A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans

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.