Factors To Be Considered in Nerve Anastomosis with Fibrin Adhesive

Abstract

Fibrin adhesives have already been used to a considerable extent in the treatment of intracranial nerves, solely because of the access conditions. However, where peripheral nerves are involved, the same surgeon will often continue to resort to conventional suture techniques although the problems associated with these are well known. In particular, the unavoidable traumatization of the nerves despite extremely elaborate techniques, the problem of suture granulomas despite the use of very fine sutures, and the impossibility of achieving a complete closure of the perineurium [7] with its resulting negative consequences have led to the need for an adhesive technique which, based on the pioneering work of Matras [6] and Kudema [7], was used for the first time in 1974. However, the first failures with dehiscence of the joined regions were reported very soon after its introduction, with the putative causal factor being the fibrinolytic activity of tissue. To prevent this, a number of different antifibrinolytic agents were studied and aprotinin was finally selected for addition. However, the modified adhesive then led to a large number of fibröses. This situation, with premature dissociation on the one hand and fibrosis on the other, is still a problem today. The regeneration process can be permanently hindered by both these events. In view of this, it is not surprising that a number of surgeons still prefer conventional suture techniques, partly for reasons of caution, but perhaps also because they have no recommendations for the best approach with fibrin adhesives.