Ra. Weber et al., A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans, PLAS R SURG, 106(5), 2000, pp. 1036-1045
This article reports the first randomized prospective multicenter evaluatio
n of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjec
ts with 136 nerve transections in the hand and prospectively randomized the
repair to two groups: standard repair, either end-to-end or with a nerve g
raft, or repair using a polyglycolic acid conduit. Two-point discrimination
was measured by a blinded observer at 3, 6, 9, and 12 months after repair.
There were 56 nerves repaired in the control group and 46 nerves repaired
with a conduit available for follow up. Three patients had a partial condui
t extrusion as a result of loss of the initially crushed skin flap.
The overall results showed no significant difference between the mio groups
as a whole. In the control group, excellent results were obtained in 43 pe
rcent of repairs, good results in 43 percent, and poor results in 14 percen
t. In those nerves repaired with a conduit, excellent results were obtained
in 44 percent, good results in 30 percent, and poor results in 26 percent
(p = 0.46). When the sensory recovery was examined with regard to length of
nerve gap, however, nerves with gaps of 4 mm or less had better sensation
when repaired with a conduit; the mean moving two-point discrimination was
3.7 +/- 1.4 mm for polyglycolic acid tube repair and 6.1 +/- 3.3 mm for end
-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or gre
ater were reconstructed with either a nerve graft or a conduit. This subgro
up also demonstrated a significant difference in favor of the polyglycolic
acid tube. The mean moving two-point discrimination for the conduit was 6.8
+/- 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the
mean moving two-point discrimination for the,graft repair was 12.9 +/- 2.4
mm, with excellent results obtained in none of the eight nerves (p < 0.001
and p = 0.06, respectively).
This investigation demonstrates improved sensation when a conduit repair is
used for nerve gaps of 4 mm or less, compared with end-to-end repair of di
gital nerves. Polyglycolic acid conduit repair also produces results superi
or to those of a nerve graft for larger nerve gaps and eliminates the donor
-site morbidity associated with nerve-graft harvesting.