Muscle in vein conduits: our experience

Main Article Content

Andrea Minini
Almerico Megaro


Muscle in vein, nerve lesions, nerve conduits, digital nerve, nerve gaps.


Muscle in vein (MIV) conduits have gradually been employed in the last 20 years as a valuable technique in bridging peripheral nerve gaps after nerve lesions who cannot undergo a direct tension-free coaptation. The advantages of this procedure comparing to the actual benchmark (autograft) is the sparing of the donor site, and the huge availability of both components (i.e. muscle and veins). Here we present a case serie of four MIV performed at our hospital from 2018 to 2019. The results we obtained in our experience confirmed its effectiveness both in nerve regeneration (as sensibility recovery) and in neuropathic pain eradication. Our positive outcomes encourage its use in selected cases of residual nerve gaps up to 3 mm.


Download data is not yet available.


Metrics Loading ...
Abstract 11 | PDF Downloads 2


1. Renner, A., F. Cserkuti, and J. Hankiss, [Late results after nerve transplantation on the upper extremities]. Handchir Mikrochir Plast Chir, 2004. 36(1): p. 13-8.
2. Siemionow, M., M. Bozkurt, and F. Zor, Regeneration and repair of peripheral nerves with different biomaterials: review. Microsurgery, 2010. 30(7): p. 574-88.
3. Dahlin, L., Techniques of peripheral nerve repair. Scand J Surg, 2008. 97(4): p. 310-6.
4. Meek, M., J. Coert, and P. Robinson, Poor results after nerve grafting in the upper extremity: quo vadis? 2005. 25(5): p. 396-402.
5. Paprottka, F., et al., Sensory recovery outcome after digital nerve repair in relation to different reconstructive techniques: meta-analysis and systematic review. Plast Surg Int, 2013.
6. Konofaos, P. and J. Ver Halen, Nerve repair by means of tubulization: past, present, future. J Reconstr Microsurg, 2013. 29(3): p. 149-64.
7. Ichihara, S., Y. Inada, and T. Nakamura, Artificial nerve tubes and their application for repair of peripheral nerve injury: an update of current concepts. Injury, 2008. 39: p. 29-39.
8. Houshyar, S., A. Bhattacharyya, and R. Shanks, Peripheral Nerve Conduit: Materials and Structures. ACS Chem Neurosci, 2019. 10(8): p. 3349-65.
9. Bushnell, B., et al., Early clinical experience with collagen nerve tubes in digital nerve repair. J Hand Surg Am, 2008. 33(7): p. 1081-7.
10. Pfister, L., et al., Nerve conduits and growth factor delivery in peripheral nerve repair. J Peripher Nerv Syst, 2007. 12(2): p. 65-82.
11. Daly, W., et al., A biomaterials approach to peripheral nerve regeneration: bridging the peripheral nerve gap and enhancing functional recovery. J R Soc Interface, 2012. 9(67): p. 202-21.
12. Meek, M., A. Varejão, and S. Geuna, Use of skeletal muscle tissue in peripheral nerve repair: review of the literature. Tissue Eng, 2004. 10(7-8): p. 1027-36.
13. Meek, M. and J. Cohert, Clinical use of nerve conduits in peripheral nerve repair: review of the literature. J Reconstr Microsurg, 2002. 18(2): p. 97-109.
14. Brunelli, G., et al., Bridging nerve defects with combined skeletal muscle and vein conduits. Microsurgery, 1993. 14(4): p. 247-51.
15. Montoya, G.J., et al., Muscle-conditioned media and cAMP promote survival and neurite outgrowth of adult spinal cord motor neurons . Exp Neurol, 2009. 220(2): p. 303-15.
16. Ronchi, G., et al., Chitosan Tubes Enriched with Fresh Skeletal Muscle Fibers for Primary Nerve Repair. Biomed Res Int, 2018. 13.
17. Nicolino, S., et al., Expression of alpha2a-2b neuregulin-1 is associated with early peripheral nerve repair along muscle-enriched tubes. Neuroreport, 2003. 14(11): p. 1541-5.
18. Marcoccio, I. and A. Vigasio, Muscle-in-Vein Nerve Guide for Secondary Reconstruction in Digital Nerve Lesions. J Hand Surg Am, 2010. 35(9): p. 1418-26.
19. Bushnell, B., et al., Early clinical experience with collagen nerve tubes in digital nerve repair. J Hand Surg Am, 2008. 33(7): p. 1081-7.
20. McAllister, R., et al., The epidemiology and management of upper limb peripheral nerve injuries in modern practice. J Hand Surg Br., 1996. 21(1): p. 4-13.
21. Braga Silva, J., et al., Nerve conduits for treating peripheral nerve injuries: A systematic literature review. Hand Surg Rehabil., 2017. 36(2): p. 71-85.
22. Rosberg, H., et al., Injury to the human median and ulnar nerves in the forearm -- analysis of costs for treatment and rehabilitation of 69 patients in southern Sweden. J Hand Surg Br., 2005. 30(1): p. 35-9.
23. Jaquet, J., et al., Median, ulnar, and combined median-ulnar nerve injuries: functional outcome and return to productivity. J Trauma, 2001. 51(4): p. 687-92.
24. Siemionow, M. and G. Brzezicki, Current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol, 2009. 87: p. 141-72.
25. Clark, W., et al., Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg Am., 1992. 17(4): p. 677-87.
26. Yi, C. and L. Dahlin, Impaired nerve regeneration and Schwann cell activation after repair with tension. Neuroreport, 2010. 21(14).
27. de Medinaceli, L., M. Prayon, and M. Merle, Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation: review of 2,181 nerve lesions. Microsurgery, 1993. 14(4): p. 244-6.
28. Stang, F., et al., Posterior interosseus nerve vs. medial cutaneous nerve of the forearm: differences in digital nerve reconstruction. Arch Orthop Trauma Surg, 2013. 133(6): p. 875-80.
29. Safa, B. and G. Buncke, Autograft Substitutes: Conduits and Processed Nerve Allografts. 2016. 32(2): p. 127-40.
30. Dixon, A., et al., Bridging the gap in peripheral nerve repair with 3D printed and bioprinted conduits. Biomaterials, 2018. 186: p. 44-63.
31. Schmauss, D., et al., Is nerve regeneration after reconstruction with collagen nerve conduits terminated after 12 months? the long-term follow-up of two prospective clinical studies. J Reconstr Microsurg, 2014. 30(8): p. 561-8.
32. Ramli, K., et al., Efficacy of Human Cell-Seeded Muscle-Stuffed Vein Conduit in Rat Sciatic Nerve Repair. Tissue Eng Part A, 2019. 25(19-20): p. 1438-55.
33. Manoli, T., et al., Influence of immobilization and sensory re-education on the sensory recovery after reconstruction of digital nerves with direct suture or muscle-in-vein conduits. Neural Regen Res, 2016. 11(2): p. 338-44.
34. Jabir, S. and F. Iwuagwu, Postoperative mobilization regimens following digital nerve repair: a systematic review. Eplasty, 2014. 14: p. e5.
35. Zachary, L. and A. Dellon, Progression of the zone of injury in experimental nerve injuries. Microsurgery, 1987. 8(4): p. 182-5.
36. Tos, P., et al., Primary repair of crush nerve injuries by means of biological tubulization with muscle - vein -combined grafts. Microsurgery, 2012. 32(5): p. 358-63.