This study demonstrated that hyaluronic acid (HA) accelerated peripheral nerve regeneration after crush injury to the common peroneal nerve in an experimental rabbit model. Ten male New Zealand White rabbits, weighing 1.8 to 2.0 kg, were used in this study. After creating the nerve crush model in every right leg, rabbits were divided into two groups. Animals in group A received application of HA into the area surrounding the crushed nerve, and group B was the sham control. Electrophysiological assessment was performed every week. After 10 weeks, nerve histological examination, muscle weight and muscle histology were used to evaluate regeneration of the injured common peroneal nerve. No differences in electrophysiological assessment were observed between the two groups. In peripheral nerve histology, myelinated nerve fibers were observed more frequently and less connective tissue was observed in the crushed nerve of group A. Fewer muscle degenerative changes, such as fibrosis, atrophy, and centrally located myonuclei, were detected in group A than in group B. In conclusion, HA could become a potential neuroprotective agent for improvement of peripheral nerve regeneration after crush injury.

There are many cases of peripheral nerve injury by patient position during perioperative period. It is thought to occur by compression or traction and ischemia of nerves. We had an experience that injury of common peroneal nerve below fibular head occurred by lithotomy positon during operation for urethral stricture under spinal anesthesia. Because the nerve injury can be reduced by some caution, it is important to be well-informed about and predict the risk of peripheral neuropathy during lithotomy position.