Vein conduits for repair of nerves with a prolonged gap or in unfavorable conditions: An analysis of three failed cases

Abstract

Clinical failure of vein conduits for repair of four nerves in three cases is reported. Two digital nerves with gaps of 5.0 cm and 5.8 cm, respectively, and two median nerves with gaps of 4.0 cm and 5.0 cm were repaired with vein conduits. The digital nerves were repaired secondarily with insertion of nerve tissue slices. The median nerve lacerations were associated with compound soft tissue injuries and were repaired primarily by interfascicular vein conduits. There was no detectable recovery of sensibility in autonomous areas of these nerves and no sign of recovery of the innervated muscles during follow-up. Re-exploration revealed that the vein conduits used for repair of the median nerves were constricted by surrounding scar tissue and axon regeneration was precluded. The critical length for nerve regeneration in human beings and wound conditions unfavorable to nerve regeneration are discussed. This report suggests that vein conduits are not indicated in nerve gaps over 5.0 cm or in primary repair of nerves with compound injuries.