Chitosan Nerv Tube for Primary Repair of Traumatic Sensory Nerve Lesions of the Hand

NCT ID: NCT02372669

Last Updated: 2017-07-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

100 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-03-31

Study Completion Date

2018-09-30

Brief Summary

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The objective of this study is to evaluate whether the additional use of a nerve tube in primary microsurgical repair of traumatic sensory nerve lesions of the hand has an effect on convalescence and functional results.

Detailed Description

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Standard therapy for nerve injuries of the hand without a gap is a direct tension free microsurgical repair. Often, a nerve tube is used in addition to a direct nerve suture to protect the nerve from scar formation and guide the regenerating axons to the distal stump, but there is still a lack of data for this approach. The basic design of these nerve tubes is similar but they are made of different resorbable biomaterials. Chitosan, a derivative of chitin, is biocompatible and is similar to natural glycosaminoglycans. In vivo studies showed positive effects on the survival and orientation of Schwann cells as well as the survival and differentiation of neuronal cells and prevention of painful neuromas. Therefore it is the ideal material for a nerve tube. In this study we want to test a Chitosan based nerve tube (already certified German medical product with European label (CE-label)) - as an additional treatment for digital nerve injuries without a gap.

This study will enroll participants with traumatic sensory nerve lesions from 3 Centres: Trauma Center Ludwigshafen (Ludwigshafen, Germany), Trauma Center Frankfurt am Main (Frankfurt am Main, Germany) and Trauma Center Bochum (Bochum, Germany). After being informed about the study and its potential risks, patients with traumatic sensory nerve lesions will be consecutively screened for eligibility. The study will be conducted in four successive periods. All enrolled participants will be randomized locally by alternating local lists in the Double-Blind Period. After enrolment, the assigned subject number will be used on all Case Report Forms. The kind of intervention is blinded for the participant and for the investigator of the follow-up that was not involved in surgery. Enrolled participants will be randomized in a 1:1 ratio to primary microsurgical repair with the additional use of a nerve tube, or direct tension free microsurgical repair alone.

Data will be collected in Case Report Forms (CRFs) according to European DIN standard (International Standards Organization (EN ISO) 14155) and Good Clinical Practice recommendations. CRFs will be transmitted electronically to the executive study centre in Ludwigshafen and will be checked there for integrity, quality and consistency. The executive study centre will also ensure standardisation of the registry process, operative procedure and follow-up in all participating centers by periodic monitoring. Furthermore written instructions and a course of instruction will be provided to each Investigator. Data will be collected and analyzed in the executive study centre. There will be also CRFs for reporting drop-outs and for reporting adverse events.

The static 2-point-discrimination (2PD) after 6 months will bet the primary outcome parameter. Assumptions for the gold standard treatment can be made from literature. The mean of 2-PD after 6 months is approximately 8 mm with a standard deviation of 3 mm. A decrease of 2 mm in the 2-PD would be clinically relevant and is assumed for the experimental intervention. Using a 2-sided t-test with a level of 0.05 and a power of 80%, will require 37 patients per group in order to show superiority. The primary endpoint is tested in the per-protocol set (PPS) via an analysis of covariance with centre as factor and distance between lesion and finger pulp as covariate. Secondary objectives will be described without confirmatory analysis. In order to compensate a loss of follow-up or data 50 patients per group will be randomized.

Conditions

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Traumatic Lesion of Sensory Nerves of the Hand

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Chitosan

Enrolled participants presenting with traumatic sensory nerve lesions of the hand without defect zone that were randomized to primary microsurgical repair with the additional use of a chitosan nerve tube.

Group Type EXPERIMENTAL

Chitosan nerve tube in addition to gold standard therapy

Intervention Type DEVICE

Primary microsurgical repair of traumatic lesion of sensory nerves of the hand with use of an chitosan nerve tube in addition. Clinical Follow-up will be performed after 3,6,12 and 24 months.

Gold standard Primary microsurgical repair

Intervention Type PROCEDURE

Primary microsurgical repair of traumatic lesion of sensory nerves of the hand. Clinical Follow-up will be performed after 3,6,12 and 24 months.

Gold standard alone

Enrolled participants presenting with traumatic sensory nerve lesions of the hand without defect zone that were randomized to primary microsurgical repair without the additional use of a chitosan nerve tube.

Group Type ACTIVE_COMPARATOR

Gold standard Primary microsurgical repair

Intervention Type PROCEDURE

Primary microsurgical repair of traumatic lesion of sensory nerves of the hand. Clinical Follow-up will be performed after 3,6,12 and 24 months.

Interventions

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Chitosan nerve tube in addition to gold standard therapy

Primary microsurgical repair of traumatic lesion of sensory nerves of the hand with use of an chitosan nerve tube in addition. Clinical Follow-up will be performed after 3,6,12 and 24 months.

Intervention Type DEVICE

Gold standard Primary microsurgical repair

Primary microsurgical repair of traumatic lesion of sensory nerves of the hand. Clinical Follow-up will be performed after 3,6,12 and 24 months.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Primary complete traumatic lesion of sensory-only nerves of the hand without a defect zone
* Patient age between 18 an 67 years
* Informed Consent.

Exclusion Criteria

* Amputated or avascular fingers
* Known impaired sensibility of the injured finger
* Allergy to chitosan
* Pregnancy
* Immunodeficiency
Minimum Eligible Age

18 Years

Maximum Eligible Age

67 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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BG Unfallklinik Murnau

OTHER

Sponsor Role lead

Responsible Party

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Florian Neubrech

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Thomas Kremer, MD

Role: STUDY_CHAIR

BG Unfallklinik Ludwigshafen

Locations

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BG Universitätsklinikum Bergmannsheil Bochum

Bochum, , Germany

Site Status RECRUITING

BG Unfallklinik Frankfurt

Frankfurt, , Germany

Site Status RECRUITING

BG Unfallklinik Ludwigshafen

Ludwigshafen, , Germany

Site Status RECRUITING

Countries

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Germany

Central Contacts

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Florian Neubrech, MD

Role: CONTACT

+49-0621-8906

Thomas Kremer, MD

Role: CONTACT

+49-0621-8913

Facility Contacts

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Adrien Daigeler, MD

Role: primary

+49-0234-302-3364

Michael Sauerbier, MD

Role: primary

+49-069-475-2021

Florian Neubrech, MD

Role: primary

+49-0621-6810-8906

References

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Neubrech F, Sauerbier M, Moll W, Seegmuller J, Heider S, Harhaus L, Bickert B, Kneser U, Kremer T. Enhancing the Outcome of Traumatic Sensory Nerve Lesions of the Hand by Additional Use of a Chitosan Nerve Tube in Primary Nerve Repair: A Randomized Controlled Bicentric Trial. Plast Reconstr Surg. 2018 Aug;142(2):415-424. doi: 10.1097/PRS.0000000000004574.

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Neubrech F, Heider S, Harhaus L, Bickert B, Kneser U, Kremer T. Chitosan nerve tube for primary repair of traumatic sensory nerve lesions of the hand without a gap: study protocol for a randomized controlled trial. Trials. 2016 Jan 26;17:48. doi: 10.1186/s13063-015-1148-5.

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Other Identifiers

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BGU-LU-123

Identifier Type: -

Identifier Source: org_study_id

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