Thursday, May 31, 2012

nerve/ vein conduit digital nerves

http://journals.lww.com/plasreconsurg/Abstract/2000/10000/A_Randomized_Prospective_Study_of_Polyglycolic.13.aspx

A Randomized Prospective Study of Polyglycolic Acid Conduits for Digital Nerve Reconstruction in Humans

Weber, Robert A. M.D.; Breidenbach, Warren C. M.D.; Brown, Richard E. M.D.; Jabaley, Michael E. M.D.; Mass, Daniel P. M.D.

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Abstract

This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively randomized the repair to two groups: standard repair, either end-to-end or with a nerve graft, or repair using a polyglycolic acid conduit. Two-point discrimination was measured by a blinded observer at 3, 6, 9, and 12 months after repair. There were 56 nerves repaired in the control group and 46 nerves repaired with a conduit available for follow-up. Three patients had a partial conduit extrusion as a result of loss of the initially crushed skin flap.
The overall results showed no significant difference between the two groups as a whole. In the control group, excellent results were obtained in 43 percent of repairs, good results in 43 percent, and poor results in 14 percent. In those nerves repaired with a conduit, excellent results were obtained in 44 percent, good results in 30 percent, and poor results in 26 percent (p = 0.46). When the sensory recovery was examined with regard to length of nerve gap, however, nerves with gaps of 4 mm or less had better sensation when repaired with a conduit; the mean moving two-point discrimination was 3.7 ± 1.4 mm for polyglycolic acid tube repair and 6.1 ± 3.3 mm for end-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or greater were reconstructed with either a nerve graft or a conduit. This subgroup also demonstrated a significant difference in favor of the polyglycolic acid tube. The mean moving two-point discrimination for the conduit was 6.8 ± 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the mean moving two-point discrimination for the graft repair was 12.9 ± 2.4 mm, with excellent results obtained in none of the eight nerves (p < 0.001 and p = 0.06, respectively).
This investigation demonstrates improved sensation when a conduit repair is used for nerve gaps of 4 mm or less, compared with end-to-end repair of digital nerves. Polyglycolic acid conduit repair also produces results superior to those of a nerve graft for larger nerve gaps and eliminates the donor-site morbidity associated with nerve-graft harvesting.

Related research

  4. Clinical Article
    1. Yen-Hsun Lee M.D.1,2, 
    2. Shyh-Jou Shieh M.D., Ph.D.1,*
    Article first published online: 11 JUL 2008
    DOI: 10.1002/micr.20517
    Issue
    Microsurgery

    Microsurgery

    Volume 28, Issue 6, pages 436–440, 2008
    Additional Information(Show All)
    1. †
      Presented at the Annual Scientific Meeting of the Taiwan Surgical Association, March 25, 2007, Kaohsiung, Taiwan.

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    Abstract

    Digital nerve defects can result from neglected nerve injuries. The standard method of reconstruction is nerve grafting, but donor-site morbidity encourages searching for alternative graft materials, including vein conduit grafts. From 1995–2005, three patients with neglected digital nerve injuries received vein conduit grafting for digital nerve reconstruction in our hospital. The interval between the injury and the reconstructive procedure ranged from 17 days to 2 years, and the length of the defects ranged from 0.8 to 2.5 cm. All the vein grafts were harvested from the distal forearm. Patient 1 had a moving and a static two-point discrimination (M2PD and S2PD) of 3 and 4 mm, respectively, at a 12-year follow-up. Patient 2 had an M2PD of 5 mm and S2PD of 6 mm at an 11-year follow-up, and the patient 3 had both an M2PD and S2PD of 4 mm at a near 3-year follow-up. They all achieved useful sensory function (S3 and S3+) by modified Highet and Sander criteria. Although previous studies showed secondary repair using vein grafts yielded worse sensory recovery than that of primary repair, in our cases, secondary digital nerve reconstruction with vein conduit grafts gives excellent results at the long-term sensory evaluation, two of them with more than 10 years' follow-up. To the best of our knowledge, this might be the longest follow-up after secondary digital nerve reconstruction using a vein conduit graft. It bears the advantages of readily accessible, no donor-site morbidity, and compatible in size with digital nerves. © 2008 Wiley-Liss, Inc. Microsurgery, 2008.


    http://www.bjjprocs.boneandjoint.org.uk/content/91-B/SUPP_I/97.1.short


    DIGITAL NERVE RECONSTRUCTION IN THE HAND USING BIODEGRADABLE POLYGLYCOLIC ACID CONDUITS

    1. A. Beris

    Abstract

    Introduction: Digital nerve lesions with nerve gaps require reconstruction with the use of some form of graft or guide. Neurotube, a bioabsorbable polyglycolic acid (PGA) conduit, has been proposed as an effective solution for this kind of defect in emergency and planned surgery.
    Methods: Nineteen posttraumatic lesions of common (5 cases) or proper (14 cases) palmar digital nerves were repaired by means of Neurotube from January 2003 till January 2006. The nerve gap size averaged 22 mm (range 15–35 mm). Thirteen lesions had associated vascular, tendon or osseous injury.
    Results: Nerve regeneration was evaluated at a mean of 17 months postoperative interval. Positive results in recovery of sensibility were noticed in 73 % of the cases; static and moving two point discrimination was excellent (less than 6mm and 4mm respectively) in 9 cases and fair in 5 (7–15mm and 5–7mm respectively). Dysesthesia was present in 6 patients, cold intolerance in two, delayed wound healing in one and one patient complained for painful scar. There was no infection, conduit extrusion or allergic reaction.
    Discussion and Conclusion: Bioabsorbable polyglycolic acid conduit presents an attractive and useful alternative for the reconstruction of digital nerve lesions with a small nerve gap, especially when a direct anastomosis of the two stumps is not possible, or when the suture appears to be in tension. Its use is simple, safe and also eliminates the donorsite morbidity associated with nerve-graft harvesting
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