Resorbable Nerve Wraps: Can They Be Overtightened?

Nicolas, Celine F.; Corvi, John J.; Park, Katherine H; Akelina, Yelena; Engemann, Anne; Strauch, Robert J.

doi:10.1055/s-0042-1744274

Cited by 4 publications

(3 citation statements)

References 40 publications

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“…Attention should also be brought to the intraoperative technique of applying nerve wraps. If they are wrapped around the nerve too tightly, this can lead to adverse effects creating increased scar formation and hindering nerve regeneration [82].…”

Section: Discussionmentioning

confidence: 99%

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

Mayrhofer-Schmid,

Klemm,

Aman

et al. 2023

JPM

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Background: Peripheral nerve pathology is frequently encountered in clinical practice among peripheral nerve and extremity surgeons. One major factor limiting nerve regeneration and possibly leading to revision surgeries is the development of traumatic or postoperative adhesions and scarring around nerves. In experimental models, different materials have been studied to limit scar tissue formation when wrapped around nerves. Methods: A systematic review of studies describing nerve-wrapping materials in a non-transectional rat sciatic nerve model was performed following the PRISMA guidelines. Literature describing nerve-wrapping methods for the prevention of peripheral nerve scarring in rat sciatic nerve models was identified using PubMed and Web of Science, scanned for relevance and analyzed. Results: A total of 15 original articles describing 23 different materials or material combinations for nerve wrapping were included. The heterogeneity of the methods used did not allow a meta-analysis, thus, a systematic review was performed. Out of 28 intervention groups, 21 demonstrated a preventive effect on scar tissue formation in at least one qualitative or quantitative assessment method. Conclusions: The analyzed literature describes a variety of materials from different origins to limit peripheral nerve scarring and adhesions. Thus, a scar-preventive effect by wrapping peripheral nerves as adhesion prophylaxis seems likely. However, a quantitative comparison of the studies to identify the optimal material or technique is not possible with the diversity of used models and study designs. Therefore, further research needs to be performed to identify the optimal nerve wraps to be used routinely in clinical practice.

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Section: Discussionmentioning

confidence: 99%

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

Mayrhofer-Schmid,

Klemm,

Aman

et al. 2023

JPM

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“…The use of nerve wraps in peripheral nerve surgery is well-established ( 2 , 4 , 5 ). However, as one animal study by Nicolas et al demonstrated, the potential for over-tightening nerve wraps has detrimental effects ( 16 ). Spielman et al reported resolution of symptoms and improved VAS scores in 30 patients with recurrent or persistent carpal tunnel syndrome who had surgery that involved the use of a nerve wrap ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies

et al. 2023

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Epineural scarring following previous carpal or cubital tunnel release can lead to pain and permanent dysfunction. To prevent this cascade, nerve wraps are an option. The purpose of this study was to evaluate outcomes following use of VersaWrap nerve protector during surgical decompression and neurolysis in patients with recurrent compressive neuropathies in the upper extremity. Twenty patients comprised the patient cohort, with a mean postoperative follow-up time of 139 days (range: 42–356 days). There were 13 females and 7 males, with a mean age of 43.4 years. Fourteen surgeries were performed for revision cubital tunnel, 5 for revision carpal tunnel, and 1 for revision radial tunnel syndrome. Average duration of symptoms prior to revision surgery with VersaWrap was 2 years (range 9 months to 6 years). Postoperatively, the mean DASH score was 57.7 and VAS 3.1. Mean s2PD median distribution was 7.3, s2PD ulnar distribution 8.9, m2PD median distribution 6.9 and m2PD ulnar distribution 7.3. All patients had subjective improvement of symptoms and were satisfied with their result. No patients in our cohort required further revisional surgery. In conclusion, the use of VersaWrap as a nerve protector following revision surgery for recurrent compressive neuropathies in the upper extremity was safe and effective.Level of Evidence: IV; retrospective case series

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“…We have already shown amnion and veins to be highly effective as nerve photosealants in preventing neuroma formation after peripheral nerve injury in a rat sciatic nerve transection model [23]. While care must be taken in applying nerve wrap materials to ensure compression does not result when sutured in place, both vein and amnion are ideal in terms of their ability to self-adhere to the nerve prior to photosealing without causing compression [24,25].…”

Section: Introductionmentioning

confidence: 99%

Photosealed Neurorrhaphy Using Autologous Tissue

Rossi,

Bejar-Chapa,

Giorgino

et al. 2024

IJMS

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Photochemical sealing of a nerve wrap over the repair site isolates and optimizes the regenerating nerve microenvironment. To facilitate clinical adoption of the technology, we investigated photosealed autologous tissue in a rodent sciatic nerve transection and repair model. Rats underwent transection of the sciatic nerve with repair performed in three groups: standard microsurgical neurorrhaphy (SN) and photochemical sealing with a crosslinked human amnion (xHAM) or autologous vein. Functional recovery was assessed at four-week intervals using footprint analysis. Gastrocnemius muscle mass preservation, histology, and nerve histomorphometry were evaluated at 120 days. Nerves treated with a PTB-sealed autologous vein improved functional recovery at 120 days although the comparison between groups was not significantly different (SN: −58.4 +/− 10.9; XHAM: −57.9 +/− 8.7; Vein: −52.4 +/− 17.1). Good muscle mass preservation was observed in all groups, with no statistical differences between groups (SN: 69 +/− 7%; XHAM: 70 +/− 7%; Vein: 70 +/− 7%). Histomorphometry showed good axonal regeneration in all repair techniques. These results demonstrate that peripheral nerve repair using photosealed autologous veins produced regeneration at least equivalent to current gold-standard microsurgery. The use of autologous veins removes costs and foreign body concerns and would be readily available during surgery. This study illustrates a new repair method that could restore normal endoneurial homeostasis with minimal trauma following severe nerve injury.

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Resorbable Nerve Wraps: Can They Be Overtightened?

Cited by 4 publications

References 40 publications

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

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

Outcomes following use of VersaWrap nerve protector in treatment of patients with recurrent compressive neuropathies

Photosealed Neurorrhaphy Using Autologous Tissue

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