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Papers of the Week

2020 Apr 25


Sutureless repair of a partially transected median nerve using Tisseel glue and Axoguard nerve protector: A case report.


Suryavanshi JR, Cox C, Osemwengie BO, Jones HB, MacKay BJ
Microsurgery. 2020 Apr 25.
PMID: 32333694.


Peripheral nerve injuries in which the nerve is not completely severed often result in neuromas-in-continuity. These can cause sensory and functional deficits and must be resected and reconstructed. In defects greater than 5 mm in length, nerve graft is indicated, and suture neurorrhaphy is typically used to secure the nerve ends. However, sutures may negatively impact nerve regeneration. Fibrin glue has recently been used to mitigate the inflammatory response associated with suture neurorrhaphy. Most of the literature regarding fibrin glue covers animal models and supports its use for nerve reconstruction. Tisseel, a fibrin sealant developed as an adjunct to hemostasis, has recently shown utility in peripheral nerve repair by increasing tensile strength without additional sutures. We present the successful use of Tisseel sealant in a neuroma resection and reconstruction. In this case, a 35-year-old female presented with persistent neuropathic pain and neurologic dysfunction related to the median nerve in her hand with a history of distal forearm laceration and prior carpal tunnel release. Upon exploration, a neuroma-in-continuity involving 75% of the nerve was identified, resected, and reconstructed using processed human nerve allograft, as well as Tisseel sealant and Axoguard nerve protector to secure the repair and offload tension. At 1-year follow-up, pain was resolved, with ≤8 mm static 2-point discrimination in the median nerve distribution, and excellent improvement in hand strength compared with preoperative conditions. The outcome of this case indicates that fibrin glue may be useful to avoid excess sutures in cases of neuroma-in-continuity not involving the entire cross-section of the nerve.