Artikel
Porcine submucosa extracellular matrix nerve wrapping of scarred nerves
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Autoren
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Pieter Jordaan
- Queen Elizabeth Hospital, Birmingham, United Kingdom
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Okezika Uhiara
- Queen Elizabeth Hospital, Birmingham, United Kingdom
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Dominic Power
- Queen Elizabeth Hospital, Birmingham, United Kingdom
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Scar tissue formation in the vicinity of a peripheral nerve causes compression, ischaemia, impaired glide and tether, resulting in a pain syndrome - neurostenalgia. Neurolysis of a scarred nerve may bring initial relief from pain but secondary scar formation usually follows. Adjunctive wrapping may reduce scar formation. Biological tissues may result in donor site morbidity. The AxoGuard® nerve protector (AxoGen Inc., Alachua FL) is a layered porcine submucosal extracellular collagen matrix that may be sutured around nerves following neurolysis providing a layer for revascularization and restoration of nerve gliding. This report is on utilization, safety and outcomes of the AxoGuard® in a tertiary referral peripheral nerve service.
Methods: After obtaining ethics form the institutional audit review board, a review was performed of all cases where AxoGuard® nerve protectors were used in primary or revision nerve surgery from June 2015 to July 2018. General demographic data, indications, nerves involved, complications and early follow up data were collected and evaluated.
Results and Conclusions: Over a 3-year period AxoGuard® nerve protectors were used in 71 patients. The indication for surgery was a scarred nerve after trauma in 32 cases, scarring after primary nerve surgery in 19 cases, primary trauma in 9 cases (including one nerve transfer due to a significant size mismatch), nerve scarring after elective non-nerve surgery in 5 cases and nerve tumours in 5 cases. The most commonly involved nerves were the ulnar nerve (32), median nerve (14), digital nerves (11) and the common peroneal nerve (3).
One patient had an early re-exploration due to a post-operative haematoma and one patient had a late exploration due to adjacent tendon adhesions. There have been no complications related to the AxoGuard® nerve protector and no cases of post-operative infection.
The AxoGuard® nerve protector is a versatile tool in complex peripheral nerve surgery with no reported device related complications in a consecutive series of 71 patients.
