Circumferential Vein Wrapping Versus Vein Sheath to Improve the Outcome of Peripheral Nerve Repair

Noaman, Ayman; Abul Halim, Ihab; Elshitany, Hisham; Ahmed, Rama; Ashraf, Mohamed

doi:10.21608/ejprs.2019.65156

Circumferential Vein Wrapping Versus Vein Sheath to Improve the Outcome of Peripheral Nerve Repair

Document Type : Original Article

Authors

¹ The Departments of Plastic Surgery, Faculty of Medicine, Cairo University

² The Departments of Neurosurgery, Faculty of Medicine, Cairo University

³ The Departments of Plastic Surgery* and Neurosurgery**, Faculty of Medicine, Cairo University

10.21608/ejprs.2019.65156

Abstract

Background: Trauma to peripheral nerves is relatively
common which can be caused by blunt trauma or penetrating
injuries. An important quality of the peripheral nervous system,
as compared with the central nervous system, is its remarkable
ability to recover after an injury. To improve the outcome in
post-traumatic peripheral nerve injury beside precise suturing
and orientation of the nerve stumps is to protect the anastomosis
from the surrounding environment; this barrier should be
biologically inert, biodegradable and non-compressive. Vein
wrapping to the site of anastomosis was described to protect
the neuro-anastomosis and to improve nerve conduction and
prevent neuroma formation.
Methods: This randomized controlled study was conducted
on 60 patients presenting with either median or ulnar nerve
injuries in the forearm, they were divided into 3 groups were
group (A) The neuro-anastomosis was covered with a vein
segment passed through one segment and after the neurorrhaphy
the vein is stretched to cover the suture line, In Group < br />(B) The neuro-anastomosis was covered with a vein segment
who was circumferentially wrapped, In Group (C) the neuro
anastomosis was not covered with a vein wrap.
Results: After 12 months follow-up were: Functional
recovery of motor nerves, sensitivity and the presence of
neuroma at the site of nerve both group A and B showed a
more rapid motor and sensory recovery and a reduction of
the painful symptoms compared to the control group (C).
Conclusion: Both Vein wrapping techniques provides a
valid solution to avoid the dispersion of the nerve fibers,
adherent scars and painful neuromas formation.

Keywords

Main Subjects

New technologies and products

References

1- Griffin M.F., Malahias M., Hindocha S. and Wasim S.:
Peripheral Nerve Injury: Principles for Repair and Regeneration;
The Open Orthopaedics Journal, 8, (Suppl 1:
M10) 199-203, 2014.
2- Tessa G.: Nerve regeneration in the peripheral and central
nervous systems: J. Physiol. Jul., 1; 594 (13): 3517-3520,
2016.
3- Seddon H.J.: Three types of nerve injury. Brain, 66: 237,
1943.
4- Sunderland S.: Nerves and nerve injuries. 2nd ed. Edinburgh,
NY: Churchill and Livingstone, pp. 69-141, 1978.
5- Lars B. Dahlin and Mikael Wiberg: Nerve injuries of the
upper extremity and hand; Effort Open Reviews, Volume
2, May 2017.
6- Farnebo S., Thorfinn J. and Dahlin L.B.: Peripheral nerve
injuries of the upper extremity. In: Neligan P.C., Chang
J., van Beek A.L., eds. Hand Surgery (A volume in the
Plastic Surgery 6-Volume Set: Expert Consult Premium).
Third ed. China: Elsevier Saunders, 2012.
7- David J. Gerth, Jun Tashiro and Seth R. Thaller: Clinical
outcomes for Conduits and Scaffolds in peripheral nerve
repair; World J. Clin. Cases February, 16; 3 (2): 141-147,
2015.
8- Hudson T.W., Evans G.R. and Schmidt C.E.: Engineering
strategies for peripheral nerve repair. Orthop. Clin. North
Am., 31: 485-49, 2000.
9- S. Leuzzi, A. Armenio, L. Leone, V. De Santis and A. di
Turi: Repair of peripherial nerve with vein wrapping; G.
Chir. March-April, Vol. 35, n. 314: 101-106, 2014.
10- Eser F., Aktekin L.A., Bodur H. and Atan C.: Etiological
factors of traumatic peripheral nerve injuries. Neurol.
India, 57: 434-7, 2009.
11- Karol A.G.: Peripheral nerves and Tendon Transfers.
Selected Reading in Plastic Surgery, 9:23, 2003.
12- Mafi P., Hindocha S., Dhital M. and Saleh M.: Advances
of Peripheral Nerve Repair Techniques to Improve Hand
Function: A Systematic Review of Literature. The Open
Orthopaedics Journal, 6 (Suppl 1: M7): 60-68, 2012.
13- Adanali G., Verdi M., Tuncel A., et al.: Effects of hyaluronic
acid-carboxymethylcellulose membrane on extraneural
adhesion formation and peripheral nerve regeneration. J.
Reconstr. Microsurg., 19: 29-35, 2003.
14- Görgülü A., Imer M., Simsek O., et al.: The effect of
aprotinin on extraneural scarring in peripheral nerve
surgery: An experimental study. Acta. Neurochir. [Wien]
1998; 140: 1303-7. 316 L. Mathieu et al., Chirurgie de la
main, 31: 311-317, 2012.
15- Petersen J., Russel L., Andrus K., et al.: Reduction of
extraneural scarring by ADCON-T/N after surgical intervention.
Neurosurgery, 38: 976-84, 1996.
16- Van der Avoort D.J., S.E.R. Hovius, R.W. Selles, J.W.
van Neck and J.H. Coert: The incidence of symptomatic
neuroma inamputation and neurorrhaphy patients. Journal
of Plastic, Reconstructive & Aesthetic Surgery, 66, 1330-
1334, 2013.
17- Mathieu L., Adam C., Legagneux J., Bruneval P. and
Masmejean E.: Reduction of neural scarring after peripheral
nerve suture: An experimental study about collagen
membrane and autologous vein wrapping. Chirurgie de
la main, 31: 311-317, 2012.
18- Vozzi G., Carlucci F., Salvadori C., Dini F., Vozzi F.,
Dominici C., Arispicim, Ciardelli G. and Giusti P.: L'uso
di microguide bioerodibili nella. Nerve Regeneration Atti
SICV, 12: 213-215, 2005.
19- Carlucci F., Dini F., Vozzi G., Vozzi F., Chiono V., Salvadori
C., et al.: “The Tunnel Effect” using Bioerodable Tubes
in Nerve Regeneration. Annali. Fac. Med. Vet., 2005,
Lviii.
20- Delaviz H., Faghihi A., Delshad A. Azizzadeh, Bahadori
Mohamad hadi, Mohamadi Jamshid and Roozbehi Amrollah:
Repair of Peripheral Nerve Defects Using a Polyvinylidene
Fluoride Channel Containing Nerve Growth
Factor and Collagen Gel in Adult Rats. Cell Journal
(Yakhteh), 13 (3): 137-142, 2011.
21- Chiu D.T. and Strauch B.: A prospective clinical evaluation
of autogenous vein grafts used as a nerve conduit for
distal sensory nerve defects of 3cm or less. Plast. Reconstr.
Surg., 86: 928-934, 1990.
22- Walton R.L., Brown R.E., Matory W.E., Borah G.L. and
Dolph J.L.: Autogenous vein graft repair of digital nerve
defects in the finger: A retrospective clinical study. Plast.
Reconstr. Surg., 84: 944-949; discussion 944-949, 1989.
60 Vol. 43, No. 1 / Improving Outcome of Nerve Repair
23- Mahboub T., Abdelkader R., Nawar A. and Attia M.:
Evaluation of Vein Wrap around Peripheral Nerve Repair:
An Experimental Study. Egypt, J. Plast. Reconstr. Surg.,
January 2017.
24- Islam A.A. and Mostafa E.S.: Autogenous Vein Wrapping
for Treatment of Recurrent Carpal Tunnel Syndrome.
Egypt, J. Plast. Reconstr. Surg., Vol. 34, No. 2, July, 173-
180, 2010.
25- Jianming Xu, Sokratis E. Varitimidis, Kenneth J. Fisher
P., Matthew M.T., Dean G.S. and Pittsburgh P.A.: The
Effect of Wrapping Scarred Nerves With Autogenous Vein
Graft to Treat Recurrent Chronic Nerve Compression.
The Journal of Hand Surgery, Vol. 25A No. 1 January
2000.
26- Zinon T.K., Sameer J. and Dean G. S.: Vein wrapping at
cubital tunnel for ulnar nerve problems. J. Shoulder Elbow
Surg., 19: 91-97, 2010