Use of the turnover epineurial sheath tube for repair of peripheral nerve gaps.

Autologous nerve grafting is the conventional technique for bridging nerve gaps, despite its various disadvantages. In this study, the authors investigated the effects of the turnover epineurial sheath tube (TEST) as an alternative to nerve grafting for the repair of nerve gaps, using a rat sciatic nerve model in four groups: Group 1 (n = 5): sham control; Group 2 (n = 10): segmental nerve resection + no repair; Group 3 (n = 10): segmental nerve resection + nerve grafting; Group 4 (n = 15): segmental nerve resection + TEST. Functional recovery was evaluated by walking-track analysis. The sciatic nerves and gastrocnemius muscles were harvested for histologic and quantitative histomorphometric evaluation at 12 weeks. Sciatic functional indices and histomorphometric analyses revealed statistically significant differences between the sham control and the three experimental groups (p < 0.001). The difference between the TEST group and the nerve graft group was not significant; however functional recovery was significantly improved in these two groups, compared to the non-repaired group (p < 0.05). The authors suggest that the TEST provides a suitable conduit between two stumps, eliminates donor-site morbidity, reduces the number of suture sites, fibrosis, and operating time, and might be an alternative to nerve grafting for nerve gap repair.