Peritendinous adhesions are the most common complications that were seen after flexor tendon repair. Recently, overproduction of transforming growth factor-beta has been reported as a major cause of tissue fibrosis. In this study, we investigated the effects of suramin that was known as TGF-(3 inhibitor at the flexor tendon adhesions in a chicken model.
The study was performed on the flexor profundus tendons of long toes of 42 chickens. A partial tenotomy was made (>50%) and repaired by a modified Kessler technique using 5/0 monofilament polypropylene suture. In group I (control), a simple tendon repair was performed, in group II, 1 mg of suramin was applied regionally after tendon repair and in group III, 2 mg of suramin was applied regionally after tendon repair. At 6-week follow-up, the animals were sacrificed and functional, histological, and biomechanical examinations were performed.
Histologically, the grading scale of Tang et al was used to evaluate the extent and severity of the formation of adhesions in the peritendinous region. Statistical significance was found between group I and group II (P <.026] and group I and group III (P <.015) in terms of histological evaluation. These results showed that adhesions were decreased in groups treated with suramin. In biomechanical evaluations, the statistical significance was only present between group I (control) and group III (P<.032) in terms of Rmax values. No difference was found between the groups in terms of tendon excursions.
Suramin is effective in preventing peritendinous adhesions but it can reduce tendon strength as dose dependent. Future studies with different doses should be performed for clinical application.