Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube

Microneurosurgical techniques to reconstruct nerve gaps with nerve grafts frequently fail to achieve excellent functional results and create donor-site morbidity. In the present study, 15 patients had gaps of 0.5 to 3.0 cm (mean 1.7 cm) in digital nerves reconstructed by one surgeon with a bioabsorbable polyglycolic acid (PGA) tube. A final evaluation of sensibility was done by a second surgeon at a mean postoperative interval of 22.4 months (range 11 to 32 months). These were all secondary reconstructions. The evaluation included a digital nerve block with local anesthetic for the intact (not reconstructed) digital nerve. Excellent functional sensation (moving two-point discrimination less than or equal to 3 mm and/or static two-point discrimination less than or equal to 6 mm) was present in 33 percent and good functional sensation (moving two-point discrimination of 4 to 7 mm and/or static two-point discrimination of 7 to 15 mm) in 53 percent of the digital nerve reconstructions. One patient with poor sensory recovery and one with no recovery were judged as functional failures (14 percent). Absence of pain at the site of reconstruction was judged by the patient to be excellent in 40 percent, good in 33 percent, and poor in 27 percent. We conclude that reconstruction of nerve gaps of up to 3.0 cm with a bioabsorbable PGA tube gives clinical results at least comparable to the classic nerve graft technique while avoiding donor-site morbidity.