Vein conduits for repair of nerves with a prolonged gap or in unfavorable conditions: An analysis of three failed cases

Clinical failure of vein conduits for repair of four nerves in three cases is reported. Two digital nerves with gaps of 5.0 cm and 5.8 cm, respectively, and two median nerves with gaps of 4.0 cm and 5.0 cm were repaired with vein conduits. The digital nerves were repaired secondarily with insertion of nerve tissue slices. The median nerve lacerations were associated with compound soft tissue injuries and were repaired primarily by interfascicular vein conduits. There was no detectable recovery of sensibility in autonomous areas of these nerves and no sign of recovery of the innervated muscles during follow‐up. Re‐exploration revealed that the vein conduits used for repair of the median nerves were constricted by surrounding scar tissue and axon regeneration was precluded. The critical length for nerve regeneration in human beings and wound conditions unfavorable to nerve regeneration are discussed. This report suggests that vein conduits are not indicated in nerve gaps over 5.0 cm or in primary repair of nerves with compound injuries. © 1995 Wiley‐Liss, Inc.

[1]  G. Omer.  Injuries to nerves of the upper extremity. , 1974, The Journal of bone and joint surgery. American volume.

[2]  A Johannesson,et al.  Nerve regeneration across an extended gap: a neurobiological view of nerve repair and the possible involvement of neuronotrophic factors. , 1982, The Journal of hand surgery.

[3]  G. Lundborg,et al.  Nerve regeneration through preformed pseudosynovial tubes. A preliminary report of a new experimental model for studying the regeneration and reorganization capacity of peripheral nerve tissue. , 1980, The Journal of hand surgery.

[4]  G. Lundborg,et al.  Peripheral nerve regeneration in Gore-tex chambers. , 1988, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[5]  Y. Atsuta,et al.  Vein Graft for Repair of Peripheral Nerve Gap , 1988, Journal of reconstructive microsurgery.

[6]  R. Sidman,et al.  Nerve Regeneration through Synthetic Biodegradable Nerve Guides: Regulation by the Target Organ , 1984, Plastic and reconstructive surgery.

[7]  S. Gschmeissner,et al.  Degenerated Muscle Grafts used for Peripheral Nerve Repair in Primates , 1986, Journal of hand surgery.

[8]  D. Rice,et al.  The Use of Autogenous Vein for Nerve Grafting , 1984, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[9]  J. Gattuso,et al.  Peripheral nerve repair in humans using muscle autografts. A new technique. , 1988, The Journal of bone and joint surgery. British volume.

[10]  M. Manthorpe,et al.  Neuronotrophic and neurite-promoting factors and their clinical potentials. , 1983, Developmental neuroscience.

[11]  G. Lundborg,et al.  A study of neurotrophism in a primate model. , 1986, The Journal of hand surgery.

[12]  G. Lundborg,et al.  Ulnar nerve repair by the silicone chamber technique. Case report. , 1991, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[13]  R. C. Wray,et al.  The results of nerve grafting in the wrist and hand. , 1980 .

[14]  S. Mackinnon,et al.  Surgery of the Peripheral Nerve , 1988 .

[15]  Richard L. Sidman,et al.  Increased rate of peripheral nerve regeneration using bioresorbable nerve guides and a laminin-containing gel , 1985, Experimental Neurology.

[16]  Susan E. Mackinnon,et al.  Clinical Nerve Reconstruction with a Bioabsorbable Polyglycolic Acid Tube , 1990, Plastic and reconstructive surgery.

[17]  W. G. Hopkins,et al.  Regeneration of mouse peripheral nerves in degenerating skeletal muscle: guidance by residual muscle fibre basement membrane , 1984, Brain Research.

[18]  G. Lundborg,et al.  Nerve regeneration model and trophic factors in vivo , 1982, Brain Research.

[19]  P. Spencer,et al.  Tropism in nerve regeneration in vivo. Attraction of regenerating axons by diffusible factors derived from cells in distal nerve stumps of transected peripheral nerves , 1982, Brain Research.

[20]  A. Berger,et al.  Further experience with interfascicular grafting of the median, ulnar, and radial nerves. , 1976, The Journal of bone and joint surgery. American volume.

[21]  S. Mackinnon,et al.  A Study of Nerve Regeneration Across Synthetic (Maxon) and Biologic (Collagen) Nerve Conduits For Nerve Gaps Up to 5 Cm in the Primate , 1990, Journal of reconstructive microsurgery.

[22]  B Strauch,et al.  A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less. , 1990, Plastic and reconstructive surgery.

[23]  R. L. Walton,et al.  Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study. , 1989, Plastic and reconstructive surgery.

[24]  J. Šmahel,et al.  Stimulation of Peripheral Nerve Regeneration by an Isolated Nerve Segment , 1986, Annals of plastic surgery.

[25]  A L Dellon,et al.  An Alternative to the Classical Nerve Graft for the Management of the Short Nerve Gap , 1988, Plastic and reconstructive surgery.

[26]  Göran Lundborg,et al.  Nerve regeneration in silicone chambers: Influence of gap length and of distal stump components , 1982, Experimental Neurology.

[27]  Y. Gu,et al.  Repair of Digital Nerve Defect with Autogenous Vein Graft during Flexor Tendon Surgery in Zone 2 , 1993, Journal of hand surgery.

[28]  J. Tang,et al.  Group fascicular vein grafts with interposition of nerve slices for long ulnar nerve defects: Report of three cases , 1993, Microsurgery.

[29]  S. Mackinnon,et al.  Nerve regeneration through a pseudosynovial sheath in a primate model. , 1985, Plastic and reconstructive surgery.

[30]  S. Bowald,et al.  Regeneration of peripheral nerve through a polyglactin tube , 1982, Muscle & nerve.

[31]  C. Idé.  Nerve regeneration through the basal lamina scaffold of the skeletal muscle , 1984, Neuroscience Research.

[32]  R. Donoff,et al.  Nerve Regeneration Through Collagen Tubes , 1984, Journal of dental research.

[33]  R. Lovelace,et al.  Autogenous vein graft as a conduit for nerve regeneration , 1983 .