Efficacy and Safety of Nerve Wrapping in Recurrent Upper-extremity Compressive Neuropathies: A Systematic Review.

BACKGROUND: Recurrent upper-extremity compressive neuropathies can lead to persistent sensory and motor dysfunction. Nerve wrapping is used to reduce perineural fibrosis and improve nerve gliding after revision decompression. This systematic review evaluates outcomes of revision neurolysis using autologous (eg, vein, fat, synovium) and nonautologous (eg, amniotic membrane, extracellular matrix, collagen) nerve wraps. METHODS: Following PRISMA (preferred reporting items for systematic reviews and meta-analyses) 2020 guidelines (PROSPERO: CRD420251088116), PubMed, Ovid MEDLINE, Web of Science, and Google Scholar were searched through August 2025. Eligible studies included adults undergoing revision surgery with nerve wrapping. Reported outcomes included pain, sensory and motor recovery, functional scores, complications, recurrence, and patient satisfaction. RESULTS: Seventeen studies (16 case series, 1 cohort) involving 302 patients were included. Pain improved (visual analog scale, 6.2-2.0), grip strength increased (from 43.3% to 77.0%), and QuickDASH (Quick Disabilities of the Arm, Shoulder, and Hand) scores decreased (from 59.9 to 28.0). Sensory recovery and nerve conduction findings were consistently favorable. Overall satisfaction was high (98.2%), with low complication rates (4.6%), minimal reoperations (0.7%), and no reported recurrences during a mean 26.6-month follow-up. Both autologous and nonautologous materials demonstrated safety and efficacy, with choice varying by surgical context and availability. CONCLUSIONS: The available data suggest that neurolysis with nerve wrapping may be a safe and beneficial adjunct in revision surgery for recurrent upper-extremity compressive neuropathies. Prospective multicenter studies are needed to compare wrapping materials and assess long-term durability.