Editor's choiceTechnical Assessment of Connector-Assisted Nerve Repair
Section snippets
Materials and Methods
Ten surgeons participated in this study. Five were experienced fellowship trained hand surgeons (>5 years of experience) and 5 were fellows with approximately 8 months of hand and upper extremity fellowship experience. All participants were given verbal instructions on what types of repairs were to be performed and were shown the grading scales that would be used to judge both conduit and suture repairs. Specifically, they were advised that the goal of repair was end-to-end alignment of
Results
Across all surgeon levels, 77% (23 of 30) of connector-assisted repairs were judged good or excellent compared with 60% (18 of 30) of the suture-only repairs and 43% (13 of 30) of the connector-only repairs (P < .05 for connector-assisted vs connector-only).
However, when comparing scores broken down by level of experience (Table 1), the experienced surgeons were statistically more likely to achieve excellent or good repairs (35 out of 45 total attempts) than the inexperienced surgeons who had
Discussion
Although clinical recovery following nerve repair is based on many factors including mechanism of injury, level of injury,17 and patient age,18 the technical quality of the actual coaptation may represent 1 of the few variables within the surgeon’s control. Any discussion on improving outcomes would be incomplete without acknowledging the need to improve the rate and accuracy of axon regeneration. However, the incidental finding in Bernstein et al’s study9 that, regardless of magnification, a
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2022, Clinical Neurology and NeurosurgeryCitation Excerpt :Residents were randomly assigned a number to enable the identification and blinded evaluation of their peripheral nerve coaptations (PNC) and technical ability through video analysis. Residents completed three different types of PNCs in a similar fashion to those described by Isaacs, et al.: suture-only (DS), connector-assisted (CA), and connector-only (CO) [7,8]. The DS coaptation consisted of direct end-to-end nerve coaptation with interrupted sutures connecting the 2 sharply-cut nerve ends.
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2018, Journal of Hand SurgeryCitation Excerpt :Careful subcutaneous dissection is performed and care is taken to identify the MABCN (Fig. 5). If an end neuroma is encountered, we perform an end-to-end connector assisted repair if the distal stump can be identified, or a processed nerve allograft in cases in which tension would be present.22 If the distal stump cannot be identified, we repair the proximal MABCN stump to a triceps motor branch in an end-to-side manner (Video 2, available on the Journal’s Web site at www.jhandsurg.org).
AxoGen, Inc., provided supplies and covered some travel expenses; no authors received financial compensation for the manuscript. J.I., B.S., P.J.E., and J.G. are all on the speakers’ bureau for AxoGen, Inc. J.I. is a co-principle investigator on an industry-sponsored study (grant through the author’s university).