This article describes the reconstruction of the median nerve in the distal forearm using interposition bioabsorbable polyglycolic acid conduits (Neurotube). Two patients, aged 43 and 61, are reported where a 3-cm median nerve defect in the distal forearm was reconstructed with four separate 2.3-mm diameter, 4.0-cm long interposition conduits. Each patient recovered two-point discrimination with good localization in the thumb, index, and middle finger by 2 years after the nerve reconstruction. Both patients recovered abductor pollicis brevis function. Total follow-up was 5 years.
Traditionally, median nerve reconstruction has required multiple interfascicular interposition autologous nerve grafts with disappointing results for recovery of two-point discrimination, even in young adults. Clinical results for upper extremity peripheral nerve reconstruction with a single bioabsorbable conduit have been reported for digital nerves and for the median nerve in the palm. This is the first report of median nerve reconstruction with multiple interposition nerve conduits for a 3 cm defect. The reported results of this study are exceptionally good, particularly, considering the advanced age of the patients. This technique certainly deserves further investigation to demonstrate reliability in a larger study and superiority to reconstruction with a single conduit or nerve graft.
Nerve, Conduit, Grafts, Median, Forearm, Neurotube