Autologous Fibrin Glue Versus Microsuture in the Surgical Reconstruction of Peripheral Nerves: A Randomized Clinical Trial.

PURPOSE: This study compared the motor and sensory recovery and the operative time of autologous fibrin glue application with conventional microsuturing technique in repairing peripheral nerves at the forearm and wrist levels

METHODS

Eighty-five patients with injuries of the median, ulnar, or both nerves at the wrist and forearm levels underwent nerve repair between September 2014 and June 2018. Patients were randomly assigned at the time of diagnosis to a microsuture group (42 patients), in which standard epineurial microsurgical suturing was performed, or a fibrin glue group (43 patients), in which nerve repair was performed using autologous fibrin glue. The primary outcome measure was motor and sensory recovery. Operative time was the secondary outcome measure. Other outcome measures that were added post hoc, after trial initiation, included time to motor and sensory recovery; grip strength; pinch strength; Michigan hand outcome score; amplitude, latency, and duration of the compound motor unit action potential; and complications. All patients were followed up a minimum of 1 year.

RESULTS

At the final follow-up, both groups had regained similar motor and sensory function. The mean operative time was shorter in the fibrin glue group. Both groups had similar amplitude, latency, and duration of the compound motor unit action potential. Michigan Hand Outcome scores and mean percent recovery of grip strength and pinch strength were also similar. Six of 43 patients in the fibrin glue group compared with 8 of 42 patients in the microsuture group developed postoperative complications.

CONCLUSIONS

The use of fibrin glue to repair peripheral nerves is as effective as microsuturing in regaining motor and sensory functions and is associated with shorter operative time.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.