Effect of Motion on Digital Nerve Repair in a Fresh Cadaver Model

Mc, Malczewski; Wa, Zamboni; Mj, Haws; Rm, Johnson; Ec, Smoot; Rc, Russell

doi:10.1097/00006534-199512000-00022

Cited by 12 publications

(8 citation statements)

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“…11 Two reports utilizing cadaver models demonstrate nerve repair rupture with various degrees of range of motion, and likely underestimate physiologic tension, as perineurial inflammation and edema are naturally absent in cadaver models. 12,13 Common clinical scenarios such as the repair of multiple flexor tendons and median and/or ulnar nerves at the wrist would typically protect the nerve and tendon repairs from passive tension (bringing the wrist to neutral or into extension) for just 3 to 4 weeks. With newer, and increasingly common, stronger tendon repairs, this period may be shortened even further.…”

Section: Discussionmentioning

confidence: 99%

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

Temple

Ross

Dunning

et al. 2004

J reconstr Microsurg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Temple

Ross

Dunning

et al. 2004

J reconstr Microsurg

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“…The authors are not aware of any clinical studies which demonstrate whether splinting affects recovery after digital nerve repair or results in any significant complications. However, two studies have used human cadaver digital nerve repair models with various nerve gaps created by nerve resection (Chao et al, 2001;Malczewski et al, 1995). They compared full passive range of motion exercises (including hyperextension) with mobilization in dorsal-blocking splints and showed that no repair ruptures occurred in the unsplinted group if the resected segment was less than 5 mm.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation of Digital Nerve Repair: Is Splinting Necessary?

Clare

Mee

Belcher

2004

Journal of Hand Surgery

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Forty isolated, sharp digital nerve divisions, which had been repaired by microsurgical techniques, were reviewed between 12 and 36 months postoperatively (mean, 20 months). Half of the repairs had been splinted beyond the immediate postoperative period and half had not. Non-splinted patients returned to work significantly quicker than those who were splinted. Splinted patients reported more stiffness and cold intolerance but splinting made no difference to either the measured sensibility or movement of the digit. We would conclude that, after repair of sharp, uncomplicated digital nerve divisions, splinting beyond the immediate postoperative period is at least unnecessary and may be deleterious.

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“…It is therefore not surprising that suture repairs yield a higher strength. The nerve repair should ideally be a tension-free coaptation with enough strength to prevent dehiscence 71,72 . Six of sixteen studies reported dehiscence of fibrin glue repairs in the present study, ranging from 6% to 80%.…”

Section: Discussionmentioning

confidence: 99%