Mechanical Performance of a Novel Sutureless Adhesive-assisted Nerve Repair Solution
Alexie Wlodarczyk, MEng1, Estelle Collin, PhD1, Marie Pauchard, MEng1, Luis Martinez, MEng1, Dominic Power, MD2 and Maria Pereira, PhD3, 1TISSIUM, Paris, Ile-de-France, France, 2Queen Elizabeth University Hospital, Birmingham, West Midlands, United Kingdom, 3Tissium, Paris, France
Introduction: Direct suturing for peripheral nerve repair, although the gold standard, creates tension at the repair site which may negatively impact regeneration and risk neuroma formation (Nassimizadeh 2019). In nerve repair, fibrin glue lacks mechanical strength to be used in isolation and is more commonly used in combination with sutures (Koopman 2022). Fibrin glue may be considered as an alternative to suture when tension is reduced with interposition nerve grafts. Here we report the mechanical performance of a novel sutureless adhesive-assisted peripheral nerve repair system. This system is based on a soft biosynthetic material, poly (glycerol-co-sebacate) acrylate, that is biocompatible and biodegradable (Lang 2014, Pellenc 2019).
Methods: The proposed sutureless system comprises a coaptation chamber into which nerve ends are inserted, and an adhesive applied to both sides of the construct. The adhesive is polymerized in situ with blue light to secure the repair. The repair strength (load at break) of the proposed system was compared to direct sutures (2x 9-0 nylon) and fibrin glue. Strength was evaluated across a range of nerve diameters (1.5 to 6mm) through mechanical extension per condition). Tension at the repair site was simulated by fine element analysis and tissue morphology evaluated using scanning electron microscopy (SEM).
Results: The novel adhesive-assisted repair presented a load at break equivalent to direct sutures and was superior (5-fold higher) to fibrin glue alone (Figure 1(A)). Increasing linear positive relationship of load at break to nerve diameter was observed, highlighting the correlation between adhesive contact area and mechanical performance of the adhesive-assisted system (Figure 1(B)). The finite element analysis demonstrated stress concentration at the suture repair site, while the adhesive-assisted repair dissipated the stress along the nerve, away from the repair site. Morphological analysis by SEM demonstrated nerve alignment without tissue trauma when using the adhesive-assisted repair system.
Conclusions:The mechanical performance of the adhesive-assisted repair system is suitable for peripheral nerve repair. Loads at break equivalent to direct sutures and superior to fibrin glue are achieved, while minimizing stress concentration at the repair site and avoiding trauma to the severed nerve ends that may impact nerve regeneration.
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