From the Research
The best suture for nerve repair is typically a fine, monofilament nylon suture, specifically 8-0 to 10-0 nylon, with 9-0 nylon being considered optimal as it provides the right balance between strength and minimal tissue trauma, as supported by the most recent study 1. When performing nerve repair, the epineurium (outer covering of the nerve) should be gently approximated using these fine sutures with minimal tension.
- The repair should be performed under magnification, such as surgical loupes or an operating microscope, to ensure precise coaptation of nerve ends.
- Microsurgical instruments are essential for handling these delicate structures and fine sutures.
- The repair technique should focus on avoiding tension at the repair site, maintaining proper fascicular alignment, and minimizing trauma to the nerve tissue.
- Absorbable sutures are generally avoided for the primary nerve repair as they may cause increased inflammatory reaction. The goal of nerve repair is to create a tension-free approximation that allows axons to regenerate across the repair site while minimizing scar formation, which is why these extremely fine, non-reactive sutures are preferred over other options, as also suggested by 2 and 3. Additionally, the use of a microvascular background material can provide better visualization of the proximal and distal ends while performing the repair, and it is important to sharply guillotine the ends of the nerve to freshen up the laceration and provide healthy nerve ends for repair, as mentioned in 1. It is also worth noting that alternative methods, such as the use of fibrin glue, have been investigated and shown to reduce inflammation and improve axonal regeneration, as reported in 4.