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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Porcine submucosa extracellular matrix nerve wrapping of scarred nerves

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  • presenting/speaker Pieter Jordaan - Queen Elizabeth Hospital, Birmingham, United Kingdom
  • Okezika Uhiara - Queen Elizabeth Hospital, Birmingham, United Kingdom
  • Dominic Power - Queen Elizabeth Hospital, Birmingham, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1953

doi: 10.3205/19ifssh1333, urn:nbn:de:0183-19ifssh13337

Published: February 6, 2020

© 2020 Jordaan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Scar tissue formation in the vicinity of a peripheral nerve causes compression, ischaemia, impaired glide and tether, resulting in a pain syndrome - neurostenalgia. Neurolysis of a scarred nerve may bring initial relief from pain but secondary scar formation usually follows. Adjunctive wrapping may reduce scar formation. Biological tissues may result in donor site morbidity. The AxoGuardŽ nerve protector (AxoGen Inc., Alachua FL) is a layered porcine submucosal extracellular collagen matrix that may be sutured around nerves following neurolysis providing a layer for revascularization and restoration of nerve gliding. This report is on utilization, safety and outcomes of the AxoGuardŽ in a tertiary referral peripheral nerve service.

Methods: After obtaining ethics form the institutional audit review board, a review was performed of all cases where AxoGuardŽ nerve protectors were used in primary or revision nerve surgery from June 2015 to July 2018. General demographic data, indications, nerves involved, complications and early follow up data were collected and evaluated.

Results and Conclusions: Over a 3-year period AxoGuardŽ nerve protectors were used in 71 patients. The indication for surgery was a scarred nerve after trauma in 32 cases, scarring after primary nerve surgery in 19 cases, primary trauma in 9 cases (including one nerve transfer due to a significant size mismatch), nerve scarring after elective non-nerve surgery in 5 cases and nerve tumours in 5 cases. The most commonly involved nerves were the ulnar nerve (32), median nerve (14), digital nerves (11) and the common peroneal nerve (3).

One patient had an early re-exploration due to a post-operative haematoma and one patient had a late exploration due to adjacent tendon adhesions. There have been no complications related to the AxoGuardŽ nerve protector and no cases of post-operative infection.

The AxoGuardŽ nerve protector is a versatile tool in complex peripheral nerve surgery with no reported device related complications in a consecutive series of 71 patients.