Effect of Amniotic Membrane Nerve Wrapping in Final Results of Traumatic Peripheral Nerve Repair

BACKGROUND Preventing perineural adhesions and scars formation in the traumatic peripheral injuries is very important on the recovery process. We aimed to evaluate the effect of using the amniotic membrane wrapping on the results of surgical treatment of damaged peripheral nerves. METHODS This cohort study included 30 patients with symptoms of acute peripheral nerve injuries due to penetrating trauma in the forearm or wrist in January 2019 to November 2020 referred to the Hand and Microsurgery Department, 15 Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. In 15 patients, after nerve repair, amniotic membrane coverage was used around the nerve, all patients were followed for 12 months. Ultrasound study for neuroma formation and nerve regeneration was determined based on EMG and NCV findings. The modified Medical Research Councile classification (MRCC) was used to evaluate of motor and sensory recovery. RESULTS In the amniotic membrane wrapping group, all patients had nerve regeneration and functional nerve recovery occurred after 12 months. In the control group, 5 patients (33.4%) did not have nerve recovery and had functional and sensory impairment. In terms of functional capabilities; there was a significant difference in pinch strength, grip power and MRCC scoring between the two groups. Moreover, the mean volume of neuroma in these patients who used amniotic membrane covering was 2.7 mm3 and in the control group, it was 3.9 mm3 (P=0.001). Five patients who did not have a damaged nerve, the neuroma volume was 4.8 ± 0.9 mm3. CONCLUSION The use of amniotic membrane covering is effective methods in the improve results of peripheral nerve repair and nerve function recovery.

[1]  A. Mohammadi,et al.  Ultrasonography Assessment of Repaired Median Nerve , 2021 .

[2]  I. Pluvy,et al.  Can the amniotic membrane be used to treat peripheral nerve defects? A review of literature. , 2019, Hand surgery & rehabilitation.

[3]  Niranjan Kumar,et al.  PMMC Flap Revisited and its Clinical Outcome in 150 Patients , 2019, Journal of Maxillofacial and Oral Surgery.

[4]  A. Alfouzan.  Review of surgical resection and reconstruction in head and neck cancer , 2018, Saudi medical journal.

[5]  Dipanwita Roy,et al.  Factors affecting postoperative removal of nasogastric tube and tracheostomy tube in oral cancer: a retrospective analysis of 234 cases , 2018, Oral Cancer.

[6]  C. Ketonis,et al.  Neurolysis with Amniotic Membrane Nerve Wrapping for Treatment of Secondary Wartenberg Syndrome: A Preliminary Report. , 2017, The journal of hand surgery Asian-Pacific volume.

[7]  Michael P. Gaspar,et al.  Recurrent cubital tunnel syndrome treated with revision neurolysis and amniotic membrane nerve wrapping. , 2016, Journal of shoulder and elbow surgery.

[8]  G. Kaka,et al.  Study of Transected Sciatic Nerve Repair by Amniotic Membrane with Betamethasone in Adult Albino Wistar Rats. , 2016, Archives of Iranian medicine.

[9]  D. Agrawal,et al.  Reconstruction in oral malignancy: Factors affecting morbidity of various procedures , 2015, Annals of maxillofacial surgery.

[10]  R. K. Karwasra,et al.  Pectoralis major myocutaneous flap in head and neck reconstruction: An experience in 100 consecutive cases , 2015, National journal of maxillofacial surgery.

[11]  M. Khurram,et al.  Use of pectoralis major myocutaneous flap for resurfacing the soft tissue defects of head and neck , 2014 .

[12]  T. Pereira,et al.  Use of hybrid chitosan membranes and human mesenchymal stem cells from the Wharton jelly of umbilical cord for promoting nerve regeneration in an axonotmesis rat model★ , 2012, Neural regeneration research.

[13]  S. W. Jung,et al.  Analysis of 120 Pectoralis Major Flaps for Head and Neck Reconstruction , 2012, Archives of plastic surgery.

[14]  M. Kuriakose,et al.  Pectoralis major flap for head and neck reconstruction in era of free flaps. , 2012, International journal of oral and maxillofacial surgery.

[15]  Krishnakumar Thankappan,et al.  Flap Hitching Technique to the Teeth after Oral Cancer Resection , 2012, Journal of surgical technique and case report.

[16]  A. Kolokythas.  Long-Term Surgical Complications in the Oral Cancer Patient: a Comprehensive Review. Part II , 2010, Journal of oral & maxillofacial research.

[17]  S. Mardini,et al.  Intraoral reconstruction using local and regional flaps. , 2010, Seminars in plastic surgery.

[18]  A. Varejão,et al.  Use of chitosan scaffolds for repairing rat sciatic nerve defects. , 2010, Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia.

[19]  R. Midha,et al.  Practical considerations concerning the use of stem cells for peripheral nerve repair. , 2009, Neurosurgical focus.

[20]  K. Narasimhan,et al.  Closure of Orocutanous Fistula Using a Pedicled Expanded Deltopectoral Flap , 2008, The Canadian journal of plastic surgery = Journal canadien de chirurgie plastique.

[21]  H. Dua,et al.  Amniotic membrane use in ophthalmology , 2005, Current opinion in ophthalmology.

[22]  G. Filiz,et al.  Combined Application of Human Amniotic Membrane Wrapping and Hyaluronic Acid Injection in Epineurectomized Rat Sciatic Nerve , 2004, Journal of reconstructive microsurgery.

[23]  N. Danielsen,et al.  Locally-applied Collagenase and Regeneration of Transsected and Repaired Rat Sciatic Nerves , 2002, Scandinavian journal of plastic and reconstructive surgery and hand surgery.

[24]  C B Novak,et al.  Clinical Outcome following Nerve Allograft Transplantation , 2001, Plastic and reconstructive surgery.

[25]  S. O'Kane,et al.  Transforming growth factor βs and wound healing , 1997 .

[26]  S. Ariyan.  The Pectoralis Major Myocutaneous Flap A Versatile Flap for Reconstruction in the Head and Neck , 1979, Plastic and reconstructive surgery.