Early clinical experience with collagen nerve tubes in digital nerve repair.

PURPOSE In cases of digital nerve injury in which nerve ends cannot be approximated without tension, autologous nerve grafts represent the most commonly used method for reconstruction. Recently, interest in synthetic nerve guides as an alternative to grafting has increased. Although several basic science studies have shown promise for collagen tubes, clinical studies of their success in humans are limited. The purpose of this study was to review our early clinical experience with collagen nerve tubes. METHODS The authors identified and followed all cases involving digital nerve repair at our institution over a 2-year period. Twelve patients had repair of a digital nerve with a collagen nerve tube during the study period. Two patients were lost to follow-up, and 1 patient had amputation of the grafted finger secondary to complications of other injuries. The primary outcome data points for the remaining 9 patients were the static 2-point discrimination (2PD), Semmes-Weinstein monofilament testing, and a Quick Disabilities of the Arm, Shoulder, and Hand (DASH) outcome survey at final follow-up. RESULTS Nine patients had follow-up of at least 1 year, with an average follow-up time of 15 months (range 12-22 months). There were no intraoperative or postoperative complications related to the nerve tubes. Using modified American Society for Surgery of the Hand guidelines, 2PD results were good or excellent in 8 out of 9 of patients. Semmes-Weinstein testing results were full in 5 patients, diminished light touch in 2, diminished protective sensation in 1, and loss of protective sensation in 1. Average Quick DASH scores for the group were 10.86 overall, 4.86 for the work module, and 23.21 for the sports/performing arts module. CONCLUSIONS Although the patients in this study are still within the early follow-up period, our initial results compare favorably with those reported in the existing literature for various types of nerve repair and reconstruction, suggesting that collagen nerve tubes might offer a clinically effective option for restoration of sensory function. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.

[1]  P. Kallio.  The Results of Secondary Repair of 254 Digital Nerves , 1993, Journal of hand surgery.

[2]  C. Krarup,et al.  Factors Contributing to Preferential Motor Reinnervation in the Primate Peripheral Nervous System , 1999, The Journal of Neuroscience.

[3]  C. Bombardier,et al.  Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. , 2001, Journal of hand therapy : official journal of the American Society of Hand Therapists.

[4]  B Strauch,et al.  Use of nerve conduits in peripheral nerve repair. , 2000, Hand clinics.

[5]  Tatsuo Nakamura,et al.  Regeneration of Peripheral Nerve Gaps with a Polyglycolic Acid-Collagen Tube , 2004, Neurosurgery.

[6]  Stefano Geuna,et al.  Evaluation of two biodegradable nerve guides for the reconstruction of the rat sciatic nerve. , 2007, Bio-medical materials and engineering.

[7]  C. Krarup,et al.  Factors that influence peripheral nerve regeneration: An electrophysiological study of the monkey median nerve , 2002, Annals of neurology.

[8]  N. Poppen,et al.  Recovery of sensibility after suture of digital nerves. , 1979, The Journal of hand surgery.

[9]  M. Ward,et al.  The shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH): validity and reliability based on responses within the full-length DASH , 2006, BMC musculoskeletal disorders.

[10]  D. Efstathopoulos,et al.  Clinical assessment of primary digital nerve repair. , 1995, Acta orthopaedica Scandinavica. Supplementum.

[11]  S. Kim,et al.  Peripheral Nerve Regeneration Using a Three Dimensionally Cultured Schwann Cell Conduit , 2007, The Journal of craniofacial surgery.

[12]  S T Li,et al.  Peripheral nerve repair with collagen conduits. , 1992, Clinical materials.

[13]  S. Wolfe,et al.  Peripheral Nerve Injury and Repair , 2000, The Journal of the American Academy of Orthopaedic Surgeons.

[14]  M. Meek,et al.  Secondary digital nerve repair in the foot with resorbable p(DLLA-epsilon-CL) nerve conduits. , 2006, Journal of reconstructive microsurgery.

[15]  Tatsuo Nakamura,et al.  REGENERATION OF PERIPHERAL MOTOR NERVE GAPS WITH A POLYGLYCOLIC ACID‐COLLAGEN TUBE: TECHNICAL CASE REPORT , 2007, Neurosurgery.

[16]  R. Weber,et al.  A Randomized Prospective Study of Polyglycolic Acid Conduits for Digital Nerve Reconstruction in Humans , 2000, Plastic and reconstructive surgery.

[17]  T. Trumble,et al.  A comparison of polyglycolic acid versus type 1 collagen bioabsorbable nerve conduits in a rat model: an alternative to autografting. , 2007, The Journal of hand surgery.

[18]  S T Li,et al.  A collagen‐based nerve guide conduit for peripheral nerve repair: An electrophysiological study of nerve regeneration in rodents and nonhuman primates , 1991, The Journal of comparative neurology.

[19]  C. Heath,et al.  The development of bioartificial nerve grafts for peripheral-nerve regeneration. , 1998, Trends in biotechnology.

[20]  N. Weinzweig.  Crossover Innervation After Digital Nerve Injury: Myth or Reality? , 2000, Annals of Plastic Surgery.

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

[22]  Stefano Geuna,et al.  Nerve repair by means of tubulization: Literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair , 2005, Microsurgery.

[23]  M. Spector,et al.  Early peripheral nerve healing in collagen and silicone tube implants: myofibroblasts and the cellular response. , 1998, Biomaterials.

[24]  M. Meek,et al.  US Food and Drug Administration/Conformit Europe-Approved Absorbable Nerve Conduits for Clinical Repair of Peripheral and Cranial Nerves , 2008, Annals of plastic surgery.

[25]  C. Krarup,et al.  Monkey median nerve repaired by nerve graft or collagen nerve guide tube , 1995, The Journal of neuroscience : the official journal of the Society for Neuroscience.

[26]  A Azzarà,et al.  Results of Primary Repair of Digital Nerves , 1991, Journal of hand surgery.

[27]  Tatsuo Nakamura,et al.  Surgical relief of causalgia with an artificial nerve guide tube: Successful surgical treatment of causalgia (Complex Regional Pain Syndrome Type II) by in situ tissue engineering with a polyglycolic acid-collagen tube , 2005, Pain.

[28]  K. Endo,et al.  Facial nerve repair accomplished by the interposition of a collagen nerve guide. , 2000, Journal of neurosurgery.

[29]  W. Baylis,et al.  Outcome of digital nerve injuries in adults. , 1996, The Journal of hand surgery.

[30]  C. Bombardier,et al.  Development of an upper extremity outcome measure: The DASH (disabilities of the arm, shoulder, and head) , 1996 .

[31]  V. Hentz,et al.  The nerve gap dilemma: a comparison of nerves repaired end to end under tension with nerve grafts in a primate model. , 1993, The Journal of hand surgery.

[32]  R. Birch,et al.  The Long Term Result of Digital Nerve Repair in No-Man’s Land , 1992, Journal of hand surgery.

[33]  H. Machens,et al.  Überbrückung peripherer Nervendefekte durch den Einsatz von Nervenröhrchen , 2007, Der Chirurg.