Management of the scarred nerve using porcine submucosa extracellular matrix nerve wraps

Objectives: Scar tissue formation around the peripheral nerves causes nerve compression and ischemia, but it also causes adherence of nerves to the surrounding tissues, decreasing the nerve's ability to glide, and therefore, causing neurostenalgia – nerve pain with motion due to tether. Our unit has been using a porcine submucosal extracellular matrix (AxoGuard® AxoGen Inc., Alachua, FL, USA) nerve wrap to prevent nerve scarring. The aim of this study is to present a case series of our use of the AxoGuard® and early follow-up data. Methods: This study describes the use of AxoGuard® nerve protectors, including the indications, anatomic locations, and complications. After obtaining ethics approval from the Institutional Audit Review Board, a retrospective review was performed of all cases where AxoGuard® nerve protectors were used from June 2015 to July 2018. Results: Over a 3-year period, AxoGuard® nerve wraps were used in 71 cases. The indication for surgery was a scarred nerve after trauma surgery in 32 cases, scarring after primary nerve surgery in 19 cases, primary trauma in 9 cases, nerve scarring after elective nonnerve surgery in 5 cases, and nerve tumors in 5 cases. There have been no complications directly related to the use of the AxoGuard® nerve protector and no cases of postoperative infection. Conclusions: The AxoGuard® nerve protector has many clinical indications, an excellent safety profile with no reported complications directly related to the nerve wrap, and is effective in mitigating the effects of neurostenalgia following revision neurolysis.