Epineurial versus perineurial repair of peripheral nerves

A survey of clinical and experimental work concerning the efficacy of epineurial versus perineurial suture techniques for the treatment of peripheral nerve disruption has been presented. It seems that little differences result from the utilization of either of these methods. Therefore, suture of the outer epineurium is the technique of choice for most acute nerve lacerations, since it is easier, faster, and requires less manipulation of the delicate internal neural structure. Clinical indications for outer epineurial or inner epineurial (group funicular) repair have also been discussed. The reasons why these techniques lead to similar results remain unclear. However, it would seem to be impossible to align individual axons if their vast numbers and the dynamic disruptive phenomena that occur after nerve transection are taken into account. It is now recognized that peripheral nerve regeneration studies must address events occurring at the level of the injury and additionally in the periphery and the cell body itself. The answer to the clinical problem of nerve transection will lie in our ability to manipulate axonal regeneration from the central nervous system to correct peripheral end organs. This question will not be solved by the position in which suture material is placed.