Synthetic nerve conduits: Indications and technique

Synthetic nerve conduits are an important advance in the reconstruction of peripheral nerves. Based on decades of basic science developments showing the potential role of neurotrophic factors in axonal regeneration, conduits create a controlled environment that allows neurites to grow across gaps in an ordered fashion, thereby offering improved function compared to end-to-end repair and significantly less donor site morbidity than nerve grafts. Although vein graft tubes have been used in humans, recently available polyglycolic acid (PGA) conduits are mechanically superior and obviate the need for harvesting autogenous vein. Silicone and Gore-Tex tubes can be used in those cases where a PGA conduit is not available, but they require a second operation for removal. Placement of a conduit is straightforward. The nerve ends are trimmed, a U-stitch is used to draw the nerve ends into the tube, and the remaining space is filled with heparinized saline. Future advances will allow longer gaps to be spanned in a shorter period of time with even better functional results.