Experimental, Clinical, and Technical Aspects of Polyethylene Glycol Application to End-to-End Peripheral Nerve Repair.

Abstract

Conventional peripheral neurorrhaphy techniques often yield suboptimal functional outcomes. The addition of polyethylene glycol (PEG), a hydrophilic polymer, has emerged as a promising adjunct to enhance axonal regeneration and expedite recovery following nerve transection. This manuscript provides a comprehensive overview of the biochemical properties of PEG with its unique features used in peripheral nerve injuries, and the technical considerations underlying its application in acute peripheral nerve repair. We review preclinical and clinical literature evaluating PEG-mediated axonal fusion, including meta-analyses of animal studies and recent human trials. Emphasis is placed on PEG's mechanism of action, as well as the role of complementary agents such as methylene blue. Additionally, we describe our institution's standardized surgical protocol for PEG-assisted end-to-end neurorrhaphy, supported by intraoperative technical rationale. Data from rodent models and human patients consistently demonstrate accelerated sensory and motor recovery when PEG is integrated into neurorrhaphy protocols. PEG's nonspecific dehydration of axonal membranes facilitates immediate axonal fusion, restoring neural continuity and reducing the latency of regenerative processes. Clinical outcomes are particularly favorable in clean transections repaired within 72 hours, with no significant PEG-related adverse events reported to date. PEG-mediated fusion represents a potential enhancement to standard microsurgical nerve repair. While further investigation is needed to optimize application parameters, address axonal specificity, and define long-term efficacy, current evidence supports PEG as a safe, effective, and accessible technique to improve outcomes in peripheral nerve repair.