Ducic Ivica, Safa Bauback, DeVinney Erick
Washinton Nerve Institute, McLean, Virginia.
The Buncke Clinic, San Francisco, California.
Microsurgery. 2017 Mar;37(3):256-263. doi: 10.1002/micr.30151. Epub 2016 Dec 30.
Peripheral nerve repair can be very rewarding for both surgeon and patient when expected outcomes are achieved. In many cases, however, the results are suboptimal due to number of possible objective and technical reasons. Although we cannot influence patent's comorbidities, the extent or mechanism of the nerve injury, we may help optimize technical details when aiming towards improved outcomes. While the suture coaptation for primary nerve repair or nerve reconstruction with grafting served as the reconstructive standard for many decades, technical imperfections remain threats to reconstructive goals. Tension, fascicular misalignment generated by over tightening suture coaptation, deeply placed sutures, reactive scarring to foreign material at anastomosis site, may all negatively affect axonal regeneration. As the goal of every nerve repair is to have ideally opposed tension free nerve fascicles, protected from the deleterious effects of the wound bed. The utilization of coaptation aids to overcome the challenges of nerve repair has been suggested as an alternative to the classical suture repair. A review of clinical literature was performed to assess the evidence for this technique and the critical success factors to consider when implementing this technique. Twelve clinical studies met criteria, majority suggesting improved outcomes by the utilization of a coaptation aid. Most commonly reported improvements were improved sensory outcomes, reduced tenderness or pain at the coaptation site and reduced operative time. The current clinical evidence data suggests that utilization of a coaptation aid is a technical innovation to help provide better nerve repair and reconstructive functional outcomes.
当达到预期效果时，周围神经修复对外科医生和患者来说都可能非常有意义。然而，在许多情况下，由于多种可能的客观和技术原因，结果并不理想。虽然我们无法影响患者的合并症、神经损伤的程度或机制，但在追求更好的结果时，我们可以帮助优化技术细节。几十年来，用于初次神经修复或神经移植重建的缝合对接一直是重建的标准，但技术上的不完善仍然威胁着重建目标。张力、缝合对接过紧产生的束状错位、深层缝合、吻合部位对异物的反应性瘢痕形成，都可能对轴突再生产生负面影响。由于每次神经修复的目标都是使神经束理想地对合且无张力，并免受伤口床的有害影响。有人提出使用对接辅助工具来克服神经修复的挑战，作为经典缝合修复的替代方法。我们对临床文献进行了综述，以评估该技术的证据以及实施该技术时需要考虑的关键成功因素。有12项临床研究符合标准，大多数研究表明使用对接辅助工具可改善结果。最常报告的改善是感觉结果改善、对接部位压痛或疼痛减轻以及手术时间缩短。目前的临床证据数据表明，使用对接辅助工具是一项技术创新，有助于提供更好的神经修复和重建功能结果。
