An alternative to the classical nerve graft for the management of the short nerve gap.
Reconstruction of a short nerve gap by a nerve graft produces donor-site scarring, loss of donor nerve function, and neuroma formation. This study compared the regeneration achieved after 1 year in 16 monkeys across a 3-cm upper arm ulnar nerve gap with a bioabsorbable polyglycolic acid nerve conduit with the regeneration achieved with a classical interfascicular interpositional sural nerve graft. The results demonstrated electrophysiologic and histologic evidence of neural regeneration across the gaps in all experimental groups. The bioabsorbable nerve conduit groups and the sural nerve graft group had mean fiber diameters, amplitudes, and conduction velocities each significantly less than those of normal control ulnar nerves. There was, however, no significant difference between any of the experimental groups. Electromyography demonstrated recovery of 19 of the 28 (68 percent) intrinsic muscles studied. These results demonstrate that the primate peripheral nerve can regenerate across short nerve gaps when guided by an appropriate nerve conduit, suggesting that a single-stage biodegradable polyglycolic acid conduit may be used as an alternative to a short interfascicular nerve graft.
Dellon
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Division of Plastic Surgery and Neurosurgery, Johns Hopkins Hospital, Baltimore, MD.
Mackinnon
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D000714:Anastomosis, Surgical; D000818:Animals; D004195:Disease Models, Animal; D004576:Electromyography; D005069:Evaluation Studies as Topic; D008252:Macaca fascicularis; D008297:Male; D009416:Nerve Regeneration; D009436:Neural Tube Defects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011100:Polyglycolic Acid; D013127:Spinal Nerves / Q000637:transplantation*; D013497:Sural Nerve / Q000473:pathology / Q000503:physiopathology / Q000637:transplantation*; D013526:Surgical Mesh; D013536:Suture Techniques; D013997:Time Factors; D014459:Ulnar Nerve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*
D011100:Polyglycolic Acid