Fibrin Glue: An Alternative Technique for Nerve Coaptation—Part II. Nerve Regeneration and Histomorphometric Assessment Lorraine Ornelas, M.D., 1 Luis Padilla, M.D., 1 Mauricio Di Silvio, M.D., 1 Paul Schalch, M.D., 1 Sandro Esperante, M.D., 1 Raul Lo ´ pez Infante, M.D., 1 Juan Carlos Bustamante, M.D., 1 Pablo Avalos, M.D., 1 Deborah Varela, M.D., 1 and Manuel Lo ´ pez, M.D. 1 ABSTRACT The results of nerve repair with fibrin glue and microsuture were evaluated in rat nerve transection models. Ninety Wistar-Furth rat median nerves were exposed, trans- ected, and repaired in an end-to-end fashion with one of four substances/techniques: 1) human fibrin sealant (Quixil); 2) autologous graft and human fibrin sealant (Quixil); 3) bovine fibrin sealant (Tissucol); and 4) nylon microsuture, epineurial technique. Histologic analyses were performed at 3-, 6-, and 9-month postoperative intervals, and factors evaluated included: presence of inflammatory cells (i.e., macrophages and T cells); number of Schwann cells at the repair site; number of blood vessels; fibrosis; axonal regeneration; and fiber alignment. An additional group underwent histologic analysis at 3 weeks following repair with Quixil. Surgical time of repair was also measured. Nerve repairs performed with fibrin sealants produced less inflammatory response and fibrosis, and better axonal regeneration and fiber alignment than nerve repairs performed with microsuture. In addition, the fibrin sealant techniques were quicker and easier to use. The authors conclude that fibrin sealant represents a good alternative technique to microsuture for peripheral-nerve repair. KEYWORDS: Fibrin glue, nerve repair, microsuture The results of peripheral microsurgical nerve repair in humans in terms of motor and sensory recovery are unpredictable and often disappointing. In general, the more distal the nerve injury site, and the younger the patient, the better the functional prognosis. 1–4 The search for a nerve-repair technique, which offers results superior to those of more traditional repair methods, remains an important endeavor. Coaptation of severed nerve ends with microsuture is effective, but traumatic to the nerve. The use of fibrin glue to reapproximate nerve ends has been shown to be quicker and easier than the more traditional use of microsuture, 5,6 but whether it provides superior histological results (e.g., nerve fiber alignment, axonal sprouting, etc.) remains questionable. The present study was designed to further examine the histology of rat median nerve transection and repair, Journal of Reconstructive Microsurgery, Volume 22, Number 2, 2006; accepted for publication September 29, 2005. Address for correspondence and reprint requests: Lorraine Ornelas, M.D., Cerrada de la Soledad #11, La Herradura, Huixquilucan 52784, Edo. de Mexico. 1 School of Medicine, Anahuac University, Mexico City, Mexico. Copyright # 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. 0743-684X,p;2006,22,02,123,128,ftx,en;jrm01170x. 123