Technical Assessment of Connector-Assisted Nerve Repair. 2016

Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA. Electronic address: jonathan.isaacs@vcuhealth.org.

OBJECTIVE Clinical outcomes of nerve repair have not substantially improved over the last several decades. Although clearly a multifactorial problem, basic principles including proper fascicular alignment are not always realized. The use of short conduits as connectors may enhance nerve alignment by entubulating and directing the approximation of nerve ends. METHODS Ten hand surgeons (5 experienced and 5 inexperienced) performed a series of in vitro human cadaver nerve repairs. Three small-diameter (2 mm), 3 medium-diameter (3-4 mm), and 3 large-diameter (5-6 mm) nerves were repaired (under 10× magnification) utilizing each of 3 techniques: suture-only, connector-only (sutures placed through the ends of the connector), and connector-assisted (alignment sutures at the nerve interface plus connector). Three judges (blinded to who performed the repairs) assessed each repair for fascicular alignment based on predetermined qualitative scales. RESULTS Across all surgeons, 23 of 30 connector-assisted repairs were judged good or excellent versus 18 of 30 of the suture-only and 13 of 30 of the connector-only repairs. Experienced surgeons in general did better repairs and in particular were more likely to obtain superior alignment for conduit-only repairs (73.3% vs 13.3% good or excellent) and suture-only repairs (73.3% vs 46.7% good or excellent) and were not statistically different for connector-assisted repairs (86.7% vs 66.7% good or excellent) compared with inexperienced surgeons. CONCLUSIONS In a cadaver nerve model, there was no significant difference in the technical alignment of conduit-assisted repairs between experienced and inexperienced surgeons whereas inexperienced surgeons were more likely to achieve inadequate alignment with suture-only or conduit-only repairs. CONCLUSIONS Connector-assisted repairs combining suture-approximation and entubulation may improve the technical alignment of nerve repairs performed, especially by less-experienced surgeons.

UI MeSH Term Description Entries
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D002983 Clinical Competence The capability to perform acceptably those duties directly related to patient care. Clinical Skills,Competence, Clinical,Clinical Competency,Clinical Skill,Competency, Clinical,Skill, Clinical,Skills, Clinical,Clinical Competencies,Competencies, Clinical
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013537 Sutures Materials used in closing a surgical or traumatic wound. (From Dorland, 28th ed) Staples, Surgical,Surgical Staples,Staple, Surgical,Surgical Staple,Suture
D059348 Peripheral Nerve Injuries Injuries to the PERIPHERAL NERVES. Peripheral Nerve Injury,Nerve Injuries, Peripheral,Nerve Injury, Peripheral
D019635 Neurosurgical Procedures Surgery performed on the nervous system or its parts. Procedures, Neurosurgical,Surgical Procedures, Neurologic,Neurologic Surgical Procedure,Neurologic Surgical Procedures,Neurosurgical Procedure,Procedure, Neurologic Surgical,Procedure, Neurosurgical,Procedures, Neurologic Surgical,Surgical Procedure, Neurologic
D019736 Prostheses and Implants Artificial substitutes for body parts, and materials inserted into tissue for functional, cosmetic, or therapeutic purposes. Prostheses can be functional, as in the case of artificial arms and legs, or cosmetic, as in the case of an artificial eye. Implants, all surgically inserted or grafted into the body, tend to be used therapeutically. IMPLANTS, EXPERIMENTAL is available for those used experimentally. Implants, Artificial,Prostheses and Implant,Prosthesis,Prosthetic Implant,Endoprostheses,Endoprosthesis,Prostheses,Prosthetic Implants,Artificial Implant,Artificial Implants,Implant and Prostheses,Implant, Artificial,Implant, Prosthetic,Implants and Prostheses,Implants, Prosthetic

Related Publications

Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
March 2017, Microsurgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
February 1984, Journal of hand surgery (Edinburgh, Scotland),
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
March 1995, Plastic and reconstructive surgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
February 2012, World journal of surgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
May 2010, The Journal of hand surgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
January 2011, The Journal of hand surgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
January 2021, International braz j urol : official journal of the Brazilian Society of Urology,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
October 2016, The spine journal : official journal of the North American Spine Society,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
August 1989, Journal of neurosurgery,
Jonathan Isaacs, and Bauback Safa, and Peter J Evans, and Jeffrey Greenberg
January 1995, Neurosurgical review,
Copied contents to your clipboard!