Experience of using the bioresorbable copolyester poly(DL-lactide-ε-caprolactone) nerve conduit guide Neurolac™ for nerve repair in peripheral nerve defects: Report on a series of 28 lesions

Abstract

Synthetic nerve guides are occasionally used to repair nerve defects. The aim of the present work was to analyse the results of Neurolac™ use in a series of 23 patients. We operated on 28 nerve lesions located on various sites: arm (n = 1), elbow (n = 5), forearm (n = 4), wrist (n = 2), palm (n = 5), fingers (n = 11). Defects averaged 11.03 mm and were repaired using Neurolac™. After an average of 21.9 months' follow up (3-45 months), subjective criteria (pain, cold intolerance, Quick DASH) and objective criteria (strength, Weber and Semmes-Weinstein sensitivity tests) were compared with the contralateral side. Average pain score was 2.17/10. Cold intolerance was reported in fifteen cases. Quick DASH averaged 35.37/100. Grip strength averaged 64.62% of the contralateral side. As regards sensitivity, the difference between the two sides was 18.89 on Weber's test, and 46.92 on Semmes-Weinstein. Defect size did not affect the outcomes. We observed eight complications the most serious being two fistulizations of the Neurolac™ device close to a joint and one neuroma. Neurolac™ presents some advantages (resorption, semi-permeability, emergency use, tenseless repair) like other synthetic guides used for nerve regeneration and its transparency constitutes an added benefit. However, some difficulty in its handling and its expensiveness represent real disadvantages. Our results are not in favour of its use in repairing hand nerve defects.

Overcoming Short Gaps in Peripheral Nerve Repair: Conduits and Human Acellular Nerve Allograft

“…Conduit assisted repair of major peripheral nerve repairs with more legitimate gaps is less optimistic. Chiriac et al only reported acceptable recovery in 1 out of 12 conduit assisted major peripheral nerve repairs [7]. Moore et al reported on four out of four major peripheral nerve repair failures and recommend against their use in that particular clinical scenario [34].…”

“…Chiriac et al looked at 27 nerve repairs throughout the upper extremity utilizing PCL conduits for gap sizes averaging 11 mm (up to 25 mm; and diameters ranging from 1.5 to 4 mm). Only six patients, five of which had digital nerve repairs, had satisfactory outcomes [7].…”

“…This potential biological advantage, however, must be weighed against challenging handling characteristics. Polycaprolactone tubes are so rigid that passing a microsuture through the wall can be difficult, and concerns about extrusion, fistula formation, and foreign body reaction, especially in areas of thin overlying tissue or around joints, have been raised [7,14].…”

Clinical Evaluation After Peripheral Nerve Repair With Caprolactone Neurotube

“…The discomfort seems to be more important when it is placed across a finger joint. Hernandez-Cortes et al 11 and Chiriac et al 5 reported cases of tube extrusion after being placed across the joint in the proximal area of the thumb. Likely, the greater mobility of this area, which was associated with the hardness of the tube, favored the bad results.…”

“…In a Chiriac et al series, 5 28 nerves were operated with caprolactone tubes. The authors did not consider the results favorable regarding the use of this neurotube and did not recommend it.…”