Reconstruction of Upper‐Extremity Peripheral‐Nerve Injuries with ePTFE Conduits

Abstract

This reported investigation was designed to determine the role of a new synthetic conduit-expanded polytetrafluoroethylene (ePTFE) tube--in clinical repair of median and ulnar nerves in the upper extremities. The main goals of this study were: to determine the effectiveness of the ePTFE conduit in clinical nerve reconstruction; to evaluate the potential of this technique in reconstruction of various nerve gaps (1.5 to 6 cm); and to analyze the results of repair with the ePTFE tube regarding different mechanisms of injury. Forty-three patients were evaluated. They had upper-extremity peripheral-nerve injuries (21 injuries to the median nerve, and 22 ulnar nerve injuries) located at the various levels of the upper extremities. All surgical procedures described in the study were secondary reconstructions, and the average delay from injury to repair was 4.2 months. With regard to the nerve-gap lengths, patients were categorized in two groups. Group 1 (gaps from 1.5 to 4 cm) included 28 patients (17 median nerve injuries and 11 ulnar nerve injuries), and Group 2 (gaps from 4.1 to 6 cm) comprised 15 patients (4 median nerve injuries and 11 ulnar nerve injuries). Results showed that 78.6 percent of patients from Group 1 demonstrated functional motor and sensory recovery, while reconstruction of only 13.3 percent of peripheral nerves from Group 2 resulted in useful reinnervation. According to published results, ePTFE conduit is a reliable and successful surgical procedure for nerve repair in reconstruction of nerve gaps up to 4 cm between the ends of median and ulnar nerves in various levels of the upper extremity. Because of its properties, ePTFE conduit has the advantages of promoting better nerve regeneration, compared to other synthetic tubes, especially in reconstruction of proximal nerve injuries, larger nerve gaps, and in cases with unfavorable mechanisms of nerve injury.

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

“…The original idea was to provide support, structure to guide axonal regrowth and form a stable barrier against connective tissue infiltration [73,100,101]. Synthetic nerve conduits made of ePTFE were successfully applied in a 4-cm nerve gap, in human [102]. Second-generation nerve conduits are resorbable, biocompatible tubes and are FDA approved and commercially available through different materials.…”

Nerve repair: toward a sutureless approach

“…Testing the diameter and thickness of these conduits found that increasing one or both of these parameters resulted in reduced functional recovery for the patient [44]. Furthermore, neither silicone nor PTFE showed potential in nerve regeneration in gaps larger than 4 cm in human studies [89]. Interestingly however, silicone conduits with small punctures produced improved regeneration on rat sciatic nerves compared to solid silicone conduits [24].…”

Current management of the mangled upper extremity

“…One must avoid tension at the repair site, at all costs. Small nerve gaps can be resolved by mobilizing the nerve ends, through proximal nerve transpositions, or by using bridging veins, nerve conduits, silicone and absorbable tubes [47][48][49]. Although the epineural microsurgical suture is mostly performed, there is also the proposition for microsurgical interfascicular nerve grafting when there are larger gaps [50].…”