University Hospitals Of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom.
Whittington Health Trust, Magdala Avenue, London N19 5NF, United Kingdom.
J Plast Reconstr Aesthet Surg. 2021 Mar;74(3):549-559. doi: 10.1016/j.bjps.2020.10.085. Epub 2020 Nov 8.
The recurrence of symptoms following primary nerve compression surgery can occur in up to 25% of cases. Nerve wrapping can be utilised for revision surgery. An ideal barrier should minimise the chance of fibrosis, scarring and allow for adequate nerve gliding. This review evaluates the use of autologous or commercially available allograft and xenograft options as barriers against nerve scarring following revision surgery.
PubMed, Ovid Embase and Cochrane databases were searched using the All Fields Index. Nine hundred titles underwent title screening with 11 studies being included in the final analysis. The risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool. PRISMA guidelines were followed at all stages and the review was registered with PROSPERO (CRD 42020182818).
The 11 studies comprised of all case series. In total, 114 patients were included, with ages ranging from 28 to 90. Previously, the number of revision surgeries ranged from 0 to 5. Autologous veins were used in 6 studies, collagen in 3 studies and human amniotic membrane in 2 studies. Improvements in subjective and objective outcomes were seen with all wrap types. Pain was the most common residual symptom (46% of patients). The most common complication was pain at the donor site following vein harvest (19% of patients).
This is the first systematic review to summarise the outcomes of nerve wraps for revision compression neuropathy. While improvements in outcomes were reported, further comparative studies are needed to determine the best nerve wrap.
原发性神经压迫手术后症状复发的发生率可达 25%。神经包裹术可用于翻修手术。理想的屏障应最大限度地减少纤维化、瘢痕形成的机会，并允许足够的神经滑动。本综述评估了自体或市售同种异体和异种移植物作为翻修手术后防止神经瘢痕形成的屏障的应用。
使用全文索引在 PubMed、Ovid Embase 和 Cochrane 数据库中进行检索。经过标题筛选，有 900 个标题，最终有 11 项研究纳入了最终分析。使用非随机研究方法学指数（MINORS）工具评估偏倚风险。在所有阶段都遵循 PRISMA 指南，并在 PROSPERO（CRD 42020182818）上进行了注册。
这 11 项研究均为病例系列研究。总共纳入了 114 名患者，年龄从 28 岁到 90 岁不等。之前，翻修手术次数从 0 到 5 次不等。6 项研究中使用了自体静脉，3 项研究中使用了胶原蛋白，2 项研究中使用了人羊膜。所有包裹类型都能改善主观和客观的结果。疼痛是最常见的残留症状（46%的患者）。最常见的并发症是静脉采集后供区疼痛（19%的患者）。
这是第一项总结神经包裹术治疗复发性压迫性神经病结果的系统综述。尽管报告了结果的改善，但仍需要进一步的比较研究来确定最佳的神经包裹物。
