Prospective Clinical Study on Digital Nerve Repair with Collagen Nerve Conduits and Review of Literature

Abstract

Little data are available concerning conduit repair of digital nerve lesions. We are presenting a prospective two-center cohort study on digital nerve reconstruction with collagen nerve conduits. The data are put into the context of a comprehensive review of existing literature. Over a period of 3 years, all consecutive digital nerve lesions that could not be repaired by tensionless coaptation with a gap length of less than 26 mm were reconstructed with nerve conduits made from bovine collagen I. Sensibility was assessed 1 week, 3, 6, and 12 months postoperatively by static and moving 2-point-discrimination (2PD) and monofilament testing. Forty-nine digital nerve lesions in 40 patients met the inclusion criteria. The mean nerve gap was 12.3 ± 2.3 mm (span 5-25 mm). Forty nerve reconstructions could be included in the 12-month follow-up. Three cases, assessed 12 months postoperatively, showed excellent sensibility (static 2PD <6 mm). Seventeen achieved good (2PD 6-10 mm), 5 fair (2PD 11-15 mm), 6 poor (2PD >15 mm, but protective sensibility), and 9 achieved no sensibility. Monofilament test results were significantly better if gap length was shorter than 12 mm. Our results confirm tubulization as one possible technique in nerve reconstruction for gap lengths of 5 to 25 mm.

An Optimized Collagen-Fibrin Blend Engineered Neural Tissue Promotes Peripheral Nerve Repair

“…The study presented focuses on improving EngNT technology, an approach developed for the construction of living artificial nerve tissue that mimics key features of the nerve graft and has previously been made using type I collagen. Collagen has been proven to be a suitable and versatile endogenous biomaterial for peripheral nerve regeneration, being used as a tube material, 22 as well as luminal filler in various forms, and has been shown to be compatible with delivery of Schwann cells. 23 , 24 While collagen-based EngNT has been used to deliver a range of potential cell therapies, 25 , 26 for long-distance defects Schwann cells (or Schwann cell-like therapeutic cells) have to remain in a pro-regenerative proliferative state over a prolonged period of time.…”

Anatomical Considerations to Optimize Sensory Recovery in Breast Neurotization with Allograft

“…In terms of nerve gap bridging mediums, a mixed sensory-motor autograft for aforementioned reasons may adequately bridge the gap, but have less than adequate sensory recovery and the gap length during breast neurotization far exceeds what is recommended for reconstruction with nerve conduits, which is about 6 mm. 38–44 The most comprehensive review on tube conduits and allografts as an alternative to nerve autografts was performed by Safa and Buncke 45 in 2016 and they found that in gaps under 6 mm, tube conduits performed well, but beyond this length the reliability declined rapidly and outcomes were significantly less consistent. In light of these findings, the favorable breast neurotization results reported by Spiegel et al, 18 who used 40 mm hollow tube conduits are rather surprising and not otherwise replicated.…”

Stem cell therapy for nerve injury

“…They run a follow-up survey and monitored 5 infants with transplanted collagen conduits and reported significant motor recovery. Lohmeyer et al[ 38 ] also used collagen conduits for nerve reconstruction and reported a 55% of two-point discrimination and 77% of protective sensation recovery. Boeckstyns et al[ 39 ] used collagen tubules for recovery of the injured median and ulnar nerves and Sosa et al[ 40 ] used collagen tubules containing platelet-rich fibrin for a patient with ulnar neuroma and both of them reported significant motor and sensory recovery.…”