In reply:

Abstract

We thank Drs Meek and Coert for their comments and critical review of our study. They have an obvious interest in the use of conduits to repair peripheral nerve gap defects. The purpose of our investigation was simply to introduce a potential alternative technique for repairing nerve gap defects; therefore, the review of the use of conduits was intentionally limited for one fundamental reason. There is an evolving and interesting body of literature that investigates various conduits, with and without growth factors and Schwann cells, but in the clinical setting the use of autogenous nerve grafts to repair nerve gap defects is the current standard.1 A number of studies from Dr Meek's laboratory using a rat model in addition to a lone clinical study that does not evaluate motor function are referenced. We do not dispute the results of these investigations; however, all must agree that the use of artificial conduits has not displaced autogenous nerve grafting and therefore we stand by our comments. Clearly, the ideal nerve conduit will include Schwann cells and growth factors in a manner that reproduces autogenous nerve grafts. There have been no studies of nerve conduits crossing joints and bridging gaps of greater than 4.0 cm, situations in which autogenous grafts are routinely used. In the clinical setting there have been problems with nerve conduits eroding through skin, which have not reported for autogenous nerve grafts.