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Ulnar Nerve Regeneration in a 70-Year-Old Patient Assessed upon Revision of a Degradable Nerve Guide after 9 Months
01 December 2008 (online)
The rate of unsuccessful recovery from peripheral nerve gap lesions in the elderly is higher than average.   The gold standard in treating nerve gap injuries is the autograft, but harvesting a donor nerve graft, unfortunately, may have significant morbidity.    We do not advocate autograft as a routine indication in patients > 65 years of age (and similar consideration may be applied to allografts). In our experience it also appears there is an increasing difficulty in proposing an autograft to patients who do not accept the sacrifice of another nerve in their body coupled with the not-fully-guaranteed positive outcome of the grafting procedure; they may perceive that, in the worst case, they will end up with two lesions instead of one.
Approximately 20 years ago, artificial nerve guides (or conduits) were introduced into clinical practice as a reliable alternative to autograft. An overview of the clinical outcome of artificial nerve guides in peripheral nerve gap injuries showed that they perform at least as well as autografts in gaps not > 20 mm, and possess the significant advantage of avoiding donor site sacrifice and morbidity.   Early guides were made of silicone and were not degradable: they were shown to be capable of supporting nerve regeneration, but subsequently, they were considered responsible for stenosis of the regenerated nerve. It was suggested that they must be removed to achieve a positive outcome; degradable guides were proposed and are widely used today. 
The use of a degradable nerve guide, and its removal after a clinical recovery was achieved, proved beneficial in treating a 70-year-old patient, giving him a better outcome than what would be expected with a traditional autograft transplantation.
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Antonio Merolli, M.D.
Orthopaedics and Hand Surgery Unit, The Catholic University in Rome
Complesso Columbus, via Moscati 31, 00168 Rome, Italy