Koenig Zachary A, Burns Jack C, Hayes John D
West Virginia University School of Medicine, Morgantown, W.Va.
Charleston Area Medical Center, Charleston, W.Va.
Plast Reconstr Surg Glob Open. 2022 Jun 14;10(6):e4378. doi: 10.1097/GOX.0000000000004378. eCollection 2022 Jun.
Various techniques exist for treating recurrent carpal and ulnar tunnel syndrome, but AxoGuard nerve wrap has shown promising results for treatment of compression neuropathies when used in conjunction with neurolysis and tenosynovectomy. Prior results demonstrate no safety concerns, and there have not been any reported cases of infection, persistent inflammation, or recurrent perineural fibrosis. A 41-year-old, right-hand-dominant woman experienced repeated bouts of carpal and ulnar tunnel syndromes, which were treated with a small intestine submucosa matrix wrap around the median and ulnar nerves in the wrist. Here, we report a case of necrotic granulomatous inflammation 2.5 months after AxoGuard xenograft nerve wrap was placed around the median and ulnar nerves. As a salvage, NuShield placental allograft was wrapped around the median nerve, which has shown promising results at several months follow-up. Placental allograft nerve wraps represent a useful tool in compression neuropathy resistant to autografts, xenografts, and revision decompression operations.
治疗复发性腕管综合征和尺管综合征有多种技术，但AxoGuard神经包裹物与神经松解术和腱鞘切除术联合使用时，在治疗压迫性神经病变方面已显示出有前景的结果。先前的结果表明没有安全问题，也没有任何感染、持续性炎症或复发性神经周围纤维化的报告病例。一名41岁、惯用右手的女性反复出现腕管综合征和尺管综合征，通过在手腕的正中神经和尺神经周围包裹小肠黏膜下层基质进行治疗。在此，我们报告一例在AxoGuard异种移植神经包裹物置于正中神经和尺神经周围2.5个月后发生坏死性肉芽肿性炎症的病例。作为补救措施，NuShield胎盘同种异体移植物包裹在正中神经周围，在几个月的随访中已显示出有前景的结果。胎盘同种异体移植神经包裹物是治疗对自体移植、异种移植和翻修减压手术耐药的压迫性神经病变的一种有用工具。
