title: Neurological recovery across a 12-cm-long ulnar nerve gap repaired 3.25 years post trauma: case report.
abstract: BACKGROUND
  The standard clinical technique for repairing peripheral nerve gaps is the use of autologous sensory nerve grafts. The present study tested whether a collagen tube filled with autologous platelet-rich fibrin could induce sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, and reduce or eliminate neuropathic pain.
  
  
  METHODS
  Two years postrepair, good ring and small finger motor function had developed that could generate 1 kg of force, and topographically correct 2-point discrimination and sensitivity to vibration in the small and ring finger and proximal but not distal wrist had developed. The patient's excruciating neuropathic pain was reduced to tolerable, and he avoided the indicated extremity amputation. The 12-cm-long nerve gap was bridged with a collagen tube filled with autologous platelet-rich fibrin.
  
  
  CONCLUSIONS
  We demonstrate that a conduit filled with platelet-rich fibrin can induce limited, but appropriate, sensory and motor recovery across a 12-cm nerve gap repaired 3.25 years post trauma, without sacrificing a sensory nerve, can reduce existing excruciating neuropathic pain to tolerable, and allow avoidance of an indicated upper-extremity amputation. We believe the technique can be improved to induce more extensive and reliable neurological recovery.
authors.affiliation: Institute of Neurobiology, University of Puerto Rico, San Juan, Puerto Rico 00901, USA. dkuffler@hotmail.com
authors.forename: Damien P
authors.initials: DP
authors.lastname: Kuffler
authors.forename: Onix
authors.initials: O
authors.lastname: Reyes
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Sosa
authors.forename: Jose
authors.initials: J
authors.lastname: Santiago-Figueroa
mesh_terms: D003094:Collagen / Q000627:therapeutic use; D005337:Fibrin / Q000627:therapeutic use; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009416:Nerve Regeneration / Q000502:physiology*; D010147:Pain Measurement; D020127:Recovery of Function / Q000502:physiology*; D013497:Sural Nerve / Q000637:transplantation*; D020424:Ulnar Neuropathies / Q000601:surgery*
chemical_list: D005337:Fibrin; D003094:Collagen