The Relative Merits of Various Suture Materials for the Repair of Severed Nerves

Sunderland, Sydney; Smith, Grant K.

doi:10.1111/j.1445-2197.1950.tb03733.x

Cited by 18 publications

(3 citation statements)

References 15 publications

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“…Traumatic reactions due to needle insertion, as seen in our prepa rations, have been described previously by Sunderland and Smith [9]. The reactions produced by the autograft fibers may thus be mainly con sidered the result of the trauma from the insertion of the fibers.…”

Section: Discussionsupporting

confidence: 70%

Autograft Suture in Peripheral Nerves

Nebel¹,

Rosenberg²,

Tobias³

et al. 1977

Eur Surg Res

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Fresh collagen fibers prepared from rabbit tendons or aponeurosis were inserted in either median or sciatic nerves of the same animal. The tissue reactions induced by the autologous fibers were compared histologically with those caused by similarly inserted silk, catgut and homograft sutures in contralateral nerves. Sham operations, passing empty needles, were performed on control nerves. The treated nerves were removed on the 5th to the 30th postoperative day, and histological sections were prepared. The insertion of the different sutures in peripheral nerves resulted in tissue reactions of varying types and degrees, depending on the material used. Catgut and silk thread induced extensive degenerative and inflammatory reactions which persisted for more than 4 weeks. Homograft sutures underwent rapid organization with a minor degree of degeneration and inflammation, which persisted for only a short time. Autograft fibers resulted in minimal myelin degeneration and mild inflammatory processes for 5–10 days, which was only slightly different from the regular course of healing seen in sham-operated control nerves. These initial observations suggest that sutures of autograft fibers may prove advantageous in nerve repair.

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Section: Discussionsupporting

confidence: 70%

Autograft Suture in Peripheral Nerves

Nebel¹,

Rosenberg²,

Tobias³

et al. 1977

Eur Surg Res

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“…TM Surgical attempts aimed at reducing such fibroblastic reaction from sutures were recommended by Sunderland and Smith. 36 Sutureless bonding of the ends of anastomosed nerves has stimulated the interest of researchers for years. Their aim was to prevent the neurorrhaphy site from being infiltrated by fibrous tissues from the outside, to eliminate foreign-body reaction to suture material, and to limit or reduce the escape of regenerating axons into the surrounding extraneural tissues.…”

Section: Discussionmentioning

confidence: 99%

Laser-assisted nerve repair in primates

Bailes¹,

Cozzens²,

Hudson³

et al. 1989

Journal of Neurosurgery

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Studies on the peripheral nerves in rats and other species have helped in the development of laser-assisted nerve anastomosis (LANA), but offer little in evaluating the efficacy of this technique in primates. The authors present a study of LANA in the peripheral nerves of rhesus monkeys. Twelve adult rhesus monkeys underwent bilateral resection of a portion of the peroneal nerve followed by placement of autogenous sural nerve interposition fascicular grafts. The grafts were completed with conventional microsurgical suture technique on one side and with LANA on the other. At 5, 8, 10, and 12 months, the grafted nerves were evaluated for continuity, nerve conduction, and histology (both light and electron microscopy). No significant difference in continuity, conduction velocity, nerve degeneration, nerve regeneration, axon fiber number, or axon fiber density was found in any animal between grafts performed by conventional microsuture and LANA grafts. There was no difference in distal or proximal myelinated fiber density between the LANA grafts and the conventional microsuture grafts. It was concluded that LANA is as effective as microsurgical suture nerve anastomosis in a primate model of nerve repair and grafting.

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“…The ideal neural anastomosis should have accurate approximation of fascicles without t e n~i o n ,~~.~' minimal disruption of the vascular supply, and use an inert material which is easy to handle and which produces minimal trauma and tissue reaction. 26 Nitrocellulose paper has been used experimentally as a vehicle to study axon outgrowth in the central nervous system, with or without a seeding layer of immature astrocytes or a covering of basement membrane derived from amniotic membrane^.^'-^^ Nitrocellulose paper has also been used as a bridge for examining the outgrowth of peripheral axons around grafted optic nerves in the peripheral nervous system,30 when it was noticed that the paper caused minimal tissue inflammation and that the nerve ends, which are inherently 'sticky', will adhere to dry paper allowing them to be accurately approximated. Nitrocellulose paper is manufactured with variable pore sizes: the use of paper with a pore size of 0.45 pm allows the free passage of nutrients but not cells.…”

mentioning

confidence: 99%

Evaluation of a new method of neural anastomosis using nitrocellulose paper*

Jones

Hall

2009

Clinical Otolaryngology &Amp; Allied Sciences

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Nerve regeneration was examined in 108 mouse sciatic nerves in a prospective morphometric study in which a new anastomotic technique using nitrocellulose paper was compared with conventional suturing and simple sectioning. Mice were randomly allocated to one of the three arms of the trial and sciatic nerves were examined following surgery at time intervals up to 8 weeks. Serial sections were taken for qualitative and quantitative morphometric analyses. Counts demonstrated that the rate of regeneration was faster in the nitrocellulose group than following nerve section alone, but that the suture group was even better. However, 8 weeks after surgery, there were no significant differences in myelinated axon counts 4 mm distal to the site of section between any of the experimental groups. The superlative regenerative capacity of rodent axons may limit the applicability of this model to human nerve tissue.

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The Relative Merits of Various Suture Materials for the Repair of Severed Nerves

Cited by 18 publications

References 15 publications

Autograft Suture in Peripheral Nerves

Autograft Suture in Peripheral Nerves

Laser-assisted nerve repair in primates

Evaluation of a new method of neural anastomosis using nitrocellulose paper*

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