**5. Further investigations and today's conclusions**

There is still enough controversy about tension tolerance in peripheral nerve surgery.

Clinical outcomes oppose to the experimental background, which on deeper analysis is rather weak, as the literature on the subject is scarce.

Out of our actual clinical and scientific knowledge, we believe that further investigation could be conducted in several ways:

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Tension in Peripheral Nerve Suture

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http://dx.doi.org/10.5772/intechopen.78722

[4] Kirjavainen M, Remes V, Peltonen J, Rautakorpi S, Helenius I, Nietosvaara Y. The function of the hand after operations for obstetric injuries to the brachial plexus. Journal of

[5] Kennedy R. Suture of the brachial plexus in birth paralysis of the upper extremity. British

[7] Trumble T. Overcoming defects in peripheral nerves. In: Gelberman RH, editor. Operative

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[9] Driscoll PJ, Glasby MA, Lawson GM. An in vivo study of peripheral nerves in continuity: Biomechanical and physiological responses to elongation. Journal of Orthopaedic

[10] Hentz VR, Rosen JM, Xiao SJ, McGill KC, Abraham G. The nerve gap dilemma: A comparison of nerves repaired end to end under tension with nerve grafts in a primate

[11] Maeda T, Hori S, Sasaki S, Maruo S. Effects of tension at the site of coaptation on recovery of sciatic nerve function after neurorrhaphy: Evaluation by walking-track measurement, electrophysiology, histomorphometry, and electron probe X-ray microanalysis.

[12] Miyamoto Y. Experimental study of results of nerve suture under tension vs. nerve grafting.

[13] Okamoto H, Oka Y. Experimental study on tension and stretching to peripheral nerve.

[14] Rodkey WG, Cabaud HE, McCarroll HR Jr. Neurorrhaphy after loss of a nerve segment: Comparison of epineurial suture under tension versus multiple nerve grafts. Journal of

[15] Scherman P, Kanje M, Dahlin LB. Bridging short nerve defects by direct repair under tension, nerve grafts or longitudinal sutures. Restorative Neurology and Neuroscience.

[16] Terzis J, Faibisoff B, Williams HB. The nerve gap: suture under tension vs. graft. Plastic

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Meanwhile, we continue to use all available "tricks" and refinements to decrease the gap and the suture tension, to allow optimal nerve fiber regeneration, without any visual help to follow this biological process after reconstructive surgery.

Never should our analysis allow bad techniques with insufficiently cleared stumps, undue tension on the coaptation after three or four knots, the introduction of stronger filament material (3 or 4/0), not adapted to the local anatomy, extension of the proposed technique to smaller nerves with fine epineurium, and not supporting suture material thicker than 10 or 11/0.

But with further developments, we may define indications and good surgical background conditions with limited nerve damage, good mobilization capacity of stumps, good microsurgical coaptation, and rewarded after a good technique with a significant functional result.
