suitable as an alternative in handling cases of tendon rupture.
physiological and adequate, the fine instrument , workplace is free of blood,
suture material that is unreactive, strong,
7. Diameter of Tendon Pre-
not delayed, it can easily be made the
Post technique of
Kessler tight suture, tendon suture technique is
Modification KM
Based on Table 5.10 can be known that of all samples that exist in the
treatment group, Samu Modification techniques SM most has different of
pre post diameter 0,1 cm.
Various experimental studies and clinical trials previously concluded that
strong and does not cause a blockage of blood flow and does not disturb the
tendon gliding, does not injure the blood vessels around the tendon, treatment by
a specialist or surgeon, good lighting and assistants who can well-cooperated
Surya, 2004.
According to the researchers, the early mobilization of the tendon that has
technique of tendon sutures Kessler
been spliced, would decrease the
Modification KM is an effective occurrence of tendon adhesion with the
surrounding tissue and will repair the technique in tendons grafting, this is
caused by the minimal adhesion tendon
gliding. However,
early formation due to changes or additions
mobilization will cause the connection diameter tendon which is minimal, so
gap gap formation
greater that many surgeons, especially surgical
facilitates re-rupture Surya, 2004. Changes in diameterwhich is
formed on the tendon with Kessler Modification techniques KM is quite
minimal, this is caused by the closing or lack of tendon gap connection that are
formed, making it impossible to grow new tissue in the surrounding tendons
and reduce the formation of tendon adhesion, and does not disturb the
tendon gliding. Thus Kessler Modification technique KM is very
safe to use in surgery, particularly orthopedic surgery, because in this
research the Kessler Modification technique KM including in effective
category, this is due to the minimal change in the diameter of the tendon.
8. Effectiveness of Kessler Modification KM suture technique
Based on the table 5:10, it is known that of all samples that exist in the
treatment group Kessler Modification techniques KM, most of the difference
tendon in test prepost 0.1 cm so include in effective category.
The basic principle for the success or effectiveness of the technique of
tendon sutures, is a surgical technique atraumatic which include: the way of
work is smooth gentle, the use of a magnifying glass, incision that
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orthopedic using this technique, in addition to many researchers are also
using this technique as a comparison technique with other techniques, this is
because the technique of Kessler Modification KM is include in
effective category.
9. Comparison of suture tendon strength between Samu Modification SM
technique and Kessler Modification KM technique
From the research ranking the strength of the tendon connections in
Kessler Modification technique SM = 10, while Samu Modification techniques
SM = 90, so the technique of Samu Modification SM is stronger than the
Kessler Modification technique KM. Statistical tests to prove the significance
of this comparison value þ α 0.00 0.05, which means that H1 is accepted
meaning that there are significant comparisons on the strength of the
tendon sutures between Samu Modification techniques SM with
Kessler Modification technique KM.
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. sutures strength
include resistance to prevent the rupture of tendon sutures connection
tensile strength and the ability to prevent occurence of gap connection
sutures gap formation Rizal 2010.
In this study found a significant difference statistically in the strength of
sutures tensile strength between techniques of Samu Modification SM
and technique of Kessler Modification KM where the technique Samu
Modification SM is stronger than in the situation is somewhat different from
the actual circumstances occur as explained above. This invivo research
in the animal experiments and clinical trials to look at the advantages and
disadvantages of Samu Modification technique and Kessler Modification
technique, have never reported the results, but the results of this study on
these two techniques, can be used to maintain the connection sutures tendons
of fingers, which will be conducted early mobilization with passive movement,
because passive movement requires tendon resistence force of 0.1-0.9 kgf.
Based on these results, obtained that tendon sutures strength is greater than
the tendon force resistence in passive
technique of Kessler Modification movement, in which the sutures strength
KM, because in Samu Modification techniques SM are not too many
punctures sutures in the tendon, while the Kessler technique Modification
KM there are more puncture sutures of the tendons so that can facilitate re-
rupture of the tendon that has been spliced. Researchers can not compare
these results with other studies, since the amount of literature study, the
researchers did, no one has to compare these two techniques in particular, but
when we see the results of technique Kessler Modification KM, in this study
the strength of sutures in average of 1 kgf and the connection gap formed at
average loads 0.6 Kg obtained result that is smaller, compared to the results
of other researchers such as D. Pohan. This is caused by two things: In this
study, researchers used a method cyclic loading and intermittent, in this study,
researchers use the tendon rooster as a model, while in the study D. Pohan
using rabbit tendon as a model. In vivo of Modification Samu technique
average of 1.1 kgf, and Kessler Modification technique average of 1
kgf. These different sutures strength is caused by Samu Modification
techniques SM which is atraumatic, causing granulation tissue and
connective tissue, which is less, so that the possibility of adhesion can be
eliminated. Granulation tissue and connective tissue, have contributed in
terms of adhesion formation, which in the end inhibit movement while conduct
early mobilization. In addition, the technique of Samu Modification SM
has a knot on both sides of the tendon that prevents sutures become loose or
even release, thus minimizing the gap formation that is formed. The Kessler
Modification KM technique which criss-cross has a tendency to disturb the
vascularization intratendon.
10. Comparison of the Tendon suture effectiveness of Samu Modification
force that received by the spliced technique
SM with
Kessler
tendons , at the time of passive motion postoperative is relatively small force
repeatedly cyclic. In this research the Modification technique KM
Based on the research the ranking of the effectiveness of Samu
force applied to the connection on Samu Modification technique
SM = 90, Modification technique SM and
Kessler Modification technique KM is a force that is both continuous and
progressive until the sutures broke back,
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while Kessler Modification technique KM = 10, so that the technique of
Modification Kessler KM is more effective than Samu Modification
technique SM. Statistical tests to prove the significance of the
comparison of this both technique is þ α 0.00 0.05. Which means that H1
is accepted that there are significant comparisons on the level of
effectiveness of tendon suture technique between Samu Modification SM with
Kessler Modification KM
Besides suturing technique, a lot of things that affect the success of tendon
grafting surgery, however there are three factors that play an important role,
namely: Strength of tendon sutures, postoperative mobilization, good
nutrition tendon Surya, 2004.
Comparative effectiveness on the research is considered of great small
changes in the diameter of the tendon, before and after connected with these
two techniques. The Technique of Kessler Modification KM is more
function properly. Gliding or movement of the tendon can be restrained because
adhesion, caused by the pull of the tendon in the first 3 weeks of healing,
inflammatory reaction caused by infection or sutures that are not sterile
and circulatory disorders from the tendon base. The effectiveness of
different suture techniques is caused by Samu modification techniques SM is
more atraumatic that causes granulation tissue and connective tissue is fewer so
the possibility of adhesion can be eliminated. Granulation tissue and
connective tissue has a contribution in terms of adhesion formation, which in
the end inhibits movement during early mobilization. In addition, the technique
of Samu Modification SM has a knot on both sides of the tendon that prevents
suture become loose or even release, thus minimizing the gap formation that
effective than the technique of Samu is formed.
Kessler Modification Modification SM, this is due to the
changes in diameter that are formed on the Kessler Modification technique
KM is minimal, if compared with the technique of Samu modification,
because in the technique of Kessler Modification KM formed a minimal
gap at the connection of the tendon, so it does not allow growth of new tissue
around the tendon that will form adhesions. The effectiveness of different
suture is caused by the Kessler technique Modification KM, the
formation of adhesions or adhesions are less or minimal cause granulation tissue
and connective tissue that is a little more so the possibility of adhesion can be
Techniques KM which criss-cross has a tendency to disturb the vascularization
of intratendon.
Conclusion 1. The formation of Tendon connection
gap with technique of Samu Modification SM
By using the test load continuously and progressively, obtained the data
gaps that formed, most of the load to 600 grams, because Samu modification
techniques SM are not too many punctures Suturing.
2. The formation of Tendon connection gap with technique of Kessler
Modification SM eliminated. Granulation tissue
and By using the test load continuously
connective tissue has a contribution in terms of adhesion formation, which in
and progressively, obtained the data gaps that formed, most of the load to
the end inhibits movement while early 600 grams, because
Kessler mobilization. Almost completely, the
healing tendon that has been sutured for the cellular response of the essence,
because the penetration or capillary pressure on the tendon. This is also
going to cause adhesion, or adhesions that prevention efforts are needed, in an
effort to tendon healing process, so that the results of the tendon connection can
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modification techniques SM are not too many punctures Suturing.
3. The strength of tendon suture with technique of Samu Modification SM
Strength of Samu Modification techniques mostly 1.1 Kgf, and includes
in category of quite strong, because there are too many punctures suturing.
