Rose Ryan Adam, Bliss Ryan, Bromage Timothy, Hu Bin, Gopman Jared M, Melamed Eitan
UTHSCSA, San Antonio, Tex.
Baton Rouge Orthopaedic Clinic, Baton Rouge, La.
Plast Reconstr Surg Glob Open. 2021 May 10;9(5):e3566. doi: 10.1097/GOX.0000000000003566. eCollection 2021 May.
Preparation of nerve ends is an essential part of nerve repair surgery. Multiple instruments have been described for this purpose; however, no consensus exists regarding which is the least traumatic for tissue handling. We believe that various instruments used for nerve-end excision will lead to different surface roughness.
Median and ulnar nerves from fresh frozen cadavers were dissected, and 1-2 cm lengths were excised using a No. 11 blade, a razor blade, or a pair of scissors. Using electron microscopy, 3-dimensional surface analysis of roughness (Sa) for each specimen was performed using ZeeScan optical hardware and GetPhase software (PhaseView, Buisson, France). An ANOVA or Kruskal-Wallis test compared roughness measures among cutting techniques.
Forty nerves were included. Of these, 13 (32.5%) were cut using scissors, 15 (37.5%) using a razor blade, and 12 (30%) using a No. 11 blade. An ANOVA test showed statistical differences in Sa among the cutting techniques ( = 0.002), with the lowest mean Sa noted in the scissors group (7.2 µM, 95% CI: 5.34-9.06), followed by No. 11 blade (7.29 µM, 95% CI: 5.22-9.35), and razor blade (11.03 µM, 95% CI: 9.43-12.62). Median Ra (surface profile roughness) was 4.58 (IQR: 2.62-5.46). A Kruskal-Wallis test demonstrated statistical difference in Ra among techniques ( = 0.003), with the lowest by No. 11 blade (3 µM, IQR: 1.87-4.38), followed by scissors (3.29 µM, IQR: 1.56-4.96), and razor (5.41 µM, IQR: 4.95-6.21).
This novel technique of 3-dimensional surface analysis found razor blade use demonstrated poor roughness, whereas a No. 11 blade or nerve-specific scissors led to equivocally smooth nerve ends.
神经断端的制备是神经修复手术的重要组成部分。为此已描述了多种器械；然而，对于哪种器械对组织操作的创伤最小尚无共识。我们认为，用于神经断端切除的各种器械会导致不同的表面粗糙度。
解剖新鲜冷冻尸体的正中神经和尺神经，使用11号刀片、剃须刀片或剪刀切除1 - 2厘米长的神经段。使用电子显微镜，通过ZeeScan光学硬件和GetPhase软件（PhaseView，法国比松）对每个标本的粗糙度（Sa）进行三维表面分析。采用方差分析或Kruskal - Wallis检验比较不同切割技术之间的粗糙度测量值。
共纳入40条神经。其中，13条（32.5%）用剪刀切断，15条（37.5%）用剃须刀片切断，12条（30%）用11号刀片切断。方差分析显示不同切割技术之间的Sa存在统计学差异（ = 0.002），剪刀组的平均Sa最低（7.2µM，95%CI：5.34 - 9.06），其次是11号刀片（7.29µM，95%CI：5.22 - 9.35），剃须刀片最高（11.03µM，95%CI：9.43 - 12.62）。中位Ra（表面轮廓粗糙度）为4.58（IQR：2.62 - 5.46）。Kruskal - Wallis检验显示不同技术之间的Ra存在统计学差异（ = 0.003），11号刀片最低（3µM，IQR：1.87 - 4.38），其次是剪刀（3.29µM，IQR：1.56 - 4.96），剃须刀片最高（5.41µM，IQR：4.95 - 6.21）。
这种新的三维表面分析技术发现，使用剃须刀片时粗糙度较差，而11号刀片或神经专用剪刀可使神经断端表面同样光滑。
