Polyethylene Glycol–Mediated Nerve Repair Improves Early Recovery in Severe Nerve Injuries: Study
USA: A new study has revealed that polyethylene glycol (PEG)-mediated neurorrhaphy was associated with faster sensory recovery and lower early postoperative pain compared with standard repair in patients with Sunderland grade V median and ulnar nerve injuries. Patients undergoing PEG-assisted nerve repair also showed significantly better sensory and motor outcomes, as well as improved Michigan Hand function scores.
The findings were reported in a pilot double-blind randomized clinical trial published in the Journal of the American College of Surgeons by Barite Gutama and colleagues from the Department of Plastic Surgery at Vanderbilt University Medical Center.
Peripheral nerve injuries often lead to significant motor and sensory impairment, and up to 40% of nerve repairs fail to achieve adequate functional recovery. Researchers highlighted PEG as a promising adjunct for nerve repair due to its potential to promote early axonal fusion and limit Wallerian degeneration following injury.
To evaluate its effectiveness, the investigators enrolled adults aged 18 to 75 years with Sunderland grade V median or ulnar nerve injuries and randomized them to undergo either PEG-assisted neurorrhaphy or standard nerve repair.
Recovery outcomes were assessed from the early postoperative period through more than 13 months of follow-up using the Michigan Hand Questionnaire (MHQ) and Medical Research Council Classification (MRCC) sensory and motor grading systems. Statistical analyses included univariate testing and mixed-effect linear regression modeling.
The trial revealed the following findings:
- The final analysis included 13 patients, with 8 assigned to the PEG-mediated repair group and 5 to the standard repair group.
- A total of 17 nerve injuries were evaluated, of which 59% involved the ulnar nerve and 41% involved the median nerve.
- No significant demographic or clinical differences were observed between the PEG and standard repair groups at baseline.
- Within 22 days after surgery, patients in the standard repair group generally remained at sensory and motor recovery grades of S2/M2 or lower.
- Patients who underwent PEG-assisted nerve repair achieved sensory recovery grades of S3 or higher and motor recovery grades of M3 or higher within the same postoperative period.
- The PEG group reported significantly lower postoperative pain scores compared with the non-PEG group.
- Across all follow-up visits, PEG-mediated repair was associated with significantly better sensory recovery outcomes.
- Patients treated with PEG-assisted repair also demonstrated improved motor recovery compared with those receiving conventional neurorrhaphy.
- Michigan Hand Questionnaire scores were significantly higher in the PEG group, indicating better hand function and patient-reported quality of life.
The authors suggested that PEG-mediated axonal fusion may promote earlier nerve function recovery, reduce postoperative pain, and improve patient-reported quality of life following median and ulnar nerve repair in the distal forearm.
However, they noted that the findings are limited by the study’s small sample size and pilot design, highlighting the need for larger studies with adequately powered subgroup analyses to validate the results and assess long-term outcomes of PEG-assisted nerve repair.
Reference:
Gutama, Barite MD; Cornely, Ronald M MPH; Nemani, Sriya BA; Weikert, Douglas R MD; Wong, Lesley MD, FACS; Liu, Yusha Katie MD, PhD; Drolet, Brian C MD, FACS; Elmaraghi, Shady MD; Hill, J Bradford MD; Thayer, Wesley P MD, FACS, PhD; for the PEG-Mediated Axon Fusion in Upper Extremity Study Group. Role of Polyethylene Glycol-Mediated Axonal Fusion in Early Recovery of Median and Ulnar Nerve Injury: A Pilot Double-Blind Randomized Clinical Trial. Journal of the American College of Surgeons 242(5):p 1243-1257, May 2026. | DOI: 10.1097/XCS.0000000000001795
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