Different nerve grafting and wrapping options in upper extremity surgery

Abstract

Scar tissue can interfere with axonal regeneration and ultimate nerve function. Resection of scar tissue, however, results either in a nerve defect (if the scar tissue is intraneural) or the potential for recurrent extraneural scarring. Both biologic and off-the-shelf options exist for bridging short nerve gaps though understanding their limitations will improve the chances of successful application. Similarly, an appreciation of the available biologic and off-the-shelf nerve wrapping options can facilitate choosing the most appropriate adhesion barrier.

Barriers to Epineural Scarring: Role in Treatment of Traumatic Nerve Injury and Chronic Compressive Neuropathy

“…The ideal barrier to perineural scarring should have the following characteristics: (1) minimal or no chance of rejection or inflammatory reaction; (2) sufficient porosity to facilitate diffusion of nutrients without allowing axonal escape; (3) avoidance of scar induced ischemia; (4) promote nerve gliding; (5) minimal or no donor site morbidity; (6) minimal cost or supply restraints (Table 1). 1…”