Antiadhesion Barrier Gels in Peripheral Nerve Surgery

ABSTRACT

Reconstructive procedures on peripheral nerves have benefited from many recent advances. Unfortunately, compression syndromes caused by postoperative scar adversely affect a significant number of patients even after an impeccable surgical repair. Scar tissue still represents a formidable impediment to new nerve regeneration, and its long-term effects may cause irreversible neurologic damage and unremitting pain. Conservative therapy has little to offer, whereas secondary surgery is afflicted by frequent recurrences. Because the formation of symptomatic scar is unpredictable, its prophylaxis can only be achieved through a multidisciplinary approach, which includes meticulous surgical technique and the use of new biomaterials. Notwithstanding the intensive biotechnologic quest toward safe and effective adhesion barriers, their use and acceptance remains to be established. Prevention of perineural scar is discussed in relation to the pathogenetic mechanisms of peripheral nerve adhesion and compression syndromes. The requirements for an adequate adhesion barrier are proposed, and current experience with novel antiadhesion devices is reviewed.

KEYWORD

Peripheral nerves - postoperative adhesions - antiadhesion gel - scar tissue

REFERENCES

• 1 Dagum A B. Peripheral nerve regeneration, repair, and grafting.  J Hand Ther . 1998;  11 111-117
• 2 Terzis J K, Vekris M D, Soucacos P N. Outcomes of brachial plexus reconstruction in 204 patients with devastating paralysis.  Plast Reconstr Surg . 1999;  104 1221-1240
• 3 Harris M E, Tindall S C. Techniques of peripheral nerve repair.  Neurosurg Clin N Am . 1991;  2 93-104
• 4 Frank U, Giunta R, Krimmer H, Lanz U. Neueinbettung des N. medianus nach Vernarbung im Karpalkanal mit der Hypothenar-Fettgewebslappenplastik.  Handchir Mikrochir Plast Chir . 1999;  31 317-322
• 5 Mackinnon S E. Secondary carpal tunnel surgery.  Neurosurg Clin N Am . 1991;  2 75-91
• 6 Mustoe T A, Han H. The effect of new technologies on plastic surgery.  Arch Surg . 1999;  134 1178-1183
• 7 Dellon A L. Wound healing in nerve.  Clin Plast Surg . 1990;  17 545-570
• 8 Flores A J, Lavernia C J, Owens P W. Anatomy and physiology of peripheral nerve injury and repair.  Am J Orthop . 2000;  29 167-173
• 9 Lundborg G, Dahlin L B. Anatomy, function, and pathophysiology of peripheral nerves and nerve compression.  Hand Clin . 1996;  12 185-193
• 10 Mackinnon S E, Dellon A L, Hudson A R, Hunter D A. Chronic human nerve compression-a histological assessment.  Neuropathol Appl Neurobiol . 1986;  12 547-565
• 11 Millesi H, Zöch G, Reihsner R. Mechanical properties of peripheral nerves.  Clin Orthop . 1995;  314 76-83
• 12 Millesi H. The nerve gap. Theory and clinical practice.  Hand Clin . 1986;  2 651-663
• 13 Tracey D J, Walker J S. Pain due to nerve damage: are inflammatory mediators involved?.  Inflamm Res . 1995;  44 407-411
• 14 Olsson Y. Microenvironment of the peripheral nervous system under normal and pathological conditions.  Crit Rev Neurobiol . 1990;  5 265-311
• 15 Millesi H. Peripheral nerve repair: terminology, questions, and facts.  J Reconstr Microsurg . 1985;  2 21-31
• 16 Lluch A L. Thickening of the synovium of the digital flexor tendons: cause or consequence of the carpal tunnel syndrome?.  J Hand Surg [Br] . 1992;  17 209-212
• 17 Nath R K, Kwon B, Mackinnon S E. Antibody to transforming growth factor beta reduces collagen production in injured peripheral nerve.  Plast Reconstr Surg . 1998;  102 1100-1106
• 18 Millesi-Eberhard D, König B, Millesi H. Kompressionssyndrome des N. axillaris und des N. suprascapularis.  Handchir Mikrochir Plast Chir . 1999;  31 311-316
• 19 Merle M, de Medinaceli L. Primary nerve repair in the upper limb. Our preferred methods: theory and practical applications.  Hand Clin . 1992;  8 575-586
• 20 Lee W P, Constantinescu M A, Butler P E. Effect of early mobilization on healing of nerve repair: histologic observations in a canine model.  Plast Reconstr Surg . 1999;  104 1718-1725
• 21 Grewal R, Xu J, Sotereanos D G, Woo S L. Biomechanical properties of peripheral nerves.  Hand Clin . 1996;  12 195-204
• 22 Millesi H, Rath T, Reihsner R, Zöch G. Microsurgical neurolysis: its anatomical and physiological basis and its classification.  Microsurgery . 1993;  14 430-439
• 23 Palazzi S, Palazzi J L. Neurolysis in compressive neuropathies.  Int Surg . 1980;  65 509-514
• 24 Xu J, Varitimidis S E, Fisher K J, Tomaino M M, Sotereanos D G. The effect of wrapping scarred nerves with autogenous vein graft to treat recurrent chronic nerve compression.  J Hand Surg [Am] . 2000;  25 93-103
• 25 Sunderland S. A classification of peripheral nerve injuries producing loss of function.  Brain . 1951;  74 491
• 26 Mackinnon S E, Dellon A L. Surgery of the Peripheral Nerve.  New York: Thieme 1988: 1-33
• 27 Botte M J, von Schroeder P H, Abrams R A, Gellman H. Recurrent carpal tunnel syndrome.  Hand Clin . 1996;  12 731-743
• 28 Hunter J M. Recurrent carpal tunnel syndrome, epineural fibrous fixation, and traction neuropathy.  Hand Clin . 1991;  7 491-504
• 29 Langloh N D, Linscheid R L. Recurrent and unrelieved carpal tunnel syndrome.  Clin Orthop Rel Res . 1972;  83 41-47
• 30 Tham S K, Ireland D C, Riccio M, Morrison W A. Reverse radial artery fascial flap: a treatment for the chronically scarred median nerve in recurrent carpal tunnel syndrome.  J Hand Surg [Am] . 1996;  21 849-854
• 31 Tubiana R. Carpal tunnel syndrome. Some views on its management.  Ann Hand Surg . 1990;  9 325-330
• 32 Mackinnon S E, Dellon A L. Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube.  Plast Reconstr Surg . 1990;  85 419-424
• 33 Rogers M R, Bergfield T G, Aulicino P L. The failed ulnar nerve transposition. Etiology and treatment.  Clin Orthop . 1991;  269 193-200
• 34 Davies M A, Vonau M, Blum P W. Results of ulnar neuropathy at the elbow treated by decompression or anterior transposition.  Aust N Z J Surg . 1991;  61 929-934
• 35 Plancher K D, McGillicuddy J O, Kleinman W B. Anterior intramuscular transposition of the ulnar nerve.  Hand Clin . 1996;  12 435-444
• 36 Glasby M A, Gschmeissner S E, Huang C L, <~>De Souza B A. Degenerated muscle grafts used for peripheral nerve repair in primates.  J Hand Surg [Br] . 1986;  11 347-351
• 37 Dumanian G A, McClinton M A, Brushart T M. The effects of free fat grafts on the stiffness of the rat sciatic nerve and perineural scar.  J Hand Surg [Am] . 1999;  24 30-36
• 38 Masear V R, Colgin S. The treatment of epineural scarring with allograft vein wrapping.  Hand Clin . 1996;  12 773-779
• 39 Fields R D, Le Beau M J, Longo F M, Ellisman M H. Nerve regeneration through artificial tubular implants.  Prog Neurobiol . 1989;  33 87-134
• 40 Heijke G C, Klopper P J, Dutrieux R P. Vein graft conduits versus conventional suturing in peripheral nerve reconstructions.  Microsurgery . 1993;  14 584-588
• 41 Ruch D S, Spinner R M, Koman L A. The histological effect of barrier vein wrapping of peripheral nerves.  J Reconstr Microsurg . 1996;  12 291-295
• 42 Braga-Silva J. The use of silicone tubing in the late repair of the median and ulnar nerves in the forearm.  J Hand Surg [Br] . 1999;  24 703-706
• 43 Merle M, Dellon A L, Campbell J N, Chang P S. Complications from silicon-polymer intubulation of nerves.  Microsurgery . 1989;  10 130-133
• 44 Sanger J R, Kolachalam R, Komorowski R A. Short-term effect of silicone gel on peripheral nerves: a histologic study.  Plast Reconstr Surg . 1992;  89 931-940
• 45 Archibald S J, Shefner J, Krarup C, Madison R D. Monkey median nerve repaired by nerve graft or collagen nerve guide tube.  J Neurosci . 1995;  15 4109-4123
• 46 Kline D G. Nerve surgery as it is now and as it may be.  Neurosurgery . 2000;  46 1285-1293
• 47 Molander H, Olsson Y, Engkvist O. Regeneration of peripheral nerve through a polyglactin tube.  Muscle Nerve . 1982;  5 54-57
• 48 Gibson K L, Remson L, Smith A. Comparison of nerve regeneration through different types of neural prostheses.  Microsurgery . 1991;  12 80-85
• 49 Sparmann M. Nervenprothetik. Aktueller Stand.  Orthopäde . 1998;  27 433-440
• 50 Loick J, Joosten U, Lücke R. Einsatz von oxidierter, regenerierter Zellulose zur Rezidivprophylaxe bei der chirurgischen Therapie des Karpaltunnelsyndroms.  Handchir Mikrochir Plast Chir . 1997;  29 209-213
• 51 Nagamatsu M, Podratz J, Windebank A J, Low P A. Acidity is involved in the development of neuropathy caused by oxidized cellulose.  J Neurol Sci . 1997;  146 97-102
• 52 Görgülü A, I;aDmer M, Şimşek O. The effect of aprotinin on extraneural scarring in peripheral nerve surgery: an experimental study.  Acta Neurochir (Wien) . 1998;  140 1303-1307
• 53 Petersen J, Russell L, Andrus K. Reduction of extraneural scarring by ADCON-T/N after surgical intervention.  Neurosurgery . 1996;  38 976-984
• 54 Palatinsky E A, Maier K H, Touhalisky D K. ADCON^℗-T/N reduces in vivo perineural adhesions in a rat sciatic nerve reoperation model.  J Hand Surg [Br] . 1997;  22 331-335
• 55 Merle M, Foucher G, Egloff D V. Peritendinous and perineural scar and adhesions-treatment with a new anti-adhesion barrier gel, ADCON-T/N. In: Rehart S, Zichner L, eds. Hand Surgery A Current Concepts Review. Frankfurt International Hand Surgery Conference New York: Thieme 1997: 33-40
• 56 Geisler F H. Prevention of peridural fibrosis: current methodologies.  Neurol Res . 1999;  S9-S22 (S9-S22)