Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity

Ali M. Soltani, Bassan J. Allan, Matthew J. Best, Haaris S. Mir, Zubin Panthaki

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: Recurrent or persistent compression neuropathies of the upper extremity, including carpal and cubital tunnel syndrome, present a difficult treatment challenge to the hand or peripheral nerve surgeon. Collagen conduits have been used successfully for decades in nerve injury repair, but have not been studied in the treatment of compression neuropathy. METHODS: Patients with recurrent or persistent compression neuropathies treated with a repeat decompression and collagen wrap from a 5-year period were retrieved from the Computerized Patient Record System database and 15 patient records were identified. A systematic review was performed for all articles from 1946 to 2012 on secondary carpal and cubital tunnel syndrome. RESULTS: The mean age of the 15 patients treated was 63.3 years and ranged from 35 to 86 years. The patients with revision carpal tunnel decompression had an 89% subjective response rate, whereas those with revision cubital tunnel decompression had an 83% resolution or improvement of symptoms. Visual analog scale decreased from a preoperative mean 2.47 to 0.47 postoperatively and the mean number of opiate medications decreased from 0.67 to 0.40. We identified 32 papers using various treatment strategies for recurrent carpal tunnel syndrome with success rates ranging from 53% to 100%. We identified 18 papers on recurrent cubital tunnel syndrome, with success rates ranging from 33% to 100%, with a weighted success of 78.1% overall but 71.7% in the submuscular transposition group. CONCLUSIONS: Here we report on the novel technique of using a collagen matrix wrap in recurrent compression neuropathies with good success. The collagen wrap allows nerve gliding, protection from perineural scar formation, and a favorable microenvironment. Submuscular transposition seems to be no better than other methods of decompression for recurrent cubital tunnel syndrome in contrary to traditional teaching.

Original languageEnglish
Pages (from-to)572-578
Number of pages7
JournalAnnals of Plastic Surgery
Volume72
Issue number5
DOIs
StatePublished - Jan 1 2014

Fingerprint

Cubital Tunnel Syndrome
Decompression
Upper Extremity
Collagen
Carpal Tunnel Syndrome
Opiate Alkaloids
Wrist
Visual Analog Scale
Peripheral Nerves
Cicatrix
Teaching
Therapeutics
Hand
Tomaculous neuropathy
Databases
Wounds and Injuries

Keywords

  • collagen
  • hand surgery
  • mediannerve compression
  • peripheral nerve surgery
  • persistent carpal tunnel syndrome
  • persistent cubital tunnel syndrome
  • recurrent carpal tunnel syndrome
  • recurrent cubital tunnel syndrome
  • systematic review
  • ulnar nerve compression

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. / Soltani, Ali M.; Allan, Bassan J.; Best, Matthew J.; Mir, Haaris S.; Panthaki, Zubin.

In: Annals of Plastic Surgery, Vol. 72, No. 5, 01.01.2014, p. 572-578.

Research output: Contribution to journalArticle

Soltani, Ali M. ; Allan, Bassan J. ; Best, Matthew J. ; Mir, Haaris S. ; Panthaki, Zubin. / Revision decompression and collagen nerve wrap for recurrent and persistent compression neuropathies of the upper extremity. In: Annals of Plastic Surgery. 2014 ; Vol. 72, No. 5. pp. 572-578.
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abstract = "BACKGROUND: Recurrent or persistent compression neuropathies of the upper extremity, including carpal and cubital tunnel syndrome, present a difficult treatment challenge to the hand or peripheral nerve surgeon. Collagen conduits have been used successfully for decades in nerve injury repair, but have not been studied in the treatment of compression neuropathy. METHODS: Patients with recurrent or persistent compression neuropathies treated with a repeat decompression and collagen wrap from a 5-year period were retrieved from the Computerized Patient Record System database and 15 patient records were identified. A systematic review was performed for all articles from 1946 to 2012 on secondary carpal and cubital tunnel syndrome. RESULTS: The mean age of the 15 patients treated was 63.3 years and ranged from 35 to 86 years. The patients with revision carpal tunnel decompression had an 89{\%} subjective response rate, whereas those with revision cubital tunnel decompression had an 83{\%} resolution or improvement of symptoms. Visual analog scale decreased from a preoperative mean 2.47 to 0.47 postoperatively and the mean number of opiate medications decreased from 0.67 to 0.40. We identified 32 papers using various treatment strategies for recurrent carpal tunnel syndrome with success rates ranging from 53{\%} to 100{\%}. We identified 18 papers on recurrent cubital tunnel syndrome, with success rates ranging from 33{\%} to 100{\%}, with a weighted success of 78.1{\%} overall but 71.7{\%} in the submuscular transposition group. CONCLUSIONS: Here we report on the novel technique of using a collagen matrix wrap in recurrent compression neuropathies with good success. The collagen wrap allows nerve gliding, protection from perineural scar formation, and a favorable microenvironment. Submuscular transposition seems to be no better than other methods of decompression for recurrent cubital tunnel syndrome in contrary to traditional teaching.",
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