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American Association for Hand Surgery

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Strength comparison of fibrin glue and suture constructs in upper extremity peripheral nerve coaptations: an in-vitro study
Eric C Mitchell, MD1, Mohammad Haddara, MESc1, Kitty Wu, MD, FRCSC1, Spencer B Chambers, MD1, Louis Ferreira, PhD, P Eng2 and Joshua A Gillis, MD, FRCSC3, (1)Western University, Roth | McFarlane Hand and Upper Limb Centre, London, ON, Canada, (2)Western University, London, ON, Canada, (3)Division of Plastic Surgery, Western University, Roth | McFarlane Hand and Upper Limb Centre, London, ON, Canada

Introduction: Multiple techniques exist in the field of peripheral nerve surgery to repair lacerated nerves or perform coaptations following nerve grafts or transfers. Historically, suture neurorrhaphy has been the mainstay of coaptation, however tissue adhesives have become increasingly utilized. The purpose of this study was to compare the in-vitro failure loads of nerve coaptations using fibrin glue alone, suture alone, and a combination of fibrin glue and suture.
Methods: The median, radial and ulnar nerves from fifteen fresh-frozen cadaveric upper extremity specimens (forty-five nerves in total) were dissected in-vitro and transected 5 cm proximal to the wrist crease to simulate an injury requiring coaptation. Three coaptation techniques were used: fibrin glue alone, suture alone, and suture augmented with fibrin glue. Load to failure of each repair was measured using a linear-servo actuator with an in-line force sensor. Results were analyzed using two-way repeated measures ANOVA tests and pairwise comparisons with Bonferroni correction.
Results: The nerve coaptation technique and the specific nerve that was repaired both had a significant effect on failure load. Suture-glue repair had the highest load to failure of 11.2±2.9 N and significantly increased load to failure by 2.9±1.7 N compared to glue repair alone (p=0.009) (Figure 1). There was no significant difference between suture-glue repair and suture repair. Compared to glue repair alone, suture repair increased failure load by 1.6±2.34 N, however this was not significant (p=0.154).
Conclusion: In this in-vitro cadaveric model, nerve injury coaptation using both suture and fibrin glue resulted in the strongest repair. No significant difference was found between suture coaptation alone and glue coaptation alone. The addition of fibrin glue may provide some benefit when used to augment suture repair, but when used in isolation, is inferior to combined suture and glue constructs.


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