J Reconstr Microsurg 2004; 20(8): 645-650
DOI: 10.1055/s-2004-861525
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Resistance to Disruption and Gapping of Peripheral Nerve Repairs: An In Vitro Biomechanical Assessment of Techniques

C.L. F. Temple1 , D. C. Ross1 , C. E. Dunning2 , J. A. Johnson2
  • 1Division of Plastic Surgery, and Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
  • 2Department of Mechanical and Materials Engineering, University of Western Ontario, London, Ontario, Canada
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
03. Januar 2005 (online)

ABSTRACT

One potential cause of suboptimal results after nerve repair is disruption or gapping of the neurorrhaphy in the postoperative period. This study assesses the biomechanical strength of five nerve repair techniques: fibrin glue, simple epineurial sutures, and three other novel neurorrhaphy methods. Fifty rabbit sciatic nerve segments were divided and repaired utilizing one of five different methods, producing five groups of ten specimens. Fibrin glue and four epineurial suture techniques (simple, horizontal mattress, “Tajima,” “Bunnell”) were employed. Repaired nerve segments were ramp-loaded to failure on an Instron 8300 materials-testing machine at a displacement rate of 5 mm/min. Gapping at the repair site was captured using high-resolution video. Differences among the five groups were assessed for significance using ANOVA and Fisher's protected least squares differences post-hoc testing. The mean force to produce disruption was higher for mattress suture repairs relative to simple repairs, but not significantly so (p = 0.31). Both were significantly stronger than fibrin glue repairs (p < 0.0001). “Tajima” and “Bunnell“ repairs were both statistically stronger than glue (p < 0.0001), simple (p < 0.0001), or mattress (p = 0.0004) repairs, but not significantly different from one another (p = 0.48). Data for gapping at the repair site were similar with all suture techniques outperforming fibrin glue (p = 0.003). “Bunnell” repairs demonstrated the most resistance to gapping, compared to glue (p < 0.0001), simple (p = 0.0001), mattress (p = 0.007) and “Tajima” repairs (p = 0.01). These data demonstrate that repairs done utilizing fibrin glue are significantly weaker than all types of suture repairs. Two novel techniques for nerve repair (epineurial “Tajima” and “Bunnell”) are significantly more resistant to disruption and gapping. Further evaluation to assess the effect of these repair techniques on function is required.

REFERENCES

  • 1 Lundborg G, Rosen B, Dahlin L, Danielsen N, Holmberg J. Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized clinical study.  J Hand Surg. 1997;  22A 99-106
  • 2 Cabaud H E, Rodkey W G, McCarroll H R, Mutz S B, Niebaurer J J. Epineurial and perineurial fascicular nerve repairs: a critical comparison.  J Hand Surg. 1976;  1 131-37
  • 3 Tupper J W, Crick J C, Matteck L R. Fascicular nerve repairs. A comparative study of epineurial and fascicular (perineurial) techniques.  Orthop Clin North Am. 1988;  19 57-69
  • 4 Kwan M K, Savio L YW. Biomechanical properties of peripheral nerves. In: Gelberman R Operative Nerve Repair and Reconstruction Philadelphia; JB Lipincott 1991: 47-54
  • 5 Wilgis S, Murphy R. The significance of longitudinal excursions in peripheral nerves.  Hand Clin. 1986;  2 761-76
  • 6 Watchmaker G P, Mackinnon S E. Advances in peripheral nerve repair.  Clin Plast Surg. 1997;  24 63-73
  • 7 Highet W B, Sanders F K. The effect of stretching nerves after suture.  Br J Surg. 1943;  30 355-358
  • 8 Zachery R B, Holmes W. Primary suture of nerves.  Surg Gynecol Obstet. 1946;  82 632-636
  • 9 Mackinnon S E, Dellon A L. Nerve repair and nerve grafting. In Mackinnon SE, Dellon AL: Surgery of the Peripheral Nerve New York; Thieme Medical Publishers 1988: 89-130
  • 10 Temple C LF, Ross D C, Dunning C E, Johnson J A, King G JW. Tensile strength of healing peripheral nerves.  J Reconstr Microsurg. 2003;  19 483-88
  • 11 Toby E B, Rotramel J, Jayarman G, Struthers A. Changes in the stress relaxation properties of peripheral nerves after transection.  J Hand Surg. 1999;  24A 694-99
  • 12 Chao R P, Braun S A, Ta K T et al.. Early passive mobilization after digital nerve repair and grafting in a fresh cadaver.  Plast Reconstr Surg. 2001;  108 386-91
  • 13 Malczewski M C, Zamboni W A, Haws M J, Johnson R M, Smoot E C, Russell R C. Effect of motion on digital nerve repair in a fresh cadaver model.  Plast Reconstr Surg. 1995;  96 1672-75
  • 14 Sanders D W, Milne A D, Dobravec A, MacDermid J, Johnson J A, King G JW. Cyclic testing of flexor tendon repairs: an in vitro biomechanical study.  J Hand Surg. 1997;  22A 1004-1010
  • 15 Savage R. In vitro studies of a new method of flexor tendon repair.  J Hand Surg. 1985;  10B 135-141
  • 16 Nishihira S, McMaffrey T V. Repair of motor nerve defects: comparison of suture and fibrin adhesive techniques.  Otolaryngol Head Neck Surg. 1989;  100 17-21
  • 17 Cruz N I, Debs N, Fiol R E. Evaluation of fibrin glue in rat sciatic nerve repairs.  Plast Reconstr Surg. 1986;  78 369-73
  • 18 Maragh H, Meyer B S, Davenport D, Gould J D, Terzis J K. Morphofunctional evaluation of fibrin glue versus microsuture nerve repairs.  J Reconstr Microsurg. 1990;  6 331-337
  • 19 Diao E, Peimer C A. Sutureless methods of nerve repair. In: Gelberman RH Operative Nerve Repair and Reconstruction Philadelphia; JB Lipincott 1991: 305-314
  • 20 Weber R A, Breidenbach W, Brown R E, Jabaley M E, Mass D P. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.  Plast Reconstr Surg. 2000;  106 1036-1045
  • 21 Mackinnon S E. Surgical management of the peripheral nerve gap.  Clin Plast Surg. 1989;  16 587-603
  • 22 Fischer D W, Beggs J L, Kenshalo Jr D L, Shetter A G. Comparative study of microepineurial anastomoses with the use of CO2 laser and suture techniques in rat sciatic nerves.  Part 1. Neurosurgery. 1985;  17 300-308
  • 23 Benke T A, Clark J W, Wisoff P J et al.. Comparative study of suture and laser-assisted anastomoses in rat sciatic nerves.  Lasers Surg Med. 1989;  9 602-615
  • 24 Maragh H, Hawn R S, Gould J D, Terzis J K. Is laser nerve repair comparable to microsuture coaptation?.  J Reconstr Microsurg. 1988;  4 189-195
  • 25 Lauto A. Repair strength dependence on solder protein concentration: a study in laser tissue-welding.  Lasers Surg Med. 1998;  22 120-125

Douglas C RossM.D. FRCSC 

St. Joseph's Health Care, Hand and Upper Limb Centre

268 Grosvenor St., London

Ontario, Canada N6A 4L6