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Seminars in Neurosurgery 2001; 12(1): 065-080
DOI: 10.1055/s-2001-13000
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Synthetic Nerve Conduits: Indications and Technique

Robert A. Weber1 , A. Lee Dellon2
  • 1Division of Plastic Surgery, Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Texas A&M University System Health Science Center College of Medicine, Temple, TX
  • 2Johns Hopkins University School of Medicine, Baltimore, MD.
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Publication History

Publication Date:
31 December 2001 (online)

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ABSTRACT

Synthetic nerve conduits are an important advance in the reconstruction of peripheral nerves. Based on decades of basic science developments showing the potential role of neurotrophic factors in axonal regeneration, conduits create a controlled environment that allows neurites to grow across gaps in an ordered fashion, thereby offering improved function compared to end-to-end repair and significantly less donor site morbidity than nerve grafts. Although vein graft tubes have been used in humans, recently available polyglycolic acid (PGA) conduits are mechanically superior and obviate the need for harvesting autogenous vein. Silicone and Gore-Tex tubes can be used in those cases where a PGA conduit is not available, but they require a second operation for removal. Placement of a conduit is straightforward. The nerve ends are trimmed, a U-stitch is used to draw the nerve ends into the tube, and the remaining space is filled with heparinized saline. Future advances will allow longer gaps to be spanned in a shorter period of time with even better functional results.

KEYWORD

Peripheral nerve - conduit - polyglycolic acid - silicone - Gore-Tex

REFERENCES

  • 1 Bungner O V. Die degenerations-und regeneration-vorgänge am nerven verletzungen.  Beitr Pathol Anal . 1891;  10 321-393
    PubMedGoogle Scholar
  • 2 Weber R A, Warner M R, Verheyden C N, Proctor W H. Functional evaluation of gap versus abutment repair of peripheral nerves in the rat.  J Reconstr Microsurg . 1996;  12(3) 159-163
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Lundborg G, Dahlin L B, Danielson N, Nachemson A K. Tissue specificity in nerve regeneration.  Scand J Plast Reconstr Surg . 1986;  20(3) 279-283
    PubMedGoogle Scholar
  • 4 Mackinnon S E, Dellon A L, Lundborg G. A study of neurotrophism in the primate model.  J Hand Surg [Am] . 1986;  11(6) 888-894
    PubMedGoogle Scholar
  • 5 Seckel B R, Ryan S E, Gagne R J. Target-specific nerve regeneration through a nerve guide in the rat.  Plast Reconstr Surg . 1986;  78(6) 793-800
    PubMedGoogle Scholar
  • 6 Brushart T M, Seiler W A. Selective reinnervation of distal motor stumps by peripheral motor axons.  Exp Neurol . 1987;  97(2) 289-300
    CrossrefPubMedGoogle Scholar
  • 7 Williams L R, Longo F M, Powell H C. Spatial-temporal progress of peripheral nerve regeneration within a silicone chamber: parameters for a bioassay.  J Comp Neurol . 1983;  218(4) 460-470
    CrossrefPubMedGoogle Scholar
  • 8 Chiu D T, Janecka I, Krizek T J. Autogenous vein graft as a conduit for nerve regeneration.  Surgery . 1982;  91(2) 226-233
    PubMedGoogle Scholar
  • 9 Lundborg G, Gelberman R H, Longo R M. In vivo regeneration of cut nerves encased in silicone tubes: growth across a six-millimeter gap.  J Neuropathol Exp Neurol . 1982;  41(4) 412-422
    CrossrefPubMedGoogle Scholar
  • 10 Molander H, Olsson Y, Engkvist O. Regeneration of peripheral nerve through a polyglactin tube.  Muscle Nerve . 1982;  5(1) 54-57
    CrossrefPubMedGoogle Scholar
  • 11 Colin W, Donoff R B. Nerve regeneration through collagen tubes.  J Dent Res . 1984;  63(7) 987-993
    PubMedGoogle Scholar
  • 12 Lundborg G, Rosen B, Dahlin L. Tubular versus conventional repair of median and ulnar nerves in the human forearm: early results from a prospective, randomized, clinical study.  J Hand Surg [Am] . 1997;  22(1) 99-106
    PubMedGoogle Scholar
  • 13 Stanec S, Stanec Z. Reconstruction of upper-extremity peripheral-nerve injuries wit ePTFE conduits.  J Reconstr Microsurg . 1998;  14(4) 227-232
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Chiu D T. Autongenous venous nerve conduits. A review.  Hand Clin . 1999;  15(4) 667-671
    PubMedGoogle Scholar
  • 15 Braga-Silva J. The use of silicone tubing in the late repair of the median and ulnar nerves in the forearm.  J Hand Surg [Br] . 1999;  24(6) 703-706
    CrossrefPubMedGoogle Scholar
  • 16 Snyder C C. The History of Nerve Repair. In: Omer GE, Spinner M, eds. Management of Nerve Problems, 1st ed Philadelphia, PA: WB Saunders 1980: 354-355
    Google Scholar
  • 17 Terzis J, Faibisoff B, Williams B. The nerve gap: suture under tension versus graft.  Plast Reconstr Surg . 1975;  56(2) 166-170
    PubMedGoogle Scholar
  • 18 Wang W Z, Crain G M, Baylis W, Tsai T M. Outcome of digital nerve injuries in adults.  J Hand Surg [Am] . 1996;  21(1) 138-143
    PubMedGoogle Scholar
  • 19 Millesi H. Reappraisal of nerve repair.  Surg Clin North Am . 1981;  61(2) 321-340
    PubMedGoogle Scholar
  • 20 Staniforth P, Fisher T R. The effects of sural nerve excision in autogenous nerve grafting.  Hand . 1978;  10(2) 187-190
    PubMedGoogle Scholar
  • 21 Ortiguela M E, Wood M B, Cahill D R. Anatomy of the sural nerve complex.  J Hand Surg [Am] . 1987;  12(6) 1119-1123
    PubMedGoogle Scholar
  • 22 Rappaport W D, Valente J, Hunter G C. Clinical utilization and complications of sural nerve biopsy.  Am J Surg . 1993;  166(3) 252-256
    CrossrefPubMedGoogle Scholar
  • 23 Dyck P J, Lofgren E P. Nerve biopsy. Choice of nerve, method, symptoms, and usefulness.  Medical Clin North Am . 1968;  52(4) 885-893
    PubMedGoogle Scholar
  • 24 Poburski R, Malin J P, Stark E. Sequelae of sural nerve biopsies.  Clin Neurol Neurosurg . 1985;  87(3) 193-198
    CrossrefPubMedGoogle Scholar
  • 25 Perry J R, Bril V. Complications of sural nerve biopsy in diabetic versus non-diabetic patients.  Can J Neurol Sci . 1994;  21(1) 34-37
    PubMedGoogle Scholar
  • 26 Gould J SP. Digital Nerves. In: Gelberman RH, ed. Operative Nerve Repair and Reconstruction Philadelphia, PA: JB Lippincott 1991: 458
    Google Scholar
  • 27 Mackinnon S E, Dellon A L. Surgery of the Peripheral Nerve.  New York: Thieme 1988: 121
    Google Scholar
  • 28 de Medinaceli L, Seaber A V. Experimental nerve reconnection: importance of initial repair.  Microsurgery . 1989;  10(1) 56-70
    PubMedGoogle Scholar
  • 29 Koerber H R, Seymour A W, Mendell L M. Mismatches between peripheral receptor type and central projections after peripheral nerve regeneration.  Neurosci Lett . 1989;  99(1-2) 67-72
    CrossrefPubMedGoogle Scholar
  • 30 Chiu D TW. Autogenous and Synthetic Conduits for Nerve Repair. In: Omer GE, Spinner M, Van Beek AL, eds. Management of Peripheral Nerve Problems, 2nd ed Philadelphia, PA: WB Saunders 1998: 305-306
    Google Scholar
  • 31 Doolabh V B, Hertl M C, Mackinnon S E. The role of conduits in nerve repair: a review.  Rev Neurosci . 1996;  7(1) 47-84
    PubMedGoogle Scholar
  • 32 Strauch B. Use of nerve conduits in peripheral nerve repair.  Hand Clin . 2000;  16(1) 123-130
    PubMedGoogle Scholar
  • 33 Chiu D T, Strauch B. A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less.  Plast Reconstr Surg . 1990;  86(5) 928-934
    CrossrefPubMedGoogle Scholar
  • 34 Walton R L, Brown R E, Matory Jr E W. Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study.  Plast Reconstr Surg . 1989;  84(6) 944-949
    CrossrefPubMedGoogle Scholar
  • 35 Nahabedian M Y, Smolev J K. Successful reinnervation of the penis using an autogenous vein conduit.  J Reconstr Microsurg . 1998;  14(1) 31-33
    PubMedGoogle Scholar
  • 36 Miloro M. Inferior alveolar nerve regeneration through an autogenous vein graft.  J Oral Maxillofac Surg . 1996;  (suppl 3)54 65
    PubMedGoogle Scholar
  • 37 Tang J B, Gu Y Q, Song Y S. Repair of digital nerve defect with autogenous vein graft during flexor tendon surgery in zone 2.  J Hand Surg [Br] . 1993;  18(4) 449-453
    CrossrefPubMedGoogle Scholar
  • 38 Benito-Ruiz J, Navarro-Monzonis A, Piqueras A, Baena-Montilla P. Invaginated vein graft as nerve conduit: an experimental study.  Microsurgery . 1994;  15(2) 105-115
    PubMedGoogle Scholar
  • 39 Hermann J B, Kelly R J, Higgins G A. Polyglycolic acid sutures. Laboratory and clinical evaluation of a new absorbable suture material.  Arch Surg . 1970;  100(4) 486-490
    PubMedGoogle Scholar
  • 40 Marmon L M, Vinocur C D, Standiford S B. Evaluation of absorbable polyglycolic acid mesh as a wound support.  J Pediatr Surg . 1985;  20(6) 737-742
    PubMedGoogle Scholar
  • 41 Ginde R M, Gupta R K. In vitro chemical degradation of polyglycolic acid pellets and fibers.  J Appl Polymer Sci . 1987;  33 2411-2429
    PubMedGoogle Scholar
  • 42 Barrows T H. Degradable implant materials: a review of synthetic absorbable polymers and their applications.  Clinical Materials . 1986;  1(4) 233-257
    PubMedGoogle Scholar
  • 43 Mackinnon S E, Dellon A L. Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube.  Plast Reconstr Surg . 1990;  85(3) 419-424
    CrossrefPubMedGoogle Scholar
  • 44 Crawley W A, Dellon A L. Inferior alveolar nerve reconstruction with a polyglycolic acid bioabsorbable nerve conduit.  Plast Reconstr Surg . 1992;  90(2) 300-302
    CrossrefPubMedGoogle Scholar
  • 45 Weber R A, Breidenbach W C, Brown R E. A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.  Plast Reconstr Surg . 2000;  106(5) 1036-1045
    CrossrefPubMedGoogle Scholar
  • 46 Berger A, Mailander P, Schneider W, Becker M. Sensory recovery by different techniques. Presented at the Third International Hand Surgery Symposium, Tokyo, Japan, April, 1988
    Google Scholar
  • 47 Wang W Z, Crain G M, Baylis W, Tsai T M. Outcome of digital nerve injuries in adults.  J Hand Surg [Am] . 1996;  21(1) 138-143
    PubMedGoogle Scholar
  • 48 Poppen N K, McCarroll Jr R H, Doyle J R, Neibauer J J. Recovery of sensibility after suture of digital nerves.  J Hand Surg [Am] . 1979;  4(3) 212-225
    PubMedGoogle Scholar
  • 49 Efstathopoulos D, Gerostathopoulos N, Misitzis D. Clinical assessment of primary digital nerve repair.  Acta Orthop Scand Suppl . 1995;  264 45-47
    PubMedGoogle Scholar
  • 50 Al-Ghazal S K, McKiernan M, Khan K, McCann J. Results of clinical assessment after primary digital nerve repair.  J Hand Surg [Br] . 1994;  19(2) 255-257
    CrossrefPubMedGoogle Scholar
  • 51 Posch J L, delaCruz-Saddul F. Nerve repair in trauma surgery. A 10 year study of 231 peripheral injuries.  Orthop Rev . 1980;  9 35-45
    PubMedGoogle Scholar
  • 52 Beazley W C, Milek M A, Reiss B H. Results of nerve grafting in severe soft tissue injuries.  Clin Orthop . 1984;  (188) 208-212
    PubMedGoogle Scholar
  • 53 McFarlane R M, Mayer J R. Digital nerve grafts with the lateral antebrachial cutaneous nerve.  J Hand Surg [Am] . 1976;  1(3) 169-173
    PubMedGoogle Scholar
  • 54 Lundborg G, Dahlin L B, Danielsen N. Ulnar nerve repair by the silicone chamber technique. Case report.  Scand J Plast Reconstr Surg Hand Surg . 1991;  25(1) 79-82
    CrossrefPubMedGoogle Scholar
  • 55 Lundborg G, Rosen B, Abrahamson S O. Tubular repair of the median nerve in the human forearm. Preliminary findings.  J Hand Surg [Br] . 1994;  19(3) 273-276
    CrossrefPubMedGoogle Scholar
  • 56 Weber R A. Conduit Repair of Peripheral Nerves. Hand Surgery Update, Texas Society of Plastic Surgeons, Austin, TX, 1999
    Google Scholar
  • 57 Mackinnon S E, Dellon A L, Hudson A R, Hunter D A. Chronic nerve compression: an experimental model in the rat.  Ann Plast Surg . 1984;  13(2) 112-120
    CrossrefPubMedGoogle Scholar
  • 58 Mackinnon S E, Dellon A L, Hudson A R, Hunter D A. A primate model for chronic nerve compression.  J Reconstr Microsurg . 1985;  1(3) 185-195
    Article in Thieme ConnectPubMedGoogle Scholar
  • 59 Mackinnon S E, Dellon A L. Experimental study of chronic nerve compression. Clinical implications.  Hand Clin . 1986;  2(4) 639-650
    PubMedGoogle Scholar
  • 60 Dellon A L. Use of a silicone tube for the reconstruction of a nerve injury.  J Hand Surg [Br] . 1994;  19(3) 271-272
    CrossrefPubMedGoogle Scholar
  • 61 Dellon A L. Resection: nerve repair's most neglected technique.  Plast Surg Techniques . 1995;  1(3) 191-199
    PubMedGoogle Scholar
  • 62 Dellon A L. Evaluation of Sensibility and Re-Education of Sensation in the Hand.  Baltimore, MD: Williams & Wilkins; 1981
    Google Scholar
  • 63 Hudson T W, Evans G R, Schmidt C E. Engineering strategies for peripheral nerve repair.  Clin Plast Surg . 1999;  26(4) 617-628
    PubMedGoogle Scholar
  • 64 Tang J. Vein conduits with interposition of nerve tissue for peripheral nerve defects.  J Reconstr Microsurg . 1995;  11(1) 21-26
    Article in Thieme ConnectPubMedGoogle Scholar
  • 65 Francel P C, Francel T J, Mackinnon S E, Hertl C. Enhancing nerve regeneration across a silicone tube conduit by using interposed short-segment nerve grafts.  J Neurosurg . 1997;  87(6) 887-892
    CrossrefPubMedGoogle Scholar