Comparison of Nerve Repair Techniques: Suture Vs. Avitene-Polyglycolic Acid Tube

Abstract

A study was designed to determine whether a completely sutureless technique of nerve repair using avitene and polyglycolic acid (PGA) tube could provide a better repair than the standard suture repair technique. Randomized peroneal nerves of 18 male Sprague-Dawley rats were used. The study was divided into two parts. The first part was designed to test the adhesive and tensile strength of avitene at the second postoperative day in seven animals. The tensile strength of the suture repair at 498 mN +/- 130 was found to be statistically equivalent (p = 0.77) to the repair using avitene and PGA tube at 474 mN +/- 192. The second part of the study evaluated axonal regeneration in 11 animals. Evaluation by electrophysiology revealed a significant difference (p = 0.05) between the mean percentage of Integrated Mean Compound Action Potential for the suture repaired nerve (53.1 +/- 17.6 percent) and that of the avitene and PGA tube repaired nerve (72.0 +/- 17.9). The mean axonal count and mean fiber diameter for the suture repair technique (1,879 +/- 225 and 4.3 +/- 0.4 microns, respectively) were not significantly different (p = 0.61 and 0.67, respectively) from those of the avitene-PGA tube repair technique (1,938 +/- 398 and 4.2 +/- 0.4 microns, respectively).

The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery

“…[2][3][4][5][6]9 Pham emphasized theoretical advantages of absence of inflammatory reaction at the coaptation site using a tube model which prevented fibroblasts from penetrating into the repair site. 17 In posttraumatic fibrotic tissues, intraneurial fibrosis is likely to arise. 14 In their study, Pham et al discussed that success depended upon biodegradability of the tube which allowed for the growth of the diameter of the nerves, biologic nonreactivity to avoid fibrosis, and confinement of growing fascicles.…”

A utilização do tubo de ácido poliglicólico e FK506 na regeneração de nervos periféricos

“…For fixing small defects, where the nerve distance is not sufficient to allow chemotactic and chemotrophic attraction exerted by the distal stump on the axonal growth region, the results achieved are comparable to those of the autograft (2,9,12,13,23) . Recent studies have been demonstrating the polyglycolic acid tube as an alternative for nerve graft (12,24,25) . Synthetic tubes made of absorbable material showed better results when compared to non-absorbable ones (26,27) .…”

“…In group B, the polyglycolic acid tube has already been used as an alternative for nerve graft in primates when tissue loss is less than 30 mm (12,24,25,33) . In group C, the tube was associated to a drug enhancing neural growth (17,34,35) .…”

Tubo de ácido poliglicólico e GM1 na regeneração de nervos periféricos

“…[1][2][3][4][5][6][7] The tubing technique also offers additional theoretical advantages over traditional grafting methods: it provides good coaptation of both stumps with less manipulation trauma; enables a better confinement of growing fibers inside the tube, isolating the repair site from surrounding inflammatory response; guides fiber growth towards distal stump, enabling local neurotrophic factors concentration; reduces neuroma formation and fibers escape to out of the conductor; enables the flow of regeneration enhancer substances. 5,6 Several materials have been employed for building tubes, which may be absorbable 8 or non-absorbable. 1 Many recent studies established polyglycolic acid (PGA) while an absorbable artificial material for clinical use as an alternative for nerve grafting.…”