Abstract
In the field of nerve repair, one major challenge is the formation of neuroma. However, reports on both the promotion of nerve regeneration and prevention of traumatic neuroma in the clinical settings are rare in the field of nerve repair. One of the reasons could be the insufficiency in the follow-up system. We have conducted 33 cases of nerve repair using PRGD/PDLLA/β-TCP conduit without any sign of adverse reaction, especially no neuroma formation. Among them, we have selected two cases as representatives to report in this article. The first case was a patient with an upper limb nerve wound was bridged by PRGD/PDLLA/β-TCP conduit and a plate fixation was given. After nearly 3-years’ follow-up, the examination results demonstrated that nerve regeneration effect was very good. When the reoperation was performed to remove the steel plate we observed a uniform structure of the regenerated nerve without the formation of neuroma, and to our delight, the implanted conduit was completely degraded 23 months after the implantation. The second case had an obsolete nerve injury with neuroma formation. After removal of the neuroma, the nerve was bridged by PRGD/PDLLA/β-TCP conduit. Follow-up examinations showed that the structure and functional recovery were improved gradually in the 10-month follow-up; no end-enlargement and any other abnormal reaction associated with the characteristic of neuroma were found. Based on our 33-case studies, we have concluded that PRGD/PDLLA/β-TCP nerve conduit could both promote nerve regeneration and prevent neuroma formation; therefore, it is a good alternative for peripheral nerve repair.
Highlights
The reconstruction of injured peripheral nerve and the prevention of neuroma formation after surgery are still the big challenges in the field of nerve repair [1,2,3,4,5,6]
The first case was a patient with an upper limb nerve wound was bridged by PRGD/PDLLA/b-tricalcium phosphate (b-TCP) conduit and a plate fixation was given
Based on our 33-case studies, we have concluded that PRGD/PDLLA/b-TCP nerve conduit could both promote nerve regeneration and prevent neuroma formation; it is a good alternative for peripheral nerve repair
Summary
The reconstruction of injured peripheral nerve and the prevention of neuroma formation after surgery are still the big challenges in the field of nerve repair [1,2,3,4,5,6]. At the 6 months follow-up, sensory nerve conduction velocity returned to near normal level at 48 m/s as examined by the electrophysiology tests, and the functions of both wrist and finger stretch have partially recovered. First at 3 months after the operation, monofilament touch pressure test was conducted, and the measurements on distal phalanx of index and middle finger had a failed score, while the wrist joints position was 2.0 g, and palmar opposition of left thumb has partially recovered. Wrist bending of left hand has recovered 80% as compared with that of the normal side (Fig. 4C).High frequency B ultrasonography confirmed the thick nerve fibers tract in the conduit (Fig. 4D), and broken nerves between the near and far ends have been connected. In the cases which PRGD/PDLLA/b-TCP composite conduit was used to repair nerve injury, the recovery rate was 78.9%, which is a better clinical repair outcome
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