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Bone Bulletin

Abstract

Introduction

Peripheral nerves have a limited capacity to regenerate.1 Treating peripheral nerve injuries and the ensuing recovery of sensory and/or motor function are challenging for surgeons due to a number of variables that impact nerve recovery; including, the mechanism of nerve transection, the level or distance of injury relative to the target organ, patient age and comorbidities, and the repair technique employed. Most factors are not modifiable, but repair techniques are modifiable and can have a meaningful impact on outcomes. Nerve repair opt ions inc lude di r e ct end- to- end r epai r (neurorrhaphy), conduit-assisted repair, allograft reconstruction, and autograft reconstruction. In direct end-to-end suture repair, the use of sutures and augmentation with fibrin glue is often the standard surgical procedure.2 With a gap >5 mm, nerve reconstruction with conduits and grafts are the preferred technique to facilitate peripheral nerve regeneration.1,3 However, whichever technique is used, minimizing surgical trauma and minimizing tension at the repair site is central to optimizing surgical recovery. More recently, sutureless and atraumatic device systems have been developed to minimize the negative impacts of traditional nerve manipulation.9 These systems reduce tension, trauma, and subsequent nerve scarring. However, some FDAapproved conduits have the potential for devicerelated adverse effects and suboptimal regenerative success, and no implant is approved for nerve defects exceeding 3 cm.1,4 Understanding suture-free coaptation techniques, which are less technically demanding, may enhance nerve recovery and alter the training and practice of peripheral nerve surgery.

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