Goodbye sutures, hello glue: Redefining peripheral nerve repair with fibrin glue

Peripheral nerve injuries demand precise surgical repair to restore function, with traditional microsurgical sutures remaining the gold standard for decades. However, fibrin glue has emerged as a promising alternative, offering benefits such as reduced operation times, minimal tissue manipulation, and decreased inflammation. This systematic review and meta-analysis evaluated fibrin glue's efficacy in peripheral nerve repair, comparing it to conventional suture techniques and exploring combined approaches.

The findings suggest that fibrin glue delivers comparable outcomes to sutures in nerve regeneration, particularly in functional recovery, electrophysiology, and histopathology. However, repairs using fibrin glue alone demonstrated reduced tensile strength and higher rates of dehiscence, a limitation effectively mitigated by combining fibrin glue with one or two positional sutures. This hybrid approach ensures adequate nerve alignment, enhanced mechanical stability, and the prevention of postoperative complications.

Furthermore, fibrin glue significantly shortens operation times, offering potential clinical and economic advantages. Its application is especially beneficial in challenging repairs involving small or hard-to-access nerves, reducing technical demands without compromising outcomes. Despite these advantages, the review underscores the need for additional human studies, as most existing evidence stems from animal models, limiting direct clinical translation.

As a less invasive and efficient alternative, fibrin glue, particularly in combination with sutures, holds promise for advancing peripheral nerve repair. Future research should aim to standardize techniques, evaluate long-term outcomes, and establish cost-effectiveness, ultimately refining its role in modern microsurgery.