[Reducing tension in sutures of peripheral nerves]

A method is presented to reinforce normal suturing techniques in median and ulnar nerve repairs at the level of the forearm or wrist. If the distance between the stumps does not exceed 20 to 30 mm the coaptation can be protected from tension by two ribbons of polydioxanone (PDS) which are sutured to the epineurium bridging the site of the suture of the nerve. PDS ribbons proved to give remarkable support to experimental nerve repairs using epineural, perineural or Tsuge suture techniques. In further experiments with tibial nerves of rats the PDS ribbon did not interfere with the nerve function or with axon sprouting. Follow-up investigations of thirty-two median and ulnar nerve injuries treated with primary or secondary interfascicular sutures using PDS ribbons of 20 mm length and 1 mm width to protect the suture line revealed satisfactory reinnervation. The late results with this method were superior to a comparable group treated with autografts.