Microsurgical techniques and the use of tissue adhesive in the repair of peripheral nerves

Hurwitz, Peter Joel; Magora, A; Gonen, B; Appelboim, Jerahmiel; Ben-Hur, N

doi:10.1016/0022-4804(74)90115-2

Cited by 14 publications

(6 citation statements)

References 14 publications

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“…These discrepancies may be attributed to choice of CA, differences in application technique and quantity of glue applied. If seepage of glue occurs at the suture line, the CA can cause intense tissue reaction, with the foreign body response tending to push the glue fragments inward 13. In the current report, the glue was thinly applied to the epineurium, thereby minimizing seepage into the nerve core.…”

Section: Discussionmentioning

confidence: 89%

“…The widespread use of CA has been limited due to reports of toxicity. Some higher homologous forms of CA have been suggested to be histotoxic,13 and earlier studies report high tissue reactivity, inflammatory response and contraction in nerve diameter 3. On the other hand, later experiments have shown that when used as a substitute for sutures, CA provides adequate long‐term stability, minimal tissue reactivity and does not inhibit axonal regeneration 10.…”

Section: Discussionmentioning

confidence: 99%

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Ethyl‐cyanoacrylate is acutely nontoxic and provides sufficient bond strength for anastomosis of peripheral nerves

Rickett

Patel

et al. 2008

J Biomedical Materials Res

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Anastomosis is a common technique for the union of severed nerve trunks. This is commonly performed with sutures, a process that can be both time consuming and injurious to tissue. One promising alternative to suturing is the use of adhesives to join the severed segments. Cyanoacrylate-based glues have been used clinically as a surgical adhesive for soft tissues. However, the acute effects of these glues on nerve electrophysiology and the tensile strength of the rejoined tissues have not been evaluated. Using a guinea pig model, we analyzed the mechanical properties of transected sciatic nerves repaired with epineural application of ethyl-cyanoacrylate and the short term consequences of cyanoacrylate application on impulse conduction. Results showed that nerves coapted with ethyl-cyanoacrylate were capable of bearing in vivo forces. Additionally, no acute effects on conduction were observed in uninjured sciatic nerves exposed to ethyl-cyanoacrylate. In conjunction with long term in vivo reports from literature, the current results support the use of cyanoacrylates in nerve repair.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Ethyl‐cyanoacrylate is acutely nontoxic and provides sufficient bond strength for anastomosis of peripheral nerves

Rickett

Patel

et al. 2008

J Biomedical Materials Res

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“…However, cyanoacrylate induces a stronger tissue reaction than conventional non-resorbable sutures when used in tissue, resulting in a more pronounced foreign-body inflammatory reaction [12,13]. In some reports the inflammatory reaction around the anastomosis has been shown to be harmful [6,14] and to cause a focal hindrance to myelin and axonal regeneration [3]. Others have shown the inflammatory reaction to require active communication between the injured nerve and the recruited macrophages that are needed for degradation and reinnervation, and consequently to be an integral part of peripheral nerve regeneration [15 Á17].…”

Section: Introductionmentioning

confidence: 99%

Local tissue reactions after nerve repair with ethyl-cyanoacrylate compared with epineural sutures

Landegren¹,

Risling²,

Persson³

2007

Scandinavian Journal of Plastic and Reconstructive Surgery and

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Anastomosis of a nerve with cyanoacrylate following a lesion has previously been shown to indicate morphological and functional recovery to an extent comparable to that of conventional epineural sutures. In this study we examined the local tissue reactions after transection and repair of rat sciatic nerve, and compared sutures with a synthetic ethyl-cyanoacrylate adhesive. Many ED-1-immunoreactive macrophages were found accumulating on either side of the repair site whereas neurofilament labelling was less pronounced distal to the repair site seven days after reparation with cyanoacrylate compared with sutures. After six months, when reinnervation was completed, the difference in ED-1-immunoreactivity was still present but to a less extent. These results indicate that ethyl-cyanoacrylate seems to induce an increased inflammatory reaction, which may lead to accelerated Wallerian degeneration, and could therefore have benefits over conventional sutures for reconstruction of peripheral nerves.

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“…[15][16][17][18][19][20][21][22][23] In the case of the cyanoacrylate adhesives, the previous poor results have been due to the toxicity of using shortchained acrylates, causing extensive inflammation and fibrosis. 15,[23][24][25][26][27][28] Cyanoacrylate polymers yield formaldehyde as a by-product of hydrolytic degradation, which causes histotoxicity unless the level accumulated in the treated area is below the toxic threshold. The production rate of formaldehyde decreases with the increasing length of alkyl groups and molecular weight of the resulting cyanoacrylate polymers.…”

mentioning

confidence: 99%

Octyl 2-Cyanoacrylate for Repair of Peripheral Nerve

Piñeros-Fernandez

Rodeheaver

2005

Annals of Plastic Surgery

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The repair of peripheral nerves with sutures is time consuming. The aim of this study was to evaluate the benefits and functional outcome of repairing nerves with octyl 2-cyanoacrylate adhesive. The right peroneal nerve of 64 male, Lewis rats was sectioned and repaired. The rats were randomized into 3 experimental groups: A (n = 27), using only octyl 2-cyanoacrylate; B (n = 27), using 4, 10-0 nylon sutures; and C (n = 10), a sham operation. The recovery of nerve function was quantified through walking-track analyses; group A showed faster return of nerve function than B, especially at 15 days (P < 0.017). Histologic analysis showed a greater axonal regeneration in group A versus group B and no indication of tissue toxicity in group A. No dehiscence occurred during the 6-month study. Use of adhesive shortened the anastomosis time from 12 minutes to 4 minutes. These results indicate that the use of octyl 2-cyanoacrylate adhesive for nerve anastomoses is safe and effective and may have benefits compared with the use of sutures.

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Microsurgical techniques and the use of tissue adhesive in the repair of peripheral nerves

Cited by 14 publications

References 14 publications

Ethyl‐cyanoacrylate is acutely nontoxic and provides sufficient bond strength for anastomosis of peripheral nerves

Ethyl‐cyanoacrylate is acutely nontoxic and provides sufficient bond strength for anastomosis of peripheral nerves

Local tissue reactions after nerve repair with ethyl-cyanoacrylate compared with epineural sutures

Octyl 2-Cyanoacrylate for Repair of Peripheral Nerve

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