gms | German Medical Science

Objectives/Interrogation: This study evaluated the short-and mid- term results of revision neurolysis and wrapping with porcine extracellular matrix (PECM) (AxoGuard® Nerve Protector, AxoGen Inc.) as an alternative technique for the treatment of recurrent compressive neuropathy after one previous surgical decompression.

Methods: Between 2009-2017, 86 patients, 49 with recurrent carpal tunnel and 37 with recurrent cubital tunnel syndrome, were treated with decompression and PECM nerve wrap. All patients had recurrent symptoms after having previously undergone one surgical decompression. The mean patient age was 56.7 years. The surgery consisted of revision median or ulnar nerve neurolysis and PECM nerve wrapping. All patients were noted to have extensive cicatrix formation around the median or ulnar nerve at the time of revision surgery. A hypothenar fat pad flap was performed as a supplementary procedure in cases of recurrent carpal tunnel, and a minimal medial epicondylectomy was performed in 15 of 37 cases of recurrent cubital tunnel.

Results and Conclusions: The mean follow-up period was 49 months (range, 6-108). Mean patient VAS pain scores significantly improved from 8.4 preoperatively to 1.4 postoperatively. The mean grip strength was significantly increased to 85.4 % of the unaffected arm, compared with 41.3% preoperatively. The mean pinch strength improved from 63.2% of the unaffected arm before surgery to 81.6% after surgery. Static two-point discrimination improved from a mean 10.2 mm preoperatively to 7.3 mm postoperatively. 79 of 86 patients demonstrated 2 mm or more improvement in two-point discrimination postoperatively. Electro-diagnostic findings in those evaluated also improved, although not to normal values. There were no postoperative infections or wound complications. One patient with persistent elbow pain but normal electro-diagnostic findings needed further surgery 32 months after the revision cubital decompression and PECM nerve wrap. This patient was treated with revision ulnar nerve neurolysis and autologous saphenous vein nerve wrap after removal of the PECM.

Based on our short and mid-term results of 86 patients, secondary decompression combined with PECM nerve wrapping is an effective and safe alternative technique for the surgical treatment of the symptomatic patient with recurrent carpal or cubital tunnel syndrome. This technique may eliminate the possible morbidity associated with autologous tissue coverage for failed nerve decompression.