Continuous versus interrupted epineural repair in forearm nerve injuries.

BACKGROUND

Peripheral nerve repair traditionally employs interrupted suture techniques, but continuous suturing may offer advantages in operative efficiency without compromising outcomes. We compared functional recovery and surgical parameters between continuous and interrupted epineural repair techniques in forearm nerve injuries.

METHODS

We retrospectively analyzed 78 patients with acute forearm nerve injuries (median, radial, ulnar) treated between 2017 and 2020. Patients underwent primary epineural repair using either continuous (n = 40, 51.3%) or interrupted (n = 38, 48.7%) suture techniques. All procedures utilized 7-0 or 8-0 nylon sutures under microscopic visualization. Functional recovery was assessed using Highet-Zachary classification at minimum 12-month follow-up. Primary endpoints included motor/sensory recovery and operative duration. Secondary endpoints: operative times (isolated neurorrhaphy and total) and subgroup analyses by nerve type, injury level, and concomitant vascular repair.

RESULTS

Demographics were comparable between groups (mean age 30.4 ± 11.1 years, 89.7% male). Distribution included ulnar (46.2%), median (30.4%), and radial (23.1%) nerve injuries. Mean follow-up was 37.8 ± 18.1 months. Continuous suture technique significantly reduced operative time compared to interrupted technique (59.3 ± 9.8 vs 96.1 ± 12.3 min, p < 0.001). Functional outcomes showed no significant differences between groups, with successful nerve recovery (≥ M3 motor, ≥ S3 sensory) achieved in 94.9% of continuous group and 94.7% of interrupted group patients. Subgroup analyses confirmed similar results across nerve types, injury levels, and in the presence/absence of vascular repair.

CONCLUSION

Continuous epineural suture technique achieves equivalent functional outcomes to conventional interrupted repair while significantly reducing operative time by approximately 38%. This approach may offer practical advantages in peripheral nerve reconstruction without compromising neurological recovery, potentially reducing anesthesia exposure and healthcare costs.