Primary peripheral nerve repair: A systematic review of sutures, fibrin glue, and biologic-augmented approaches.

INTRODUCTION

Fibrin glue neurorrhaphy (FGN) has demonstrated functional improvements for traumatic peripheral nerve injuries (PNI) in preclinical studies; however, evidence regarding its clinical effectiveness in humans remains limited. Recent advances in regenerative medicine, particularly involving biologics such as platelet-rich plasma (PRP), represent an innovative therapeutic strategy that leverages its neuroprotective, anti-inflammatory, and immunomodulatory effects as well as trophic support for tissue regeneration. To assess the safety and effectiveness of these approaches, we conducted a systematic review comparing FGN and microsuture neurorrhaphy (MN), used either individually or in combination with biologics, for primary peripheral nerve repair.

METHODS

Systematic literature searches were conducted across multiple databases from 1990 to 2025 in accordance with PRISMA guidelines, and the protocol was registered with PROSPERO. The primary outcome of interest was motor and sensory functional recovery and safety. Other outcomes included neurophysiological examinations, pain or discomfort and operating time. The Revised Cochrane Risk of Bias Tool for Randomized Trials(RoB2) and Newcastle-Ottawa Scale(NOS) were used to assess the risk of bias.

RESULTS

A total of 164 patients from six studies were included. The mean patient age was 31.43 years, and 61.6% were female. Compared with MN, FGN achieved comparable motor and sensory recovery while offering shorter operative times and simpler technical execution. When combined with PRP, faster functional recovery was observed, and no major complications were reported.

CONCLUSION

FGN may represent a sutureless alternative to MN with comparable functional outcomes in selected patients for primary peripheral nerve repair. The adjunctive use of PRP may facilitate nerve regeneration and improve functional recovery without introducing major safety concerns. However, given the heterogeneity of nerve types and the high risk of bias among included studies, these findings should be interpreted with caution, and require confirmation in adequately powered future studies.