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An Alternative to the Classical Nerve Graft for the Management of the Short Nerve Gap
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1988
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Nerve grafting for short gaps causes donor‑site scarring, loss of donor nerve function, and neuroma formation. The study aimed to compare nerve regeneration after one year in monkeys with a 3‑cm ulnar nerve gap using a bioabsorbable polyglycolic acid conduit versus a classical sural nerve graft. Sixteen monkeys underwent a 3‑cm upper arm ulnar nerve gap repair with either the conduit or graft, and regeneration was assessed after one year. All groups showed neural regeneration, with conduit and graft groups having similar, though lower, fiber diameters, amplitudes, and conduction velocities than normal nerves, and 68 % of intrinsic muscles recovered, indicating that a biodegradable polyglycolic acid conduit can effectively replace a short interfascicular nerve graft.
Reconstruction of a short nerve gap by a nerve graft produces donor-site scarring, loss of donor nerve function, and neuroma formation. This study compared the regeneration achieved after 1 year in 16 monkeys across a 3-cm upper arm ulnar nerve gap with a bioabsorbable polyglycolic acid nerve conduit with the regeneration achieved with a classical interfascicular interpositional sural nerve graft. The results demonstrated electrophysiologic and histologie evidence of neural regeneration across the gaps in all experimental groups. The bioabsorbable nerve conduit groups and the sural nerve graft group had mean fiber diameters, amplitudes, and conduction velocities each significantly less than those of normal control ulnar nerves. There was, however, no significant difference between any of the experimental groups. Electromyography demonstrated recovery of 19 of the 28 (68 percent) intrinsic muscles studied. These results demonstrate that the primate peripheral nerve can regenerate across short nerve gaps when guided by an appropriate nerve conduit, suggesting that a single-stage biodegradable polyglycolic acid conduit may be used as an alternative to a short interfascicular nerve graft.