Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
The Buncke Clinic, San Francisco, CA.
J Hand Surg Am. 2024 Apr;49(4):346-353. doi: 10.1016/j.jhsa.2024.01.001. Epub 2024 Feb 7.
Microsuture neurorrhaphy is technically challenging and has inherent drawbacks. This study evaluated the potential of a novel, sutureless nerve coaptation device to improve efficiency and precision.
Twelve surgeons participated in this study-six attending hand/microsurgeons and six trainees (orthopedic and plastic surgery residents or hand surgery fellows). Twenty-four cadaver arm specimens were used, and nerve repairs were performed at six sites in each specimen-the median and ulnar nerves in the proximal forearm, the median and ulnar nerves in the distal forearm, and the common digital nerves to the second and third web spaces. Each study participant performed nerve repairs at all six injury locations in two different cadaver arms (n = 12 total repairs for each participating surgeon). The nerve repairs were timed, tested for tensile strength, and graded for alignment and technical repair quality.
A substantial reduction in time was required to perform repairs with the novel coaptation device (1.6 ± 0.8 minutes) compared with microsuture (7.2 ± 3.6 minutes). Device repairs were judged clinically acceptable (scoring "Excellent" or "Good" by most of the expert panel) in 97% of the repairs; the percentage of suture repairs receiving Excellent/Good scores by most of the expert panel was 69.4% for attending surgeons and 36.1% for trainees. The device repairs exhibited a higher average peak tensile force (7.0 ± 3.6 N) compared with suture repairs (2.6 ± 1.6 N).
Nerve repairs performed with a novel repair device were performed faster and with higher technical precision than those performed using microsutures. Device repairs had substantially greater tensile strength than microsuture repairs.
The evaluated novel nerve repair device may improve surgical efficiency and nerve repair quality.
显微神经吻合技术具有一定难度，且存在固有缺陷。本研究旨在评估一种新型无缝线神经吻合装置在提高效率和精度方面的潜力。
共有 12 名外科医生参与了这项研究，其中 6 名为主治手外科/显微外科医生，6 名为培训医生（骨科和整形外科住院医师或手外科研究员）。使用 24 个尸体上肢标本，在每个标本的 6 个部位进行神经修复-前臂近端的正中神经和尺神经、前臂远端的正中神经和尺神经，以及第二和第三指蹼的指总神经。每位研究参与者在两个不同的尸体上肢的所有 6 个损伤部位进行神经修复（每位参与的外科医生共进行 12 次神经修复）。记录神经修复的时间，测试拉伸强度，并对吻合线的对齐度和技术修复质量进行分级。
与显微缝合相比，新型吻合装置进行神经修复所需的时间明显减少（1.6±0.8 分钟比 7.2±3.6 分钟）。在 97%的修复中，新型装置修复被临床判定为可接受（大多数专家小组评为“优秀”或“良好”）；大多数专家小组认为，接受手术的外科医生的缝合修复中有 69.4%和培训医生的 36.1%评为“优秀”/“良好”。装置修复的平均峰值拉伸力（7.0±3.6 N）明显高于缝合修复（2.6±1.6 N）。
与使用显微缝线进行的神经修复相比，使用新型修复装置进行的神经修复速度更快，技术精度更高。装置修复的拉伸强度明显大于显微缝合修复。
评估的新型神经修复装置可能提高手术效率和神经修复质量。
