Clinical Evaluation After Peripheral Nerve Repair With Caprolactone Neurotube

Abstract

Background: Peripheral nerve injuries with substance loss are challenges to surgeons because direct suture repair may result in malfunction due to nerve suture tension. Autologous nerve grafts are alternatives for treating those lesions; however, harvesting grafts adds morbidity at donor sites. Synthetic substitutes are options to bridge the gaps in these situations. The caprolactone neurotubes are used to assist nerve regeneration, but the literature lacks studies that evaluate their results. Methods: This research was designed to clinically evaluate patients undergoing repair of peripheral nerves with that conduit. We described results of 12 case series consisting of operations with Neurolac®. All nerves severed were sensory and had small gaps (ie, less than 25 mm). Subjective and objective clinical evaluations were performed and registered. Results: Physical examination by monofilament testing and 2-point discrimination showed results rated as good or excellent. However, the patients had complaints regarding sensory changes. Conclusions: Synthetic bioabsorbable guides for nerve repair are promising. The caprolactone conduits were demonstrated to be a safe option treatment and with a simple technique. Although in our study there were some operative complications, they were in line with previous descriptions in the literature. This case series added information about the treatment prognosis, but a higher evidence level study is necessary for decision making.

Nerve grafting for peripheral nerve injuries with extended defect sizes

“…Supporting the results from den Dunnen et al. [ 19 ] a case series from Brazil indicates that the use of Neurolac® is a safe and successful procedure for peripheral nerve surgery [ 21 ].…”

“…Nerve defects extending these 3.0 cm are usually considered to be critical [ 25 ]. Good clinical and non-clinical data is available for short nerve defects not extending 3.0 cm [ 13 – 21 ]. Recently Kaplan et al.…”

The progress of biomaterials in peripheral nerve repair and regeneration

“…These conflicting results might be explained by the differences of the injury location [24,48]. Thus, the efficacy of PLCL conduits remains controversial and more clinical trials are needed [75][76][77].…”

Biomimetic Approaches for Separated Regeneration of Sensory and Motor Fibers in Amputee People: Necessary Conditions for Functional Integration of Sensory–Motor Prostheses With the Peripheral Nerves

“…Almost the totality of commercial devices for <30-mm-long PNIs consists of a hollow tubular scaffold that allows physical regeneration of the sectioned nerve through it. These scaffolds can be made by different biomaterials, such as porcine submucosa ECM, Axoguard R Nerve Connector (Axogen, Inc., FL, United States); collagen I, NeuraGen R (Integra LifeSciences Corporation, United States); polyglycolic acid, Neurotube R (Synovis Micro Companies Alliance, Inc., AL, United States); and poly-DL-lactide-co-caprolactone and polyvinyl alcohol, Neurolac R (Polyganics, Netherlands) (Tian et al, 2015;Costa Serrão de Araújo et al, 2017). Several improvements have been tested in animal models, including (i) fillings with hydrogels that favor axons regeneration; (ii) inclusion of topographic cues, like microfilaments/nanofilaments or groove patterns, to favor guidance and directionality by interacting with the growth cone; or (iii) incorporation of growth factors and supporting cells (Carvalho et al, 2019;Wang and Sakiyama-Elbert, 2019).…”