Secondary Digital Nerve Repair in the Foot with Resorbable p(DLLA-ε-CL) Nerve Conduits

ABSTRACT

Nerve guides are increasingly being used in peripheral nerve repair. In the last decade, much preclinical research has been undertaken into a resorbable nerve guide composed of p(DLLA-ε-CL). This report describes the results of secondary digital nerve reconstruction in the foot in a patient with post-traumatic neuromas of the common plantar digital nerves II-III and III-IV. The neuromas were resected and reconstruction of the nerves was carried out with resorbable Neurolac^® nerve guides. The Pressure Specified Sensory Device™ was used to measure the static (s) and moving (m) 1- and 2-point discrimination (PD).

Fourteen months after nerve repair, the m1-PD returned in all digital nerves. The s1-PD returned only on the lateral side of the second toe. The m2-PD and s2-PD did not return in any of the toes originally innervated by the reconstructed nerves. According to the British Classification System, the sensory nerve recovery was poor. However, there were no complaints of painful neuromas after this procedure.

In conclusion, this report shows no beneficial effects of Neurolac^® nerve guides in terms of return of sensibility after repair of common plantar digital nerves. Painful neuromas, however, could be well-treated.

Plantar digital nerve - painful neuroma - nerve conduit

REFERENCES

• 1 Seckel B R, Ryan S E, Gagne R J et al.. Target-specific nerve regeneration through a nerve guide in the rat.  Plast Reconstr Surg. 1986;  78 793-798
• 2 Meek M F, Bertleff M J, Ritt M J, Robinson P H, Nicolai J-PA. Een afbreekbare kunststof zenuwgeleider voor de overbrugging van perifere zenuwdefecten.  Ned Tijdschr voor Geneesk. 2003;  147 717-721
• 3 Meek M F, Coert J H. The clinical use of nerve conduits in Peripheral nerve repair; a review of the literature.  J Reconstr Microsurg. 2002;  18 97-110
• 4 Mackinnon S E, Dellon A L. Surgery of the Peripheral Nerve. New York; Thieme Medical Publishers 1988
• 5 Kim J, Dellon A L. Reconstruction of a painful post-traumatic medial plantar neuroma with a bioabsorbable nerve conduit: a case report.  J Foot Ankle Surg. 2001;  40 318-323
• 6 Dellon A L. A numerical grading scale for peripheral nerve function.  J Hand Ther. 1993;  4 152-160
• 7 Jansen K, Meek M F, van der Werff J F, van Wachem P B, van Luyn M J. Long-term regeneration of the rat sciatic nerve through a biodegradable poly(DLLA-ε-CL) nerve guide: tissue reactions with focus on collagen III/IV reformation.  J Biomed Mat Res Am. 2004;  69A 334-341
• 8 Meek M F, den Dunnen W F, Schakenraad J M, Robinson P H. Long-term evaluation of functional nerve recovery after reconstruction with a thin-walled biodegradable poly(DLLA-ε-CL) nerve guide, using walking track analysis and electrostimulation tests.  Microsurgery. 1999;  19 247-253
• 9 Den Dunnen W F, van der Lei B, Robinson P H, Holwerda A, Pennings A J. The biological performance of a degradable poly(lactic acid-ε-caprolactone) nerve guide: influence of tube dimensions.  J Biomed Mater Res. 1995;  29 757-766