314. NERVE SUTURE WITHOUT TENSION WITH DISTANT RECRUITMENT ON AN APONEUROTIC PLATEFORM

Abstract

Purpose of the study: Injury to peripheral nerves are common. Excessive tension on the suture can be a source of connective tissue reaction and ischemia unfavourable for nerve regeneration. A nerve graft is usually proposed to avoid this problem. The technique we propose was inspired by the one reported by De Medinacelli of which it reproduces solely the principle of distant recruitment.

Material and methods: We used an aponeurotic platform or a hemitendinous platform harvested at the site of the injury. Distant anchorage was sutured with a 7/O thread. The two nerve ends were brought together by rolling the aponeurotic platform around a fine forceps. The section cut was abutted with 10/0 sutures.

Results: This method has been used in 42 patients since 1995 and was preceded by an experimental phase in the rat. It has allowed us to abut nerve ends retracted up to 2.5 cm for large nerve trunks. Preliminary results are globally similar to those of an epiperineural suture or a nerve graft, depending on the case.

Discussion: This technique avoids the complexity of the princeps method of De Medinacelli. It is also much less costly. It also broadens potential indications for direct suture and reduces the need for nerve grafts.