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Peripheral nerve injuries are common, and there is no easily available formula for successful treatment. Although primary neurorrhaphy and nerve autografts are the most effective methods of repair, several newer options are at our disposal today. Though one can help speed up the nerve regeneration process to some extent, success is hindered by additional issues such as number of coaptation sites, supply of donor nerves and the limitations of nerve substitutes. There is now considerable evidence that peripheral nerves have the potential to regenerate if an appropriate microenvironment is provided. A better understanding of the biological processes involved in nerve regeneration process and the realization that nerve grafts serve as a guide for the growing neurons led to the concept of entubulation techniques. For distances of less than 3 cms, either a nerve conduit or an autologous vein graft serves equally well as nerve graft. Seeding the conduits with cultured Schwann cells has pushed the limit of nerve regeneration through a 6 cm gap. In experimental studies with Schwann cell lined bioengineered conduits gaps as large as 8cms can be bridged. Advances in bioengineering has allowed creation of composite neural tubes lined with Schwann cells and neurotropic agents that enhances regeneration of nerve fibers, block the invasion of scar tissue and autodegrade when it is no longer required. The evolution of the concept of entubulation, the early experimentation, the present development and various types of conduits are discussed here.

Background:Keloids are characterised by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Auricular keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clips and cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of the three-dimensional structure of the ear following resection is a challenge to the cutaneous surgeon.Objectives:To devise a standard protocol for management of auricular keloids with minimal distortion and recurrence.Setting and Design:The patients underwent day-care surgery and subsequent out-patient follow-up for a minimum period of 1 year.Methods:Ten patients presenting with 22 ear keloids were enrolled into a keloid protocol: (a) surgical excision and keloid rind flap cover with (b) intra-operative and post-operative intra-lesional steroid and (c) silicone sheet application. Subjective assessment on follow-up was using Patient Observer Scar Assessment Scale and objective assessment was by Beausang scale.Statistical Analysis used:Microsoft Excel and Statistical Package for the Social Sciences (SPSS). Kaplan-Meier survival analysis curve used to calculate Recurrence Free period.Results:Two out of 22 (9.1%) keloids developed post-excision recurrence after a mean follow -up period of 16 months. The average keloid recurrence free interval was 21 months.Conclusion:Triple combination therapy for keloids on the ear is a simple technique for management with preservation of contour of the ear and a low recurrence rate.

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