Management of the scarred nerve using porcine submucosa extracellular matrix nerve wraps

The management of failed cubital tunnel decompression

“… 39 The wider utility of these collagen wraps in managing the scarred nerve continues to develop. 40 Autologous vein wrapping has demonstrated efficacy, albeit at a donor site cost. 41 , 42 …”

Methylcobalamin-containing nanofiber sheets have better neuroprotective effects than small intestinal submucosa sheets

“…Additionally, soft tissue covering is not a generalized method because of the complexity of the procedure and the possibility of inducing other disorders, such as donor site morbidity and sensory disturbance. For these reasons, several nerve-protective materials and methods have been developed in recent years, and their e cacies have been reported [17][18][19][20][21][22][23][24][25][26]. Historically, there have been reports on the protection of peripheral nerves using techniques, such as vein wrapping or placing muscle or fat aps [14-16, 27, 28].…”

“…Historically, there have been reports on the protection of peripheral nerves using techniques, such as vein wrapping or placing muscle or fat aps [14-16, 27, 28]. Nonetheless, the possibility of complications, such as scarring at the donor site, has led to the development of alternative materials of nerve protection, including silicone sheets, biodegradable sheets composed of poly(L-lactide) and poly(e-caprolactone) (PCL), collagen gels, and sheets [17,18,[21][22][23][24][25][26]. However, symptom recurrence cannot be su ciently prevented [7] and no ideal treatment for peripheral nerve scarring exists in clinical settings.…”

“…However, symptom recurrence cannot be su ciently prevented [7] and no ideal treatment for peripheral nerve scarring exists in clinical settings. To prevent these unfavorable events, it is important to protect nerves from postoperative in ammation and scar formation [7,20,24,26,29]. Therefore, new treatment methods are being developed.…”

“…However, materials that prevent adhesions by acting on the in ammatory healing process have also been studied, with reports that perineural scar formation was reduced by covering the nerve with membrane tissues that release methylprednisolone, which inhibits broblasts and granulocytes [31], and that intraperitoneal administration of minocycline, used as an antibacterial agent, inhibited polarity changes to in ammatory macrophages, reducing perineural scar formation and nerve damage [32]. Although some of these implants have been used in clinical practice with generally positive results [24,31], the results have not been consistent. Additionally, a gold standard for treatment has not yet been established in terms of the risks of side effects of the released drug and the manufacturing cost of implants.…”