Platelet Rich Fibrin Membrane as Nerve Guidance Conduit for Reconstruction Case with Nerve Repair Based Morphometric and Electrophysiologic Parameters: A Systematic Review and Meta-Analysis

Introduction: Motor or sensory nerve injury is a major surgical and clinical challenge, often with disappointing results and impairing sensory and motor function. Now there are some studies to looking for ways to accelerate nerve regeneration. Platelet-rich fibrin (PRF) is made from an autologous platelet concentrate that contains progenitor cells that are essential for the healing process, along with neurotrophic factors and several growth factors. Additionally, PRF can be manufactured in the membrane form that can be wrapped around nerves in the form of tubes which tubulation has many advantages such as guiding growth within the tubular shape to improve regenerative capacity. Methods: This systematic review and meta-analysis was conducted as per the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A systematic, detailed search was carried out by the authors in the electronic databases, including PubMed, Cochrane, Research Gate, Elsevier, and PRS Journal. Studies were selected and compared based on outcome measures like Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Statistical analysis was performed using a random- effect model, pooled standard mean difference and I2 heterogeneity. Result: Four randomized studies with analyzed 4 parameters, those are Morphometric (Axon Area and Myelin Sheath Thickness) and Electrophysiologic (Amplitude and Nerve Conduction Velocity). Pooled analysis for the outcome like Myelin Sheath Thickness, Axon Area, and Amplitude showed a significant result in groups with PRF. Pooled analysis for outcome of Nerve Conduction Velocity showed no significant difference between the groups with PRF and without PRF (SMD: 0.01; 95% CI: -0.64. 0.65) with P = 0.99. Conclusion: This Meta-analysis shows that PRF membrane as nerve guidance conduit is promising method and can improve function outcome in nerve repair specially in Morphometric and Electrophysiologic parameters but outcome of Nerve Conduction Velocity showed no significant in this study.