Necrotic Granulomatous Inflammation after Use of Small Intestine Submucosa Matrix for Recurrent Compression Neuropathy

Abstract

Summary: Various techniques exist for treating recurrent carpal and ulnar tunnel syndrome, but AxoGuard nerve wrap has shown promising results for treatment of compression neuropathies when used in conjunction with neurolysis and tenosynovectomy. Prior results demonstrate no safety concerns, and there have not been any reported cases of infection, persistent inflammation, or recurrent perineural fibrosis. A 41-year-old, right-hand-dominant woman experienced repeated bouts of carpal and ulnar tunnel syndromes, which were treated with a small intestine submucosa matrix wrap around the median and ulnar nerves in the wrist. Here, we report a case of necrotic granulomatous inflammation 2.5 months after AxoGuard xenograft nerve wrap was placed around the median and ulnar nerves. As a salvage, NuShield placental allograft was wrapped around the median nerve, which has shown promising results at several months follow-up. Placental allograft nerve wraps represent a useful tool in compression neuropathy resistant to autografts, xenografts, and revision decompression operations.

Shielding the Nerve: A Systematic Review of Nerve Wrapping to Prevent Adhesions in the Rat Sciatic Nerve Model

“…Some materials, like silicone, might show favorable outcomes in animal studies with a limited follow-up, but lead to complications in clinical application [26,31,32]. Adverse reactions, as observed in some materials, run contrary to the goals of placement [31,33,34]. Furthermore, the size and diameter of the wrapping material are essential to avoid iatrogenic constriction or overfitting, possibly reducing the desired effects [35,36].…”

“…In general, tissue-based materials are well-researched in peripheral nerve surgery and frequently achieve significantly improved scar prevention and treatment results; some are already in clinical use. On the other hand, depending on the exact material, several aspects, including origin, donor site morbidity, availability, cost, and potential adverse reactions, must be considered individually for each patient [33]. While veins are frequently used due to their easy grafting and limited donor site morbidity, it is unclear if one of these materials produces superior outcomes regarding scarring and adhesion prevention.…”