Fibrin Glue: An Alternative Technique for Nerve Coaptation-Part II. Nerve Regeneration and Histomorphometric Assessment

Abstract

The results of nerve repair with fibrin glue and microsuture were evaluated in rat nerve transection models. Ninety Wistar-Furth rat median nerves were exposed, transected, and repaired in an end-to-end fashion with one of four substances/techniques: 1) human fibrin sealant (Quixil); 2) autologous graft and human fibrin sealant (Quixil); 3) bovine fibrin sealant (Tissucol); and 4) nylon microsuture, epineurial technique. Histologic analyses were performed at 3-, 6-, and 9-month postoperative intervals, and factors evaluated included: presence of inflammatory cells (i.e., macrophages and T cells); number of Schwann cells at the repair site; number of blood vessels; fibrosis; axonal regeneration; and fiber alignment. An additional group underwent histologic analysis at 3 weeks following repair with Quixil. Surgical time of repair was also measured. Nerve repairs performed with fibrin sealants produced less inflammatory response and fibrosis, and better axonal regeneration and fiber alignment than nerve repairs performed with microsuture. In addition, the fibrin sealant techniques were quicker and easier to use. The authors conclude that fibrin sealant represents a good alternative technique to microsuture for peripheral-nerve repair.

Shaping the military wound: issues surrounding the reconstruction of injured servicemen at the Royal Centre for Defence Medicine

“…Nerve graft can be interposed as a trunk, interfascicular or in a 'cable' manner as previously described. We have found fibrin glue fixation of nerve grafts to be an excellent technique which reduces operative time considerably [57].…”

Nerve repair: toward a sutureless approach

“…Fibrin glues mimic the end stages of the clotting cascade, in effect resembling a physiological blood clot, which can act as an envelope to hold the two nerve ends together [78]. Many rodent studies have indicated enhanced functional outcomes [61,74] and superior histological results [19,62], with fibrin glue compared to the direct end-to-end suturing approach. It is hypothesised that the favourable outcomes of fibrin are attributed to the way it can form a cocoon like cylinder externally, and an orientating matrix when applied internally to realign the regenerating fibres [48], while providing a barrier to the encroachment of scar tissue [78].…”

First investigation of spider silk as a braided microsurgical suture

“…8,9 Others promoted the use of carbon-dioxide laser or adhesives, for example, mostly fibrin glue, instead of microsurgical repair. 6,7,10,11 An advantage is that adhesives provide an atraumatic and faster coaptation, if compared to traditional microsuture.…”