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Impact to the nerve following suture or sutureless neuropathy techniques
Minghao Zheng, MD, PhD, FRCPath; Ruan Rui, MD
The University of Western Australia, Perth, Western Australia, Australia
Background: Tension-free neurorrhaphy is the gold standard for nerve transection repair, but suturing can disrupt axon regeneration and trigger inflammation. This study aims to evaluate impact of suture and sutureless repairs following sciatic neurorrhaphy.
Methods: A rat sciatic nerve transection model (N=60) was used to compare suture repair (1, 3, or 6 sutures), a nerve wrap (Remplir™) with a single suture or no suture repair. Histology, gait analysis, electrophysiology and muscle weight were examined at 4 and 12 weeks.
Results: Electrical conduction was restored in all groups by 4 weeks. At 4 weeks, sutureless-repaired nerves had significantly higher gastrocnemius muscle weight than 1 suture-repaired nerves. Nerves with fewer sutures showed earlier dorsiflexion recovery than nerve with more sutures. At 12 weeks, Remplir™-repaired nerves exhibited less hyperaesthesia, reduced toe curling, and stronger dorsiflexion in walking tests. Histology showed better stump alignment, with Remplir™ integrating into the epineurium without inflammation. Axon regeneration progressed well, with no adhesion of the device to surrounding tissue. Remplir™-repaired nerves restored vascular structures and resembling nearly intact nerve structure. In contrast, sutured nerves showed thickened transection sites, inflammation, and misaligned fascicles, with axons misdirecting to avoid suture-induced inflammation.
CONCLUSIONLess suture on coaptation site is better. Sutureless repair with Remplir™- showed better alignment, axon regeneration, and near-normal histology
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