A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.
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.
Weber
R A
RA
Department of Surgery, Scott & White Memorial Hospital and Clinic, Temple, Texas, USA. rweber@swmail.sw.org
Breidenbach
W C
WC
Brown
R E
RE
Jabaley
M E
ME
Mass
D P
DP
D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005385:Fingers / Q000294:innervation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration; D059348:Peripheral Nerve Injuries; D010525:Peripheral Nerves / Q000601:surgery* / Q000637:transplantation; D011100:Polyglycolic Acid; D011183:Postoperative Complications; D011446:Prospective Studies; D012677:Sensation
D011100:Polyglycolic Acid