Assessment of Conduit-Assisted Primary Nerve Repair Strength With Varying Suture Size, Number, and Location

Babovic, Nikola; Klaus, Derek; Schessler, Matthew J; Schimoler, Patrick J.; Kharlamov, Alexander; Miller, Mark Carl; Tang, Peter

doi:10.1177/1558944718769382

Cited by 9 publications

(12 citation statements)

References 23 publications

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“…Nerve cap grafts were assessed for suture retention strength using the setup shown in Figure 5A. All graft walls ( n = 10) failed with a peak force between 1.145 and 2.97 N with an average peak force of 1.93 ± 0.6 N suggesting that the nerve cap grafts had mechanical properties which were suitable for suture in nerve repair applications 13 …”

Section: Resultsmentioning

confidence: 99%

“…All graft walls (n = 10) failed with a peak force between 1.145 and 2.97 N with an average peak force of 1.93 ± 0.6 N suggesting that the nerve cap grafts had mechanical properties which were suitable for suture in nerve repair applications. 13 The nerve cap graft grafts were successfully attached to both the proximal and distal ends of the sciatic nerve at the time of implantation, with the proximal end of the nerve inserted into the nerve cap graft socket. The diameter of the graft was observed to be greater than that of the peripheral nerve trunk, and the trunk fit well within the socket of the graft.…”

Section: Mechanical Propertiessuture Retentionmentioning

confidence: 99%

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Development of an acellular nerve cap xenograft for neuroma prevention

Faust¹,

Soletti²,

Cwalina³

et al. 2022

J Biomedical Materials Res

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Neuroma formation following limb amputation is a prevalent and debilitating condition that can deeply affect quality of life and productivity. Several approaches exist to prevent or treat neuromas; however, no approach is either consistently reliable or surgically facile, with high rates of neuroma occurrence and/or recurrence. The present study describes the development and testing of a xenogeneic nerve cap graft made from decellularized porcine nerve. The grafts were tested in vitro for cellular removal, cytotoxicity, mechanical properties, and morphological characteristics. The grafts were then tested in rat sciatic nerve gap reconstruction and nerve amputation models for 8 weeks. Gross morphology, electrophysiology, and histopathology assessments were performed to determine the ability of the grafts to limit pathologic nerve regrowth. In vitro testing showed well decellularized and demyelinated nerve cap graft structures without any cytotoxicity from residual reagents. The grafts had a proximal socket for the proximal nerve stump and longitudinally oriented internal pores. Mechanical and surgical handling properties suggested suitability for implantation as a nerve graft. Following 8 weeks in vivo, the grafts were well integrated with the proximal and distal nerve segments without evidence of fibrotic adhesions to the surrounding tissues or bulbous outgrowth of the nerve. Electrophysiology revealed absence of nerve conduction within the remodeled nerve cap grafts and significant downstream muscle atrophy. Histologic evaluation showed well organized but limited axonal regrowth within the grafts without fibrous overgrowth or neuromatous hypercellularity. These results provide proof of concept for a novel xenograft‐based approach to neuroma prevention.

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Section: Resultsmentioning

confidence: 99%

Section: Mechanical Propertiessuture Retentionmentioning

confidence: 99%

Development of an acellular nerve cap xenograft for neuroma prevention

Faust¹,

Soletti²,

Cwalina³

et al. 2022

J Biomedical Materials Res

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“…Hyperextension of 30° may be a more physiologic amount of hyperextension experienced in normal activities of daily living. Multiple studies have looked at nerve repairs using various repair techniques and have reported ultimate failure between 1 and 2 N. 7,9-12 Hyperextension of 30° or less would then not produce failure of these repairs. However, the maximum tension of 0.64 N approaches or exceeds the failure strength of “glue”-only repair constructs.…”

Section: Discussionmentioning

confidence: 99%

Median and Digital Nerve In Situ Tension in the Hand

Didesch

Schimoler

Miller

et al. 2020

Hand (New York, N,Y.)

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Background: Digital nerves will experience tension under normal daily activities, and understanding the amount of tension experienced in these nerves relates directly to the necessary strength in nerve repairs. To begin quantification of tension, the tension borne by the median and digital nerves in cadaveric hands was quantified under conditions of finger hyperextension, nerve distraction, and finger flexion. Methods: Five cadaveric hands were mounted in a special fixture that allowed finger hyperextension and flexion and could apply known distractions while the tension borne by each digital nerve was measured. Sequential dissection exposed the digital nerves so that measurements of tension in the median, common, and proper digital nerves were conducted with finger hyperextension, nerve distraction, and finger flexion. Results: Metacarpophalangeal (MCP) hyperextension of 30° created mean nerve tensions up to 0.64 N, 5 mm of nerve distraction created mean nerve tensions up to 1.23 N, and 90° of MCP flexion relieved up to a mean of 1.18 N of nerve tension. Conclusions: In situ tension is present in the median and digital nerves with digital motion. Finger hyperextension and nerve distraction produce tension, whereas finger flexion reduces tension. Existing nerve repairs are strong enough to withstand in situ nerve tensions produced by reasonable digital motion if the original nerve length is present.

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“…[2][3][4] When the number of sutures decreases, the strength of the nerve repair line decreases, 5 and fringing and gaps occur at both ends, exerting negative effects on the healing process. 6 For this reason, each additional suture has its benefits and disadvantages, and this situation puts the procedure into a dilemma.…”

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confidence: 99%

The Impact of the Number of Sutures on Regeneration in Nerve Repair

Eravsar,

Özdemir,

Cüce

et al. 2023

Ann Plast Surg

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Purpose The ideal number of sutures for epineural nerve repair is still unclear. Increased number of sutures increases secondary damage and inflammation to the nerve tissue, which negatively affects nerve regeneration. When the number of sutures decreases, the strength of the nerve repair site decreases and nerve endings are fringed, which also negatively affects nerve regeneration. Therefore, each additional suture is not only beneficial but also detrimental. The aim of this study was to find out the ideal number of sutures for nerve repair. Methods Seventy rats were randomly divided into 5 groups. One of the groups was used as a control group, and right sciatic nerves of the rats in other 4 groups were repaired by using 2, 3, 4, or 6 epineural sutures, respectively, after nerve transection. Biomechanical assessment was performed on the nerves collected from these rats at 5 days of follow-up. Functional and histological analyses were evaluated after 12 weeks of follow-up. Results It was found that an increase in the number of sutures enhances resistance to tensile force in general. However, there was no significant biomechanical difference between the 6-sutured group in which the most sutures were used and the 4-sutured group. In functional examinations, overall successful results were obtained in the group with 4 sutures. In histological examinations, there was no statistical difference between the control group, 2-sutured groups, and 4-sutured groups in terms of connective tissue index. However, it was observed that the group with 6 sutures had a higher connective tissue index than the control group and groups with 2 and 4 sutures. In terms of regeneration index, it was found that repair with 4 sutures was superior to repair with 2 and 6 sutures. No difference was found between any of the suture groups according to the diameter change index. Conclusions These results indicate that repair with 4 sutures is the best method of epineural repair that provides both strength and regeneration. These findings will contribute to both the repair of clinically similar nerves and the standardization of rat nerve studies.

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Assessment of Conduit-Assisted Primary Nerve Repair Strength With Varying Suture Size, Number, and Location

Cited by 9 publications

References 23 publications

Development of an acellular nerve cap xenograft for neuroma prevention

Development of an acellular nerve cap xenograft for neuroma prevention

Median and Digital Nerve In Situ Tension in the Hand

The Impact of the Number of Sutures on Regeneration in Nerve Repair

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