Use of processed bovine pericard in peripheral nerve surgery

Objective. - Nerve damage often means a loss of the epi- and perineural sheaths, an adherence to the surrounding tissue and a loss of smooth movements. This leads to pain and functional deficits. Creating a gliding apparatus for damaged nerves is a possibility to restore physiological function and interrupt the vicious circle of pain. Patients and methods. - We investigated nine patients who were undergoing peripheral nerve surgery in the forearm and upper arm region. Surgeries included six revisions due to scar-adherence caused by bone fracture surgery, two revisions due to previous nerve compression syndrome surgery and one revision after complete severing of the nerve and previous emergency surgery of the vessels. In each case, the nerve was freed from enveloping scar tissue and a processed bovine pericard (Tutopatch (R)) was used to wrap or cover parts of the affected nerve. The patients were examined clinically and by high-resolution sonography (HRS) after surgery. Results. - All patients showed improvement in respect of function and of pain. There were no adverse reactions as a consequence of the material used. HRS showed that the Tutopatch melds with its environment, and it did not lead to re-scarring of the nerve. Conclusion. - Tutopatch appears to be a suitable allogeneic material for nerve-wrapping. (C) 2020 Published by Elsevier Masson SAS.