Surgeon Perspectives on Alternative Nerve Repair Techniques

Abstract

Background

Over the past five decades, 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

A short questionnaire was electronically distributed to the 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 general trends and 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. Common barriers to utilizing alternate techniques included lack of data regarding outcomes and unfamiliarity with new techniques. Only 40 % of responders considered metal as safe 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.