From the Research
For nerve repair, the best suture is typically a fine, non-absorbable monofilament nylon or polypropylene suture, sized 8-0 to 10-0, with 8-0 suture being preferred for its higher maximum failure load compared to 9-0 suture, as shown in a study published in 2019 1. The ideal needle is a small, tapered needle with a round body, which allows for precise placement through the epineurium while minimizing tissue damage. For microsurgical nerve repair, a micro-needle holder should be used for handling these delicate sutures. The epineural repair technique is most commonly employed, where sutures are placed only in the outer covering (epineurium) of the nerve, avoiding damage to the internal fascicles that contain the actual nerve fibers. Some key points to consider when performing nerve repair include:
- Tension-free repair is critical for successful nerve regeneration, and if direct repair would create tension, nerve grafting should be considered instead, as supported by a study published in 2024 2.
- Magnification with surgical loupes or an operating microscope is essential for precise suture placement.
- The number of sutures used can impact the strength of the repair, with increasing the number of sutures significantly increasing the maximum failure load, as shown in a study published in 2019 1.
- The use of absorbable sutures, such as vicryl, may be as effective as non-absorbable sutures, such as nylon, for nerve recovery after injury and grafting, as demonstrated in a study published in 2024 2.
- Recent advances in nerve repair, including nerve transfers, have shown promising results and are being widely performed due to an increased understanding of cortical plasticity, motor re-education, and perioperative rehabilitation, as discussed in a review published in 2019 3.