Nerve repair technique
1. Coaptation (Nerve repair)
Most commonly coaptation is performed using operating microscope or loupe magnification.
The size of sutures used depends on the size of the nerve and surgeon's preference.
Generally, an epineural repair is performed. Proximal injuries may allow for a fascicular repair, while this is not an option for distal injuries.
Fascicular repair together with epineural repair may improve reinnervation.
The following considerations should be taken into account for optimal nerve coaptation:
- The ends should have enough laxity for apposition without tension
- There should be no gap at the repair site
- The least number of sutures that allow for adequate approximation (2-4) should be used
- Avoid epineural tissue interposition at the coaptation site
Some centers use fibrin glue instead of sutures.
If the nerves cannot be coapted without tension, nerve graft should be considered.
