title: Technical Assessment of Connector-Assisted Nerve Repair.
abstract: OBJECTIVE
  Clinical outcomes of nerve repair have not substantially improved over the last several decades. Although clearly a multifactorial problem, basic principles including proper fascicular alignment are not always realized. The use of short conduits as connectors may enhance nerve alignment by entubulating and directing the approximation of nerve ends.
  
  
  METHODS
  Ten hand surgeons (5 experienced and 5 inexperienced) performed a series of in vitro human cadaver nerve repairs. Three small-diameter (2 mm), 3 medium-diameter (3-4 mm), and 3 large-diameter (5-6 mm) nerves were repaired (under 10× magnification) utilizing each of 3 techniques: suture-only, connector-only (sutures placed through the ends of the connector), and connector-assisted (alignment sutures at the nerve interface plus connector). Three judges (blinded to who performed the repairs) assessed each repair for fascicular alignment based on predetermined qualitative scales.
  
  
  RESULTS
  Across all surgeons, 23 of 30 connector-assisted repairs were judged good or excellent versus 18 of 30 of the suture-only and 13 of 30 of the connector-only repairs. Experienced surgeons in general did better repairs and in particular were more likely to obtain superior alignment for conduit-only repairs (73.3% vs 13.3% good or excellent) and suture-only repairs (73.3% vs 46.7% good or excellent) and were not statistically different for connector-assisted repairs (86.7% vs 66.7% good or excellent) compared with inexperienced surgeons.
  
  
  CONCLUSIONS
  In a cadaver nerve model, there was no significant difference in the technical alignment of conduit-assisted repairs between experienced and inexperienced surgeons whereas inexperienced surgeons were more likely to achieve inadequate alignment with suture-only or conduit-only repairs.
  
  
  CONCLUSIONS
  Connector-assisted repairs combining suture-approximation and entubulation may improve the technical alignment of nerve repairs performed, especially by less-experienced surgeons.
authors.affiliation: Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA. Electronic address: jonathan.isaacs@vcuhealth.org.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Isaacs
authors.affiliation: Buncke Medical Clinic, San Francisco, CA.
authors.forename: Bauback
authors.initials: B
authors.lastname: Safa
authors.affiliation: Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, OH.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Evans
authors.affiliation: Indiana Hand to Shoulder Center, Indianapolis, IN.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Greenberg
mesh_terms: D002102:Cadaver; D002983:Clinical Competence; D006801:Humans; D008866:Microsurgery / Q000295:instrumentation*; D019635:Neurosurgical Procedures / Q000295:instrumentation*; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D019736:Prostheses and Implants; D013537:Sutures
keywords: connector-assisted; microsuture; nerve connector; nerve repair