Flexor tendon repair with a polytetrafluoroethylene (PTFE) suture material

  • Elias Polykandriotis
  • Foued Besrour
  • Andreas Arkudas
  • Florian Ruppe
  • Katharina Zetzmann
  • Lars Braeuer
  • Raymund E. Horch



There is a consensus that after a flexor tendon repair an aggressive rehabilitation protocol with early active motion can improve functional outcome, provided that the combination of material and suturing technique can meet the higher biomechanic demands. Bearing this in mind we evaluated a polytetrafluoroethylene (PTFE) suture (SERAMON®, Serag-Wiessner) as a possible material for flexor tendon repair.

Materials and methods

40 flexor tendons were harvested from fresh cadaveric upper extremities. 3–0 and 5–0 strands were used both in the polypropylene (PPL) as well as in the PTFE group. In the first phase of the study, we evaluated knotting properties and mechanical characteristics of the suture materials themselves. In the second phase, a 2-strand Kirchmayr–Kessler suture technique was applied for a core suture of a flexor tendon (n = 16). In the third phase, we performed a tendon repair including an epitendinous running suture with 5–0 PPL or 5–0 PTFE material (n = 22). One way ANOVA tests were performed.


The linear loading strength of single strand knotted PPL 3–0 was 19.87 ± 0.59 N. The linear loading strength of knotted PTFE 3–0 was 32.47 ± 1.67 N. For PPL 3–0 maximum linear strength was achieved with five knots, for PTFE 3–0 with eight knots. When a Kirchmayr–Kessler core-only repair was performed, then in the PPL group the loading strength of the repaired tendon was 30.74 ± 9.77 N. In the PTFE group the loading strength was 23.74 ± 5.6 N (p = 0.10). However, all repairs in the PTFE group failed due to cheese wiring. When a Kirchmayr–Kessler core and epitendinous repair technique was used, then in the PPL group the loading strength of the repaired tendon was 49.90 ± 16.05 N. In the PTFE group the loading strength was 73.41 ± 19.81 N (p = 0.006).


PTFE demonstrates superior strength properties in comparison to PPL for flexor tendon repairs. However, standard 2 strand techniques have proved inadequate to bear the higher biomechanic demands.


Flexor tendon repair Polytetrafluoroethylene (PTFE) 



The study was conducted with funds from the Sana Hospital Hof. We want to thank the Xue-Hong and Hans Georg Geis, the Dr. Hans Peter Mall, and the Mrs. Boya Marshall foundations for their ongoing support of our research. Furthermore, we want to thank Ms Hafenrichter for her untiring help with the experiments.


There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Elias Polykandriotis
    • 1
    • 2
  • Foued Besrour
    • 3
  • Andreas Arkudas
    • 1
  • Florian Ruppe
    • 2
  • Katharina Zetzmann
    • 1
  • Lars Braeuer
    • 4
  • Raymund E. Horch
    • 1
  1. 1.Department of Plastic and Hand SurgeryUniversity of Erlangen Medical CenterErlangenGermany
  2. 2.Department of Plastic, Hand and Microsurgery, Sana Hospital Hof GmbHAcademic Teaching Hospital of Friedrich Alexander University Erlangen-Nurnberg FAUHofGermany
  3. 3.Besrour Plastic SurgeryFrankfurtGermany
  4. 4.Institute of Anatomy, Chair IIFriedrich Alexander University Erlangen-NurnbergErlangenGermany

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