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Surgeon Perspectives on Alternative Nerve Repair Techniques
Jonathan Isaacs, MD, Anthony Owusu, MD and Brian Mayada, MD
Department of Orthopaedics, Virginia Commonwealth University Health System, Richmond, VA
Background
Over the past 50 years microsuturing has been established as the "gold standard" for nerve repair. Alternative techniques such as fibrin glue, protein "welds", and nerve connectors have been met with variable enthusiasm. While advancements in this area continue, there is little data on surgeon attitude and acceptance of these new techniques. Methods
An electronically distributed a short questionnaire to members of the American Society for Surgery of the Hand and the American Association of Hand Surgery. Survey questions ascertained demographic information of participants (specialty, years in practice, practice setting, etc.), attitudes about current techniques (what techniques currently used, why, etc.), and attitudes about new techniques (openness to trying, factors that would persuade for/against, etc.). The surveys were distributed and administered online. Data gathered from responses was analyzed looking for not only general trends but also differences when responses were stratified based on demographic data. Results
The majority of responders still consider microsuturing as the gold standard for primary nerve repair, and it is by far the most utilized technique. However, over 90% also reported that they either currently use or would consider using alternate techniques, versus only 5% that responded that they would definitely not use anything but sutures. Common barriers to utilizing alternate techniques included lack of data regarding outcomes and unfamiliarity with new techniques. With regards to materials, our survey found that there is about a 50/50 divide amongst responders when asked about safety of metal around nerves, but most consider absorbable polymers safe. None of the underlying demographic variables including years in practice, number of nerve repair surgeries performed per month, practice setting, or specialty affected these general trends. Conclusions
Most surgeons performing nerve repairs prefer suturing as their primary repair technique, but a vast majority is open to utilizing alternate repair techniques, especially those that improve outcomes with a faster and easier procedure. While not able to direct clinical practice guidelines, this study can be used to direct focus and funding of further alternate nerve repair techniques.
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