Concern over the reaction of the nerve to suture materials and the hazards to nerve regeneration introduced by their use resulted in the search for sutureless method of uniting the nerve ends.
Several different sutureless nerve union methods, such as plasma clot, fibrin adhesive, micropore adhesive surgical tape, tissue adhesives and sutureless cuff union, etc., have been investigated; but no better method than a well-executed epineurial suture method has as yet developed.
Especially, sutureless cuff union methods have been reported since 1880 and the theoretic advantages of this type of repair are the absence of reaction to suture material, the preventing of impacting cross-stress fiber pattern, the confinement of growing fibers and fluid, and the prevention of fibroblast interposition.
Hence, an experimental study on a new sutureless cuff union method using amniotic cuff and buty1-2-cyanoacrylate was performed in repairing the sciatic nerves of 20 rats, this method for the right sciatic nerve repair and epineurial suture mothod for the left as a control respectively.
The results were evaluated monthly by EMG for 5 months and histopathologically 3 months postoperatively.
The results obtained are as follows:
1) Histopathologically, local tissue reactions, such as inflammatory reaction, foreign body reaction, proliferation of fibrous tissue, etc., in the case of amniotic cuff union method were more severe than in the case of epineurial suture method.
2) Of epineurially sutured nerves 30 percent showed neuroma formation, and nerve fragmentation phenomenon was frequently observed. But in the nerves repaired by this amniotic cuff union method, no neuroma formation was observed.
3) 3 months postoperatively, electromyograms showed almost normal electrical activities in the nerves of both groups.
It has came to light that, the nerve repair can be performed without special equipments nor experienced technique even with the naked eyes in a short time by using amniotic cuff and buty1-2 cyanoacrylate, and its functional recovery is similar to that of the epineurially sutured nerves.
However, further comprehensive study and clinical investigation will be necessary in order to put this new method into practice.
|