Peripheral Nerve Surgery with Processed Human Umbilical Cord: Clinical Case Series
Andrew Watt, MD1; Paul Sibley, DO2; Robert Hagan, MD3; Mark S. Rekant, MD4; Harry Hoyen, MD5 Bauback Safa, MD1
1The Buncke Clinic, San Francisco, CA; 2Hand and Upper Extremity Surgery, Allentown, PA; 3Neuropax Clinic, St Louis, MO; 4The Philadelphia Hand Center, Philadelphia, PA; 5MetroHealth System, Cleveland, OH
Introduction Inflammation, scar formation, and adhesions are inherent following injury or surgical intervention. When peripheral nerves are involved, resultant scarring and inflammation around nerves can lead to poor outcomes and make re-access difficult in the event of additional procedures. Placental membranes, historically used as wound dressings and coverings, lack qualities ideal for surgical applications. Human umbilical cord is a naturally resorbable and permeable membrane that's shown to modulate inflammation, separate tissue layers, and contains essential extracellular matrix molecules and endogenous growth factors. Avive® Soft Tissue Membrane (AxoGen Inc,Alachua FL) is processed human umbilical cord membrane (cord membrane) intended for use as a soft tissue covering. This material is designed to overcome specific shortcomings of placental membranes and remains intact at least 16 weeks making it ideal for use during the critical time of scar formation and maturation. Here we report on the use of cord membrane as an interpositional barrier for exposed peripheral nerves.
Materials and Methods Evaluation of the utilization of cord membrane was conducted. Following relevant consents, data was collected in cases where cord membrane was used during a surgical procedure on an exposed nerve. Information on injury, placement, and outcomes were collected. Data was reviewed to evaluate clinical application and outcomes after use in peripheral nerve surgery.
Results This series included 13 patients undergoing surgical procedures with exposed nerve in the zone of injury. The average age was 45(11-62)years. Pre-operative and surgical procedures were based on institution's standard of care. These included decompression, traumatic and planned reconstructive procedures. A majority of these nerves were in the upper extremity (Table-1). After exposure and neurolysis, cord membrane was hydrated and placed as a covering over the nerve. In eight cases, sutures (6-0/8-0) were used to secure in place. The average follow-up was 6 months. All surgeons reported the membrane conformed well, easily positioned, and remained intact. There were no reported complications /revisions and patients are recovering as expected. Additional follow-up is on-going.
Conclusions Processed human umbilical cord membrane can be used as a soft tissue covering during nerve surgery. This series included multiple injury types where the potential of post-operative scar and inflammation were a concern. Placement was successful in all cases. There were no reported complications or revisions and patients continue to recover as expected.
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