Dy Christopher J, Aunins Benjamin, Brogan David M
Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO.
Department of Orthopaedic Surgery, Division of Hand and Upper Extremity Surgery, Washington University School of Medicine, St. Louis, MO.
J Hand Surg Am. 2018 Apr;43(4):360-367. doi: 10.1016/j.jhsa.2018.01.013. Epub 2018 Feb 24.
The physiological limitations of neural regeneration make peripheral nerve surgery challenging to both the surgeon and the patient. Presence of nerve gaps and local wound factors may all influence outcome, suggesting that barriers to reduce perineural scarring, minimize fibrosis, and avoid ischemia would be beneficial. To examine the evidence supporting their use, we reviewed the autologous and commercially-available options for barriers against scarring around a nerve. Numerous clinical case series demonstrated the effectiveness and safety of local/rotational flaps and autologous vein wrapping when used in the presence of recurrent compressive neuropathy. Translational research in animal models supports the biocompatibility of commercially available nerve wraps following nerve repair. To date, there are no reports of clinical use of commercially available nerve wraps in acute nerve repair, but a growing number of case series demonstrate their effectiveness and safety in chronic compressive neuropathy. Limited clinical evidence exists to support the efficacy of vein or flap coverage in acute nerve repairs.
神经再生的生理局限性使得周围神经手术对医生和患者来说都具有挑战性。神经间隙的存在和局部伤口因素都会影响手术结果，这表明减少神经周围瘢痕形成、最小化纤维化并避免局部缺血的屏障将是有益的。为了研究支持其使用的证据，我们回顾了用于防止神经周围瘢痕形成的自体和市售屏障选项。众多临床病例系列证明，当用于复发性压迫性神经病变时，局部/旋转皮瓣和自体静脉包裹的有效性和安全性。动物模型的转化研究支持了市售神经包裹物在神经修复后的生物相容性。迄今为止，尚无关于市售神经包裹物用于急性神经修复的临床应用报告，但越来越多的病例系列证明了它们在慢性压迫性神经病变中的有效性和安全性。支持静脉或皮瓣覆盖在急性神经修复中疗效的临床证据有限。
