A Disposable Instrument to Optimize the Sharp Cut of Nerves
Antonio Merolli, MD, FBSE; Joseph Steele, PhD; Joachim Kohn, PhD, FBSE
Rutgers - The State University of New Jersey, Piscataway, NJ
Introduction. The plexiform structure and the different elastic properties of nerve components (nerve fibers; perineurium; vessels; epineurium) makes the nerve very resilient to any attempt to cut it sharply by blades or scissors. Accurate surgical technique may succeed in this task; however, we searched for a dedicated surgical instrument able to facilitate and standardize the cutting procedure. A sharp cut technique has been associated with a reduced rate of complications like neuroma and exuberant scar formation.
Materials and Methods. A probe with a double-profiled tip was designed to accommodate the nerve transverse section into a circular compartment which is open for about 1/3 of its circumference. A slit is present at right angle with this compartment and has been dimensioned to accommodate a surgical blade. The instrument has been 3D printed in several sizes. Polymeric materials have been tested for the printing procedure and our final choice was poly-Lactic Acid.
Results. The smooth tip allowed the accurate positioning of the instrument in the area where the nerve is located. Availability of different sizes allowed the precise matching of the diameter of the nerve with the circular compartment. The slit provided a path for the surgical blade to cross the nerve at right angle with the elongation of the fibers.
Conclusions. The instrument allowed a fast and accurate sharp-cut of the nerve. The manufacturing technique (3D printing) provided easily several different diameters available for surgery. The disposable character of the instrument eliminated the need for any problematic cleaning of the slit from biological materials (as it would be required for the re-use of more traditional non-disposable tools). The instrument may be useful to assist the trimming of cut-ends in gap-lesions. However, it is particularly suited for the sharp cut of an intact nerve as it is required in the harvesting of a donor autograft; in taking a whole nerve biopsy; in producing experimental gap-lesions (figure 1).
Figure 1. A blade is accommodated into the slit and a Rat sciatc nerve is placed inside the circular compartment. A braided nerve-guide can be seen, which is ready to be implanted.
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