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

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.

Nerve repair: toward a sutureless approach

“…Furthermore, compared to direct end-to-end suturing, fibrin was quicker in application, devoid from generating secondary damage, while requiring less surgical experience to apply [94]. Nevertheless, one significant disadvantage of fibrin as a reconstructive device is the low tensile strength of the repair [91], invariably requiring coaptation maintenance with stay sutures [57]. A further complication in the clinical use of fibrin is the potential for viral and prion infection with further patient sensitivities using fibrin from bovine derivatives [62].…”

Efeito da terapia com laser de arsenieto de gálio e alumínio (660Nm) sobre a recuperação do nervo ciático de ratos após lesão por neurotmese seguida de anastomose epineural: análise funcional

“…The simple epineural anastomosis was the adopted technique because of its easy execution and because it has shown high biomechanical resistance to traction, according to Temple et al 15 . The He-Ne laser (632.8Nm) in the red emission region of the electromagnetic spectrum was the most studied wavelength on the biomodulation of biological response in the repair process 16,17 .…”

Comparative Analysis of Biomechanical Performance of Available “Nerve Glues”

“…5 The current literature is lacking an encompassing scientific analysis of nerve glue holding strength although this is the most fundamental issue debated regarding its use. The purpose of this study is, therefore, to directly compare the biomechanical performance of available tissue sealants including commercially available Tisseel (Baxter Healthcare Corporation, Westlake Village, CA) and Evicel (Ethicon, Inc., Sommerville, NJ) fibrin glues, autologous fibrin glue, and DuraSeal polyethylene glycol sealant (Confluent Surgical, Inc., Waltham, MA) when applied to sutured nerve repairs.…”