Purpose
Timely primary repair of a transected peripheral nerve is the gold standard to achieve optimal outcomes1. Important technical considerations in end-to-end nerve repair include approximation under minimal tension and alignment of blood vessels1. The repair is then maintained with sutures. There currently exist several commercially available devices that assist approximation for nerve repairs.
The purpose of this presentation is to describe an innovative approximator that can be manufactured by any surgeon using readily available materials. While similar devices have previously been described using syringes2, the following description is novel.
Methodology
Construction:
The device consists of three sterile hypodermic needles. One 18G (pink) bevelled drawing-up needle, and two 30G (yellow) needles. The 18G needle is passed through the hub of each 30G needle at ninety degrees (see images).
Use:
The 30G needles are passed through the epineurium or adjacent soft tissues of the prepared proximal and distal nerve stumps, the 30G hubs are then slid down the 18G needle shaft to bring the nerve ends together (see image). The device is discarded into the sharps disposal unit on completion of the case.
Findings=
The device both immobilises and approximates the nerve ends, but also maintains alignment to facilitate an ideal repair. It can then be turned to enable suturing of the posterior part of the nerve. The sterile materials required are readily available in all operating theatres and assembly time is minimal. The cost of manufacturing this device at the time of writing is approximately AUD$0.22, compared with significantly more expensive commercial devices. Additionally, there is no requirement for sterilisation or maintenance. Larger needles can conceivably be employed in tendon repair surgery.
Conclusion
This innovative device enables accurate nerve approximation and alignment in the absence of a commercial approximator.