Fibrin seal adhesive versus nonabsorbable microsuture in peripheral nerve repair

Although nonabsorbable microsuture is the material most often used in human peripheral nerve repair, it is capable of eliciting a foreign body reaction, impairing vascularity, and potentially disrupting axonal regeneration. Sutureless methods, including fibrin seal adhesive, may offer an alternative to traditional suture techniques. This study compared the efficacy of fibrin seal with nylon microsuture in tibial microneurorrhaphy on 28 adult New Zealand white rabbits (14 with 10-0 monofilament nylon suture and 14 with fibrin seal). Each rabbit was reexplored at 1, 6, 12, and 18 weeks. The criteria used to compare the two methods were operative time, clinical function, electrophysiologic measures, and histologic findings. Fibrin seal repairs required less time to execute (p less than 0.01) but were inferior in mean conduction amplitude (p less than 0.01) and with respect to histologic criteria. Fibrin seal also appeared less effective in maintaining nerve approximation. We do not believe that fibrin seal provides a superior alternative to nonabsorbable suture in primary nerve repair in this experimental model.