Experimental study of results of nerve suture under tension vs. nerve grafting

Evoked electromyograms and myelinated fiber caliber histograms were used to compare the results of end-to-end nerve suture and nerve grafting, performed with an operating microscope. The best results were achieved after direct suture without tension. Direct suture under a tension of 25 grams produced results sometimes comparable the that of the zero tension group, but mostly quite inferior to those and even to the grafted group. The regeneration of axons in the nerve graft group was delayed more than in the sutured groups, but by the tenth month the number of regenerating fibers had increased with stable and comparatively good results. After a nerve suture under a tension of 25 grams, there is impairment of the blood flow at the suture site, and the results are not as good. In such situations I believe nerve grafting should be performed. This amount of tension also seems to be the limit which will allow accurate coaptation of a nerve by microsurgical techniques.