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Nerve wrapping for recurrent compression neuropathy: A systematic review.

Arjuna Thakker1, Sanjeev Chaand Sharma2, Niha Mariam Hussain3

  • 1University Hospitals Of Leicester NHS Trust, Leicester LE1 5WW, United Kingdom.

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
|December 3, 2020
PubMed
Summary

Nerve wraps can improve outcomes for revision nerve compression surgery. Autologous veins, collagen, and amniotic membrane all showed benefits, though pain remains a common symptom.

Keywords:
Compression neuropathyNerve wrappingRevision surgerySystematic review

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Area of Science:

  • Nerve regeneration and reconstructive surgery
  • Biomaterials in medical applications

Background:

  • Recurrent symptoms after primary nerve compression surgery affect up to 25% of patients.
  • Nerve wrapping is a viable option for revision surgery to prevent fibrosis and scarring.
  • An ideal nerve barrier promotes nerve gliding and minimizes scar tissue formation.

Purpose of the Study:

  • To systematically review the efficacy of nerve wraps in revision nerve compression surgery.
  • To evaluate autologous, allograft, and xenograft nerve wrapping options.
  • To assess outcomes and complications associated with different nerve wrap materials.

Main Methods:

  • Systematic review of PubMed, Ovid Embase, and Cochrane databases.
  • Inclusion of 11 studies (case series) following PRISMA guidelines.
  • Risk of bias assessed using the Methodological Index for Non-Randomised Studies (MINORS).

Main Results:

  • 114 patients (ages 28-90) included, with prior revision surgeries ranging from 0-5.
  • Autologous veins (6 studies), collagen (3 studies), and amniotic membrane (2 studies) were evaluated.
  • All wrap types demonstrated improvements in subjective and objective outcomes; pain was the most common residual symptom (46%).

Conclusions:

  • This is the first systematic review on nerve wraps for revision compression neuropathy.
  • All evaluated nerve wrap types showed positive outcomes.
  • Further comparative studies are necessary to identify the optimal nerve wrap for revision surgery.