Abstract
The management of peripheral nerve injury continues to be a major clinical challenge. The most widely used technique for bridging defects in peripheral nerves is the use of autologous nerve grafts. This technique, however, has some disadvantages. Many alternative experimental techniques have thus been developed, such as degradable nerve conduits. Degradable nerve guides have been extensively studied in animal experimental studies. However, the repair of human nerves by degradable nerve conduits has been limited to only a few clinical studies. In this paper, an overview of the available international published literature on degradable nerve conduits for bridging human peripheral nerve defects is presented for literature available until 2004. Also, the philosophy on the use of nerve guides and nerve grafts is given.
Highlights
The management of peripheral nerve injury continues to be a major clinical challenge
Morbidity at the acceptor and donor sites should be considered when autologous nerve grafts are used for peripheral nerve reconstruction which, is generally in practise and relatively minor
The nerve guide has served its purpose after the nerve fibers have bridged the gap between the proximal and distal nerve stumps, and its presence in the case of a nondegradable material may even have a negative influence on the regenerated nerves
Summary
Environment, thereby leading to an increase in the concentration of neurotropic and neurotrophic factors produced by the damaged nerve stumps, and by reducing fibroblast invasion and subsequent scarring of the nerve. Casanas et al (2000) described a prospective study of 17 patients with chronic lesions of the digital nerves of the hand, and lesion defects longer than 2 cm These defects were repaired by PGA tubes. To understand the discrepancy between the experimental results after 12 and 16 months of implantation, it should be stated that in the previous studies cross-sections for LM and EM work were performed to evaluate the degradation behavior, while more recently transverse-sections over the whole length of the tube including the nerve were performed (Jansen 2004). In these preparations we can still see biomaterial fragments at 16 months after implantation.
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