The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Introduction of a New Suture Method in Repair of Peripheral Nerves Injured with a Sharp Mechanism

Document Type : RESEARCH PAPER

Authors
Alireza Saied 1
Majid Asadi Shekar 1
Amirreza Sadeghifar 1
Ali Karbalaeikhani 2
1 Kerman Neuroscience Research Center, Dr Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran
2 AJA University of Medical Sciences, Emam Reza Hospital , Tehran, Iran
10.22038/abjs.2015.4680
Abstract
 
Background: The standard method for repair of an injured peripheal nerve is epineural repair with separate sutures. Herein we describe a method in which the nerve is sutured with continous sutures. In fact this method has not been utilized for nerve repair previously and our purpose was to compare it to the standard method. If it proved to be successful it would replace the standard method in certain circumstances.
Methods: The proposal of the clinical trial was given a reference number form the ethics comitee. 25 dogs in which the scaitic nerve was cut by a sharp blade under genaeral anesthesia were divided randomly into three groups: control (5 dogs), repair of sciatic nerve with simple sutures (10) and repair with continous sutures (10). In the control group the nerve was not repaired at all. After 6 weeks the dogs were killed and the nerve was studied by light and electronic microscopes. The amount of consumed suture material, time of repair, myelin thickness and axon diiameter were examined. Ultrastructural studies were performed to assess degeneration and regeneration findings.
Results: Time of repair and the amount of consumed suture material were significantly lower in the continous group (P<0.001). No difference was found with regard to light microscopy findings and regeneration was confirmed by electron microscopy in the continous group.
Conclusion: The method described in the present study, provided a result similar to the standard method. Though undobtfully it has some limitations, can replace the standard method in many circumstances.
Keywords
Nerve regeneration
Peripheral nerve injuries
Sutures
  1. Seddon HJ. The use of autogenous grafts for the repair of large gaps in peripheral nerves. Br J Surg. 1947;35(138):151-67.
  2. Zeev-Brann AB, Lazarov-Spiegler O, Brenner T, Schwartz M. Differential effects of central and peripheral nerves on macrophages and microglia. Glia. 1998; 23(3):181-90.
  3. Tupper JW, Crick JC, Matteck LR. Fascicular nerve repairs. A comparative study of epineurial and fascicular (perineurial) techniques. Orthop Clin North Am. 1988; 19(1):57-69.
  4. Hurst LC, Badalamente MA, Ellstein J, Stracher A. Inhibition of neural and muscle degeneration after epineural neurorrhaphy. J Hand Surg Am. 1984; 9(4):564-72.
  5. Boedts D. A comparative experimental study on nerve repair. Arch Otorhinolaryngol. 1987; 244(1):1-6.
  6. Birch R. Nerve Repair. In: Wolfe SW, Pederson WC, Hotchkiss RN, Kozin SH (editors). Green’s operative hand surgery. 6th ed. philadelphia: Elsevier, Churchil Livingstone. 2010; Chapter 32.
  7. Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg. 1994; 33(1):28-31.
  8. Noble J, Munro CA, Prasad VS, Midha R. Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma. 1998; 45(1):116-22.
  9. Jobe MT, Martinez SF. Peripheral nerve injuries. In: Canale ST, Beaty JH (editors). Campbell’soperative orthopedics. 11th ed. Philadelphia: Pensylvania. 2008; p.3651–2.
  10. Hudson AR, Hunter D, Kline DG, Bratton BR. Histological studies of experimental interfascicular graft repairs. J Neurosurg. 1979; 51(3):333-40.
  11. Bratton BR, Kline DG, Coleman W, Hudson AR. Experimental interfascicular nerve grafting. J Neurosurg. 1979; 51(3):323-32.
  12. Lundborg G, Rosén 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 Am. 1997; 22(1):99-106.
  13. Levinthal R, Brown WJ, Rand RW. Comparison of fascicular, interfascicular and epineural suture techniques in the repair of simple nerve lacerations. J Neurosurg. 1977; 47(5):744-50.
  14. Brushart TM, Tarlov EC, Mesulam MM. Specificity of muscle reinnervation after epineurial and individual fascicular suture of the rat sciatic nerve. J Hand Surg Am. 1983, 8(3):248–53.
  15. Ogata K, Naito M. Blood flow of peripheral nerve effects of dissection, stretching and compression. J Hand Surg Br. 1986, 11(1):10–4.
  16. Butler PE, Sims CD, Randolph MA, Menkes D, Onorato J, Lee WP. A comparative study of nerve healing in adult, neonatal, and fetal rabbits. Plast Reconstr Surg. 1999; 104(5):1386-92.
  17. Schlechter B, Guyuron B. A comparison of different suture techniques for microvascular anastomosis. Ann Plast Surg.1994; 33(1):28-31.
  18. Lee BY, Thoden WR, Brancato RF, Kavner D, Shaw W, Madden JL. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. Surg Gynecol Obstet. 1982; 155(3):353-7.
  19. Wheatley MJ, Mathes SJ, Hassett C. Comparison of continuous and interrupted suture techniques in microvascular end-to-side anastomosis. J Reconstr Microsurg. 1986; 2(2):93-6.
  20. Peerless SJ, Gamache FW Jr, Hunter IG. Continuous suture method for microvascular anastomosis: technical note. Neurosurgery. 1981; 8(6):695-8.
  21. Firsching R, Terhaag PD, Muller W, Frowein RA. Continuous and interrupted suture technique in microsurgical end-to-end anastomosis. Microsurgery. 1984; 5(2):80-4.
  22. Hamilton RB, O’Brien BM. An experimental study of microvascular patency using a continuous suture technique. Br J Plast Surg. 1979; 32(3):153-4.
  23. Chen L, Chiu DT. Spiral interrupted suturing technique for microvascular anastomosis: a comparative study. Microsurgery. 1986; 7(2):72-8.
  24. Canpolat L, Kunkner A, Canpolat I, Ozan E. Ultrastructural and morphometric analysis of peripheral nerve regeneration within silicone tubes. Tur J Med Sci. 1999; 29(2):203-10.
  25. Goel RK, Suri V, Suri A, Sarkar C, Mohanty S, Sharma MC, et al. Effect of bone marrow-derived mononuclear cells on nerve regeneration in the transection model of the rat sciatic nerve. J Clin Neurosci. 2009; 16(9):1211-7.
  26. Navarro X, Udina E. Chapter 6: Methods and protocols in peripheral nerve regeneration experimental research: part III-electrophysiological evaluation. Int Rev Neurobiol. 2009; 87(23):105-26.
  27. Goel Rk, Suri V, Suri A, Sarkar C, Mohanty S, Sharma MC, et al. Effect of bone marrow-derived mononuclear cells on nerve regeneration in the transection model of the rat sciatic nerve. J Clin Neurosci. 2009; 16(9):1211–7.
  28. Canpolat L, Kunkner A, Canpolat I, Ozan E. Ultrastructural and morphometric analysis of peripheral nerve regeneration within silicone tubes. Tur J Med Sci. 1999; 29(2):203-10.
  29. Silva-Neto JC, Vavsconcelos BC, Silva-Júnior VA, Beder-Ribeiro CM. Functional histopathological and morphometric study of the use of gangliosides in nerve regeneration in rats after axonotmesis. Int J Oral Maxillofac Surg. 2009; 38(6):682–8.
  1. Ding T, Luo ZJ, Zheng Y, Hu XY, Ye ZX. Rapid repair and regeneration of damaged rabbit sciatic nerves by tissue-engineered scaffold made from nano-silver and collagen type I. Injury. 2010; 41(5):522–7.
The Archives of Bone and Joint Surgery
Volume 3, Issue 4 - Serial Number 4
October 2015
Pages 254-259

  • Receive Date 31 January 2015
  • Revise Date 24 April 2015
  • Accept Date 12 July 2015