Comparison of Recovery of Tactile Function and Sensation after Median or Ulnar Nerve Lesions Repaired by Suture or Nerve Guide (P06.150)

Abstract

Objective: The purpose of the study was to ascertain regeneration of sensory fibers and recovery of sensation after complete lesions of the median or ulnar nerve in the distal forearm and to compare repair carried out by direct suture or the use of a collagen nerve guide. Background After complete nerve lesions peripheral nerve fibers have the capacity to regenerate. Recovery is dependent of the rate of growth of fibers, the number of axons that regenerate, innervation of target tissue and maturation of regenerated fibers. Recovery is often incomplete, and patients usually are left with sensory and motor deficits. Design/Methods: In this randomized multi-center study two surgical procedures for repair of complete nerve lesions were compared. The collagen nerve guide (NeuraGen™) was implanted in 22 of 43 patients and direct suture repair was used in 20 patients and a short graft in 1 patient. The main outcome measures included clinical pain, sensory-motor- hand-function tests - RosenScore (J Hand Surg 2000;25A:535-43) and electrophysiological studies at 1 and 2 years after repair. In a subgroup consisting of 9 nerves repaired by nerve graft and in 9 by nerve guide, tactile function was studied by recording of sensory potentials using near-nerve needles. The stimulus was a fast indentation of 300 um applied to the tip of digit 3 or digit 5. Results: Tactile sensory potentials were recorded in all 18 patients with no difference in the amplitudes or areas after the two repair procedures. The amplitudes and areas were about 50% of those recorded from the contralateral normal hand. The findings were comparable to those obtained at hand function tests. Conclusions: Regeneration over short gap was supported as well by nerve guide as by suture and in the present patient group partial recovery of sensation and sensory fiber function was observed. Supported by: Integra LifeSciences Corp. Disclosure: Dr. Krarup has received personal compensation for activities with Integra LifeSciences as a speaker. Dr. Krarup has received research support from Integra LifeSciences and Shire. Dr. Rosen has nothing to disclose. Dr. Boeckstyns has nothing to disclose. Dr. Ibsen has nothing to disclose. Dr. Archibald has received personal compensation for activities with Integra LifeSciences Corp. as an employee.