, the technique of
Kessler Modification KM use the more yarn that technique of Samu
Modification SM. Besides mobilization also influence the
formation of the connection gap in the tendons that larger so as to facilitate re-
rupture in the tendon connection. One that affects the formation of this gap is
early mobilization of tendon that has been spliced, with this early
mobilization, the movement of the tendon will be maximized, so that if the
tendon suture is not strong, the tendon will be easy to form gap, when the gap
has been formed, it can reduce the strength of tendon suture. In addition to
reducing the strength of the tendon suture, the gap formation will facilitate
the occurrence adhesion or new tissue that will disturb the process of the
tendon gliding, when the tendon gliding is disturb the functionof the tendons that
rupture and have sewn will not be optimal. While the purpose of suturing
or grafting tendons is splicing the ends of a ruptured tendon in such a way so as
to allow the healing process occurs. One target of the connecting tendon is to
repair or maintain the function of the tendon gliding. the more minimal gap
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tendon connection is formed, the better the tendon gliding function because no
tissues that out of the tendon gap.
Sutures should be strong enough to withstand the movement during the early
mobilization without damaging the structure of tissue, in the tendon that
could inhibit the healing process of the
tendon itself.. If we compare it with the technique of Samu Modification SM,
suture technique of Kessler modification KM is less powerful, it can beseen in
the formation of a gap in the group of Kessler Modification KM technique
which is a small portion is formed on the load of 400 grams, while in the group
of Samu Modifications SM technique, most of small gap if formed at the load
of 700 grams. This proves that the formation of the gap connection of
Kessler Modification KM technique is less powerful than suture techniques of
Samu Modification SM. early gap that formed on Kessler Modification KM
techniques, can also be influenced by the size of the thread that used is large
enough, which is in thisresearch, the technique of Kessler modification use
proline threads 4.0 and 6.0, while the techniqueof Samu Modification only
use proline threads 6.0 that certainly smaller than threads used in the
technique of Kessler Modification KM.
3. Strenght of tendon suture in Samu Modification SM technique
Based on Table 5.3 can be known that of all samples that exist in the
treatment group Samu modification techniques SM mostly including in
strong category.
In addition to the smooth workings gentle and fine instrument , in the
process of surgery should be using a magnifying glass. This is to provide
optimal results in grafting tendons Rizal, 2004. According to Surya
2004 tendon suture strength is determined by several factors: the type
of yarn, thread strength and technique or
type of suture. By subject, tendon suture technique is satisfactory is the maximum
tensile stregth but not damage the tendon micro-circulation and able to
prevent or reduce the occurrence of a gap, easy to perform, allowing early
mobilization that controlled and do not interfere with the tendon gliding.
According to investigators, suture strength, including resistance to prevent
tendon rupture suture connection tensile strength and the ability to prevent a
connection suture gap gap formation. Tendon suture strength is influenced by
the material or materials of suture, the size of the thread and suture techniques
that used. At this time material and size of the suture can be performed
standardization, while the suture techniques has developed rapidly. With
the discovery of a wide variety of suture techniques that diverse, each researcher
reported advantages of their suture technique. Ideally a suture technique has
a good suture strength, the connection gap is small and has a small diameter
connection, so it does not interfere with tendon gliding. in the technique of Samu
Modifications SM uses a proline thread 6.0 with roun bodiet needle inte
round shape and a pointed tip. The thread size is very small, so making it
easier for the surgeon in the connecting of tendons. In addition Samu
modification techniques SM are not too many punctures or suture, so it does
not facilitate the occurrence of a tear in the tendon. In this study, researchers
used a tendon rooster as a sample because the rooster has a high mobility
suture technique Samu Modification SM is a sutures technique that are
arguably not difficult, it is suitable for the profession of nurse or surgeon,
especially the surgical orthopedics in the handling of tendon rupture, and
therefore this is not difficult, this technique is not too time-consuming
long enough , so as to provide comfort for the nurse or other surgeons. So far
the techniques used in the treatment of tendon rupture takes quite a long time so
that the possibility could occur more severe complications such as lack of
fluid volume caused by bleeding during a long processof surgery.
4. Strenght of tendon suture in Kessler Modification KM technique
Based on Table 5.4 can be known that of all samples that exist in the
treatment group, Kessler Modification techniques KM mostly including in
strong category.
Suture technique Kessler Modification KM with epitenon
sutures, is one tendon suture technique , the most preferred of the surgeon, and
often used as a standard of comparison, with a range of new techniques that will
be researched, the Kessler Modification KMtechnique is using 2 types of
threads namely threads proline 4.0 and proline 6.0 Surya, 2004. Sutures
strength include resistance to prevent the broken off tendon sutures
connection, tensile strength and the ability to prevent the occurence of
suture connection gap gap formation Rizal 2010.
of the hens, the tendon is certainly much According to
researchers the smaller than the size of the human
tendon, so researchers conbsider-ed the technique of Samu Modification SM
includes in a powerful technique because the tendon size is relatively
small. This Samu Modified SM suture technique is able to provide optimal
strength, certainly when Samu modification techniques SM is applied
to the tendon that is larger in particular Kessler Modification techniques KM
in this study as a comparison with Samu Modification techniques SM that is
certainly Kessler Modification techniques KM possessed certain
positive side. Almost entirely, tendon sutures strength is affected by the lack of
a puncture sutures in the tendon. Besides, early mobilization is also very
influential on the strength of the tendon
the human tendons will provide a more sutures, due to
the new tendon
optimal strength. From the other side,
749
performed surgery then often undergo
mobilization will cause a malfunction of suture. It is caused by the occurence of
tendon connection gap gap formation caused by frequent early mobilization.
Gap connection tendon, which is too large and occurence of re rupture in the
tendon that spliced, indicating the function of sutures, it is influenced by
the technique of tendon sutures, material and size of the thread, and the ability of
biological and mechanical of the tendon in the early stages of tendon healing, as
described by Surya at the above the Kessler Modification KM technique
using two types of threads namely proline threads 4.0 and 6.0, where
proline thread 4.0 is large enough so that facilitates the tear in the fibers of tendon
that may cause the re-rupture. In addition to the size of the thread used
that influence the strength of the tendon suture technique is early mobilization
can accelerate the formation of the connection gap, so the tendon that had
been sutured have possibility could experience rupture again. However,
early mobilization is also has very techniques, that includes in category of
strong because the formed strength in this research is 1.1 kgf.
5. Diameter of Tendon Pre - Post Technique of Samu Modifikasi SM
Based on Table 5.7 can be known that of all samples that exist in the
treatment group, Samu Modification techniques SM most has different of
pre post diameter 0,2 cm.
Tendon suturing techniques, which has a slim shape tendon connection, it
will not disturb the process of the tendon gliding in the tendon sheath, while the
shape of the protruding connection will disturb the tendon gliding process
Surya, 2004.
The formation of tendon diameter caused by the formation of tendon
connection gap. The greater the gap tendon connection is formed, the larger
the diameter of the tendon is formed, this is due to the release of tissue, from
the tendon gap, thus forming a new tissue outside of the tendon. In the
sutures technique Samu Modification
important role in preventing the
SM, there are changes in the tendon of adhesion, because with early
mobilization, tendon that has been stitched or spliced avoid the occurrence
of adhesions between tissues that are not yet ripe with tissue in the surrounding of
the tendon so it will disturb the glidding process or the movement of the tendon.
In this research, the mobilization performed to the the tendon that has
spliced, in the form of the load continuously, it will provide action and
tendons are interested to form a gap, even experience rupture again. The
0.2 cm before and after sutured because in the technique of Samu Modification
SM there is a little puncture sutures so allowing the occurence of adhesion
to the tendon. The more adhesion is formed, the sutures technique is not
effective, because adhesion will affect the tendon gliding, so the tendon
function is not back to normal. In addition to the size of the thread used
that influence the strength of the tendon suture technique, the early mobilization
can accelerate the formation of the
action that fucntion as an early connection gap, so the tendon that had
mobilization, where the technique of Kessler Modification KM experienced
the gap formation at the load average of 600 grams and disconnected in the load
average of 1000 grams or 1 kg, so it can be said that the strength of Kessler
Modification KM technique on this research is include in category of quite
strong because of the strength of the technique is 1 Kgf, it is slightly different
from Samu Modification SM
750
been spliced has possibility could experience hte rupture again. However,
early mobilization is also has very important role in preventing the
adhesion, because with early mobilization tof endon that has been
stitched or spliced avoid the occurrence of adhesions between tissues that are not
yet ripe with tissue in the surrounding of the tendon so it will disturb the
gliding process or the movement of the
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