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Fibrin Glue Increases the Tensile Strength of Conduit-Assisted Primary Digital Nerve Repair
Peter Tang, MD, MPH1; Jessica R Childe, DO, MS1; Steven Regal, MD1; Patrick J. Schimoler, MS2; Alexander Kharlamov, MD, PhD1; Mark C. Miller, PhD1
1Allegheny General Hospital, Pittsburgh, PA; 2University of Pittsburgh, Pittsburgh, PA

Purpose
Evaluate the tensile strength of conduit-assisted primary digital nerve repairs with varying suture number and location with and without fibrin glue.

Methods
Ninety cadaveric digital nerves were harvested and divided equally into the following repair groups: A (4/4), B (2/2), C (0/2), D (0/1), E (0/0) with the first number referring to the number of sutures at the coaptation and the second number referring to the number at each proximal and distal end of the nerve-conduit junction. Fibrin glue (Tisseel, Baxter, Deerfield, IL) was added to half of each group. The nerve specimens were transected and then repaired with 8-0 nylon suture and conduit (AxoGuard Nerve Protector, Axogen, Alchua, FL). The tensile strength of the repairs was tested at a rate of 0.33 mm/s and maximum failure load was determined. The results were analyzed with a two-way and one-way ANOVA (Minitab 17, Minitab Inc., State College, PA). Tukey's Post Hoc Test with a 95% confidence interval compared repair groups if the two-way ANOVA showed a significant difference between the groups.

Results
Both suture group and glue presence significantly affected the maximum failure load. Increasing the number of sutures increased the maximum failure load and the presence of fibrin glue also increased the failure load. Groups B' and B were not statistically different from Group A, the second strongest repair, but contains half the suture (6 vs 12).

Conclusion
This is the first study to demonstrate that fibrin glue is of any benefit to increase the tensile strength of conduit-assisted primary digital nerve repair. Also, strength of the repairs can be maintained despite less suture, which may be most important at the primary coaptation to improve nerve regeneration.


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