Marcel F. Meek

This report describes two incidental findings of aberrant branches of the radial digital nerves in the middle finger of a 52-year-old man who cut himself with a grinding machine, and in the index finger of a 45-year-old female who sustained a flexor sheath infection following a dog bite. In both patients, two equally sized radial digital nerves were found and both nerves originated from one common digital nerve.

One way to improve nerve regeneration and bridge longer nerve gaps may be the use of semipermeable/porous conduits. With porosity less biomaterial is used for the nerve conduit. We evaluated the short‐term effects of porous Neurolac® nerve conduits for in vivo peripheral nerve regeneration. In 10 male Black Hooded rats, a gap of 10 mm was bridged by a porous Neurolac® nerve conduit. Evaluation point ranged from 3 to 12 weeks. The sciatic nerve function was not measurable due to automutilation and flexion contractures. The gait‐stance duration showed no improvement with time, indicating a disturbed walking pattern. The nerve guides showed very fast degradation with swelling, fragmentation, and collapse. Furthermore, a severe foreign body reaction occurred. Nerve regeneration was severely hampered. This study showed no beneficial effects of porous Neurolac® nerve conduits when compared with previous findings with nonporous copolymeric nerve guides of a slightly different composition. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.

We describe a rare case of plexiform malignant peripheral nerve sheath tumour (MPNST) of infancy and childhood in a 3.5-year-old girl. The tumour was located in the proximal phalanx of the left index finger. After initial excisions and a ray amputation, exarticulation of the third and fourth rays was required.

Several absorbable nerve conduits are approved by the US Food and Drug Administration (FDA) and Conformit Europe (CE) for clinical repair of peripheral and cranial nerves. Surgeons are often not aware of the different (bio)materials of these conduits when performing nerve repair. An overview of these FDA- and CE-approved absorbable nerve conduits for clinical use is presented. PubMed, MEDLINE, and the companies selling the conduits were consulted. The available FDA and CE absorbable nerve conduits for peripheral and cranial nerve repair are 2 collagen- and 2 synthetic-polyester-based conduits. The available clinical data, the price, the length, and the composition of the tube show significant differences. Based on the available data in this paper at this moment, we favor the PGA (Neurotube) nerve conduit for repair of peripheral and cranial nerve defects because of its advantages in length, price, and availability of clinical data. However, no prospective studies comparing the available nerve conduits have been published.

It is often clinically noted that peripheral nerve transections in infants and very young children seem to show better functional recovery after nerve repair compared with adult patients. There can be several reasons for this (e.g. outgrowing axons might have maintained their potential to locate their genuine target muscle, the distance from the lesion site to the target organ is shorter, or there is enhanced compensational capacity of central brain areas at early stages of development). We decided to study the effects on walking performance of sciatic nerve transection and repair in nine rats at the youngest age at which appreciable numbers of motoneurons survive transaction (10th day of life). The follow-up period was 52 weeks. Walking movements were recorded on video and performance was qualitatively assessed. The stance factor and the sciatic function index were calculated and abnormalities such as automutilation of the toes or flexion contractures were noted. Postmortem inspection aimed to examine the continuity of the regenerated nerve and the presence of neuromas. Nine days after the transection and nerve repair, walking performance in all rats was close to the level in rats that had not undergone the procedure. Exorotation of the hind leg on the operated side was observed in only two rats. However, 20 days after lesioning the walking performance started to deteriorate, and walking patterns in all but one rat showed severe disability until the end of the observations. Only one out of the nine animals walked relatively undisturbed, with a sciatic function index approaching normal values but with an abnormal stance factor. We conclude that a sciatic nerve transection in rats aged 10 days leads to long-term impairments in walking patterns.