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LEUZZI S, ARMENIO A, LEONE L, DE SANTIS V, DI TURI A, ANNOSCIA P, BUFANO L, PASCONE M. Repair of peripheral nerve with vein wrapping. G Chir 2014; 35:101-6. [PMID: 24841688 PMCID: PMC4321586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The post-traumatic neuro-anastomosis must be protected from the surrounding environment. This barrier must be biologically inert, biodegradable, not compressing but protecting the nerve. Formation of painful neuroma is one of the major issues with neuroanastomosis; currently there is no consensus on post-repair neuroma prevention. Aim of this study is to evaluate the efficacy of neuroanastomosis performed with venous sheath to reduce painful neuromas formation, improve the electrical conductivity of the repaired nerve, and reduce the discrepancies of the sectioned nerve stumps. PATIENTS AND METHODS From a trauma population of 320 patients treated in a single centre between January 2008 and December 2011, twenty-six patients were identified as having an injury to at least one of the peripheral nerves of the arm and enrolled in the study. Patients were divided into two groups. In the group A (16 patients) the end-to-end nerve suture was wrapped in a vein sheath and compared with the group B (10 patients) in which a simple end-to-end neurorrhaphy was performed. The venous segment used to cover the nerve micro-suture was harvested from the superficial veins of the forearm. The parameters analyzed were: functional recovery of motor nerves, sensitivity and pain. RESULTS. Average follow-up was 14 months (range: 12-24 months). The group A showed a more rapid motor and sensory recovery and a reduction of the painful symptoms compared to the control group (B). CONCLUSIONS The Authors demonstrated that, in their experience, the venous sheath provides a valid solution to avoid the dispersion of the nerve fibres, to prevent adherent scars and painful neuromas formation. Moreover it can compensate the different size of two nerve stumps, allowing, thereby, a more rapid functional and sensitive recovery without expensive devices.
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Affiliation(s)
- S. LEUZZI
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - A. ARMENIO
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - L. LEONE
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - V. DE SANTIS
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - A. DI TURI
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - P. ANNOSCIA
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - L. BUFANO
- Plastic and Reconstructive Surgery Department, University of Bari, Italy
| | - M. PASCONE
- Clinical Professor of Medicine-Plastic and Reconstructive Surgery Department, University of Bari, Italy
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Mendes MBM, de Carvalho Leite Leal Nunes CM, de Almeida Lopes MC. Anatomical relationship of lingual nerve to the region of mandibular third molar. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2014; 4:e2. [PMID: 24478912 PMCID: PMC3904728 DOI: 10.5037/jomr.2013.4402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/27/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study evaluated the relationship of the lingual nerve with the adjacent anatomical structures of the mandibular third molar region, influencing the dentist to be aware of the variability of these relationships. MATERIAL AND METHODS Samples of 24 human corpse half-heads were selected and divided according with the presence or absence of the mandibular third molars. The lingual nerve (LN) was explored, showing its run from the oblique line until its crossing with the submandibular gland duct. The measurements along the LN and the adjacent anatomical structures were taken at the retromolar, molar and sublingual region with the use of a digital caliper. RESULTS The distance from the LN and the third molar socket, which represents the horizontal distance of the lingual plate to the nerve, on average, was 4.4 mm (SD 2.4 mm). The distance from the LN and the lingual alveolar rim, which represents the vertical relationship between the nerve and the lingual alveolar rim of the third molar socket, on average, was 16.8 mm (SD 5.7 mm). The LN has a varied topography that leaves it very vulnerable during any procedure executed in this region. CONCLUSIONS Unless adequate protection of the lingual nerve is acquired by following an adequate surgical technique, the lingual nerve will always be vulnerable to damage during surgical intervention or manipulation in this region.
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Zhao X, Yao GS, Liu Y, Wang J, Satkunendrarajah K, Fehlings M. The role of neural precursor cells and self assembling peptides in nerve regeneration. J Otolaryngol Head Neck Surg 2013; 42:60. [PMID: 24351041 PMCID: PMC3878249 DOI: 10.1186/1916-0216-42-60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 11/23/2013] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Cranial nerve injury involves loss of central neural cells in the brain stem and surrounding support matrix, leading to severe functional impairment. Therapeutically targeting cellular replacement and enhancing structural support may promote neural regeneration. We examined the combinatorial effect of neural precursor cells (NPC) and self assembling peptide (SAP) administration on nerve regeneration. METHODS Nerve injury was induced by clip compression of the rodent spinal cord. SAPs were injected immediately into the injured cord and NPCs at 2 weeks post-injury. Behavioral analysis was done weekly and rats were sacrificed at 11 weeks post injury. LFB-H&E staining was done on cord tissue to assess cavitation volume. Motor evoked potentials (MEP) were measured at week 11 to assess nerve conduction and Kaplan Meier curves were created to compare survival estimates. RESULTS NPCs and SAPs were distributed both caudal and rostral to the injury site. Behavioral analysis showed that SAP + NPC transplantation significantly improved locomotor score p <0.03) and enhanced survival (log rank test, p = 0.008) compared to control. SAP + NPC treatment also improved nerve conduction velocity (p = 0.008) but did not affect cavitation volume (p = 0.73). CONCLUSION Combinatorial NPC and SAP injection into injured nerve tissue may enhance neural repair and regeneration.
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Affiliation(s)
| | | | | | | | | | - Michael Fehlings
- Department of Genetics and Development, Toronto Western Research Institute and Spinal Program, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada.
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Tan VL, Andrawos A, Ghabriel MN, Townsend GC. Applied anatomy of the lingual nerve: relevance to dental anaesthesia. Arch Oral Biol 2013; 59:324-35. [PMID: 24581856 DOI: 10.1016/j.archoralbio.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/05/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) to classify the external morphology of the lingual nerve and investigate any relationship between its external and internal morphology, (2) to explore the fascicular structure, nerve tissue density and capillary density of the lingual nerve, and (3) to provide an anatomical explanation as to why adverse clinical outcomes more commonly affect the lingual nerve following local dental anaesthesia. Where possible, comparisons were made between the lingual and inferior alveolar nerves. MATERIALS AND METHODS The lingual and inferior alveolar nerves were examined in 23 hemi-sectioned heads macroscopically and microscopically 2mm above the lingula. The lingual nerve was also examined in the regions of the third and second molars. Specimens underwent histological processing and staining with Haematoxylin & Eosin, Masson's Trichrome, anti-GLUT-1 and anti-CD 34. RESULTS The lingual nerve became flatter as it traversed through the pterygomandibular space. There was an increase in the connective tissue and a decrease in nerve tissue density along the lingual nerve (p<0.001). At 2mm above the lingula, the lingual nerve was uni-fascicular in 39% of cases, whilst the inferior alveolar nerve consistently had more fascicles (p<0.001). The lingual nerve fascicles had thicker perineurium but the endoneurial vascular density was not significantly different in the two nerves. CONCLUSIONS The greater susceptibility of lingual nerve dysfunction during inferior alveolar nerve blocks may be due to its uni-fascicular structure and the thicker perineurium, leading to increased endoneurial pressure and involvement of all axons if oedema or haemorrhage occurs due to trauma.
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Affiliation(s)
- Vui Leng Tan
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia
| | - Alice Andrawos
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Mounir N Ghabriel
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Grant C Townsend
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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Hur J, Sullivan KA, Callaghan BC, Pop-Busui R, Feldman EL. Identification of factors associated with sural nerve regeneration and degeneration in diabetic neuropathy. Diabetes Care 2013; 36:4043-9. [PMID: 24101696 PMCID: PMC3836098 DOI: 10.2337/dc12-2530] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with diabetic neuropathy (DN) demonstrate variable degrees of nerve regeneration and degeneration. Our aim was to identify risk factors associated with sural nerve degeneration in patients with DN. RESEARCH DESIGN AND METHODS Demographic, anthropometric, biochemical, and anatomical data of subjects with DN from a 52-week trial of acetyl-L-carnitine were retrospectively examined. Based on the change in sural nerve myelinated fiber density (ΔMFD%), subjects were divided into three groups: regenerator (top 16 percentiles, n = 67), degenerator (bottom 16 percentiles, n = 67), and intermediate (n = 290), with dramatically increased, decreased, and steady ΔMFD%, respectively. ANOVA, Fisher exact test, and multifactorial logistic regression were used to evaluate statistical significance. RESULTS ΔMFD%s were 35.6 ± 17.4 (regenerator), -4.8 ± 12.1 (intermediate), and -39.8 ± 11.0 (degenerator). HbA1c at baseline was the only factor significantly different across the three groups (P = 0.01). In multifactorial logistic regression, HbA1c at baseline was also the only risk factor significantly different between regenerator (8.3 ± 1.6%) and degenerator (9.2 ± 1.8%) (odds ratio 0.68 [95% CI 0.54-0.85]; P < 0.01). Support Vector Machine classifier using HbA1c demonstrated 62.4% accuracy of classifying subjects into regenerator or degenerator. A preliminary microarray experiment revealed that upregulated genes in the regenerator group are enriched with cell cycle and myelin sheath functions, while downregulated genes are enriched in immune/inflammatory responses. CONCLUSIONS These data, based on the largest cohort with ΔMFD% information, suggest that HbA1c levels predict myelinated nerve fiber regeneration and degeneration in patients with DN. Therefore, maintaining optimal blood glucose control is likely essential in patients with DN to prevent continued nerve injury.
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Chandra A, Kumar A, Noushif M, Gupta V, Kumar V, Srivastav PK, Malhotra HS, Kumar M, Ghoshal UC. Neurovascular antropylorus perineal transposition using inferior rectal nerve anastomosis for total anorectal reconstruction: preliminary report in humans. Tech Coloproctol 2013; 18:535-42. [DOI: 10.1007/s10151-013-1092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/29/2013] [Indexed: 02/07/2023]
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Owens CM, Marga F, Forgacs G, Heesch CM. Biofabrication and testing of a fully cellular nerve graft. Biofabrication 2013; 5:045007. [PMID: 24192236 DOI: 10.1088/1758-5082/5/4/045007] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Rupture of a nerve is a debilitating injury with devastating consequences for the individual's quality of life. The gold standard of repair is the use of an autologous graft to bridge the severed nerve ends. Such repair however involves risks due to secondary surgery at the donor site and may result in morbidity and infection. Thus the clinical approach to repair often involves non-cellular solutions, grafts composed of synthetic or natural materials. Here we report on a novel approach to biofabricate fully biological grafts composed exclusively of cells and cell secreted material. To reproducibly and reliably build such grafts of composite geometry we use bioprinting. We test our grafts in a rat sciatic nerve injury model for both motor and sensory function. In particular we compare the regenerative capacity of the biofabricated grafts with that of autologous grafts and grafts made of hollow collagen tubes by measuring the compound action potential (for motor function) and the change in mean arterial blood pressure as consequence of electrically eliciting the somatic pressor reflex. Our results provide evidence that bioprinting is a promising approach to nerve graft fabrication and as a consequence to nerve regeneration.
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Affiliation(s)
- Christopher M Owens
- Department of Physics and Astronomy, University of Missouri, Columbia, MO 65211, USA
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Abstract
Development of neural prostheses over the past few decades has produced a number of clinically relevant brain-machine interfaces (BMIs), such as the cochlear prostheses and deep brain stimulators. Current research pursues the restoration of communication or motor function to individuals with neurological disorders. Efforts in the field, such as the BrainGate trials, have already demonstrated that such interfaces can enable humans to effectively control external devices with neural signals. However, a number of significant issues regarding BMI performance, device capabilities, and surgery must be resolved before clinical use of BMI technology can become widespread. This chapter reviews challenges to clinical translation and discusses potential solutions that have been reported in recent literature, with focuses on hardware reliability, state-of-the-art decoding algorithms, and surgical considerations during implantation.
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Berrocal YA, Almeida VW, Levi AD. Limitations of nerve repair of segmental defects using acellular conduits. J Neurosurg 2013; 119:733-8. [DOI: 10.3171/2013.4.jns121938] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors present the case of a 20-year-old man who, 3 months after his initial injury, underwent repair of a 1.7-cm defect of the ulnar nerve at the wrist; repair was performed with an acellular nerve allograft. Given the absence of clinical or electrophysiological recovery at 8 months postrepair, the patient underwent reexploration, excision of the “regenerated cable,” and rerepair of the ulnar nerve with sural nerve autografts. Histology of the cable demonstrated minimal axonal regeneration at the midpoint of the repair. At the 6- and 12-month follow-ups of the sural nerve graft repair, clinical and electrophysiological evidence of both sensory and motor reinnervation of the ulnar nerve and associated hand muscles was demonstrated. In this report, the authors describe a single case of failed acellular nerve allograft and correlate the results with basic science and human studies reporting length and diameter limitations in human nerve repair utilizing grafts or conduits devoid of viable Schwann cells.
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Abstract
Since the last update on nerve conduits and allograft in 2000, investigations have established the efficacy of these alternatives to autograft in the repair of small sensory neural gaps. However, limited insights into the biology of the regenerating nerve continue to preclude intelligent conduit design. Ongoing discoveries in neuroscience and biomaterial engineering hold promise for the eventual development of allograft and conduits with potential of surpassing nerve autografts in clinical efficacy. In this review, we summarize the history, recent advances, and emerging developments in nerve conduits and allograft.
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Affiliation(s)
- Michael Y Lin
- Department of Orthopaedic Surgery, University of California Irvine, 2226 Gillespie Neuroscience Research Facility, Irvine, CA 92697, USA
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Chandra A, Kumar A, Noushif M, Gupta N, Kumar V, Chauhan NK, Gupta V. Feasibility of neurovascular antropylorus perineal transposition with pudendal nerve anastomosis following anorectal excision: a cadaveric study for neoanal reconstruction. Ann Coloproctol 2013; 29:7-11. [PMID: 23586008 PMCID: PMC3624985 DOI: 10.3393/ac.2013.29.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/28/2012] [Indexed: 12/03/2022] Open
Abstract
Purpose Perineal transposition of the antropyloric valve following an anorectal excision as a substitute for a permanent colostomy has recently been reported in humans. However, the problem of neural control still remains in these patients. Our aim herein was to study the anatomical feasibility of an anastomosis between the pudendal nerve branches (inferior rectal nerve) innervating the external anal sphincter and the anterior vagal branches of the perineally-transposed antropyloric segment in cadavers. Methods The antropyloric segment, along with its carefully dissected branch of the anterior vagus, was mobilized based on the left gastroepiploic pedicle in six fresh human cadavers. The antropyloric valve was then transposed in the perineum after the pudendal nerve branches had been dissected out, and an approximation of these two nerves was performed to ascertain the technical feasibility of their neural anastomosis. Results The anterior vagus innervating the antropylorus could be harvested in all cadavers below the hepatic division of the main vagus trunk. The inferior rectal nerve or its branches were found consistently around the 3 or the 9 o'clock position in the ischioanal fossa. An anatomical tension-free approximation of the anterior vagus branch (of the transposed antropyloric segment) to the inferior rectal nerve in the perineum was feasible in all the cadavers studied. Conclusion An inferior rectal nerve anastomosis with the anterior vagal branch of the perineally-transposed antropyloric segment can be achieved anatomically. This preliminary step can be the basis for future animal studies and subsequent clinical application of the procedure for possible neural control of the transposed antropyloric segment in the perineum.
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Affiliation(s)
- Abhijit Chandra
- Department of Surgical Gastroenterology, Chhatrapati Shahuji Maharaj Medical University (King George's Medical University), Lucknow, India
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Xu YP, Yen SC, Ng KA, Liu X, Tan TC. A Bionic Neural Link for peripheral nerve repair. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:1335-8. [PMID: 23366145 DOI: 10.1109/embc.2012.6346184] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Peripheral nerve injuries with large gaps and long nerve regrowth paths are difficult to repair using existing surgical techniques, due to nerve degeneration and muscle atrophy. This paper proposes a Bionic Neural Link (BNL) as an alternative way for peripheral nerve repair. The concept of the BNL is described, along with the hypothetical benefits. A prototype monolithic single channel BNL has been developed, which consists of 16 neural recording channels and one stimulation channel, and is implemented in a 0.35-µm CMOS technology. The BNL has been tested in in-vivo animal experiments. Full function of the BNL chip has been demonstrated.
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Affiliation(s)
- Yong Ping Xu
- Dept of Electrical and Computer Engineering, National University of Singapore, 4 Engineering Dr 3, Singapore.
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Martins RS, Siqueira MG, Heise CO, Foroni L, Teixeira MJ. A Prospective Study Comparing Single and Double Fascicular Transfer to Restore Elbow Flexion After Brachial Plexus Injury. Neurosurgery 2013; 72:709-14; discussion 714-5; quiz 715. [DOI: 10.1227/neu.0b013e318285c3f6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
BACKGROUND:
The recovery of elbow flexion in upper brachial plexus injury can be achieved by the reinnervation of the biceps muscle (single reinnervation), but concomitant restoration of brachialis and biceps function (double reinnervation) has been recommended to improve elbow flexion strength.
OBJECTIVE:
To prospectively compare morbidity and outcomes of single or double muscle reinnervation in restoring elbow flexion following incomplete injury to the brachial plexus.
METHODS:
Forty consecutive patients were prospectively submitted to single or double muscle reinnervation. Elbow flexion strength was evaluated with a push-and-pull dynamometer 12 months after surgery. Hand morbidity related to the procedures was evaluated by the Semmes-Weinstein monofilaments test, quantification of static 2-point discrimination, and measurements of handgrip and lateral pinch strength in serial evaluations up to the final follow-up.
RESULTS:
Similar results for the strength of elbow flexion were observed in both groups. A worsening of sensibility, measured by using Semmes-Weinstein monofilaments, was identified in 8 patients, all of whom showed recovery during follow-up. No worsening of 2-point discrimination was observed. A decrease in handgrip and lateral pinch strength was identified in 8 and 9 patients, respectively, which improved during follow-up. There was no difference between the groups in the incidence of hand motor morbidity parameters.
CONCLUSION:
The strength of elbow flexion did not differ significantly between the groups treated with single or double muscle reinnervation. Deterioration of handgrip, lateral pinch strength, and sensibility measured by using Semmes-Weinstein monofilaments, was temporary, resulting in low morbidity for both techniques.
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Affiliation(s)
- Roberto Sergio Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
- Hospital Santa Marcelina, São Paulo, Brazil
| | - Mario Gilberto Siqueira
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos Otto Heise
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Luciano Foroni
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
- Hospital Santa Marcelina, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, Brazil
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FDA approved guidance conduits and wraps for peripheral nerve injury: a review of materials and efficacy. Injury 2012; 43:553-72. [PMID: 21269624 DOI: 10.1016/j.injury.2010.12.030] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/27/2010] [Indexed: 02/02/2023]
Abstract
Several nerve guidance conduits (NGCs) and nerve protectant wraps are approved by the US Food and Drug Administration (FDA) for clinical use in peripheral nerve repair. These devices cover a wide range of natural and synthetic materials, which may or may not be resorbable. This review consolidates the data pertaining to all FDA approved materials into a single reference, which emphasizes material composition alongside pre-clinical and clinical safety and efficacy (where possible). This article also summarizes the key advantages and limitations for each material as noted in the literature (with respect to the indication considered). In this context, this review provides a comprehensive reference for clinicians which may facilitate optimal material/device selection for peripheral nerve repair. For materials scientists, this review highlights predicate devices and evaluation methodologies, offering an insight into current deficiencies associated with state-of-the-art materials and may help direct new technology developments and evaluation methodologies thereof.
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Nectow AR, Marra KG, Kaplan DL. Biomaterials for the development of peripheral nerve guidance conduits. TISSUE ENGINEERING PART B-REVIEWS 2011; 18:40-50. [PMID: 21812591 DOI: 10.1089/ten.teb.2011.0240] [Citation(s) in RCA: 262] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps >5 mm is the autologous nerve graft; however, this treatment is associated with a variety of clinical complications, such as donor site morbidity, limited availability, nerve site mismatch, and the formation of neuromas. Despite many recent advances in the field, clinical studies implementing the use of artificial nerve guides have yielded results that are yet to surpass those of autografts. Thus, the development of a nerve guidance conduit, which could match the effectiveness of the autologous nerve graft, would be beneficial to the field of peripheral nerve surgery. Design strategies to improve surgical outcomes have included the development of biopolymers and synthetic polymers as primary scaffolds with tailored mechanical and physical properties, luminal "fillers" such as laminin and fibronectin as secondary internal scaffolds, surface micropatterning, stem cell inclusion, and controlled release of neurotrophic factors. The current article highlights approaches to peripheral nerve repair through a channel or conduit, implementing chemical and physical growth and guidance cues to direct that repair process.
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Affiliation(s)
- Alexander R Nectow
- Department of Biomedical Engineering, Tufts University, Medford, Massachusetts 02155, USA
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Delaviz H, Faghihi A, Azizzadeh Delshad A, Bahadori MH, Mohamadi J, Roozbehi A. Repair of peripheral nerve defects using a polyvinylidene fluoride channel containing nerve growth factor and collagen gel in adult rats. CELL JOURNAL 2011; 13:137-42. [PMID: 23508804 PMCID: PMC3584471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 07/21/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE As effectiveness of the autologous graft in the repair of long nerve defects is very limited an effective substitute is needed. This study was conducted to determine the poled polyvinylidene fluoride (PVDF) tube as an alternative to nerve autograft. MATERIALS AND METHODS The left sciatic nerve was transected in 45 male Wistar rats. The animals were then divided randomly into three groups: in an epineural group the nerve was sutured end to end; in an autograft group a 10 mm piece of sciatic nerve was cut, rotated 180° and sutured in the nerve gap; and in a nerve guidance channel group (NGC), PVDF, tube containing nerve growth factor (NGF) and collagen gel was placed in the gap. In a control (n=15) group the sciatic nerve was exposed but not transected. To determine axonal regeneration, retrograde DiI tracer was injected into the gastrocnemius muscle. One week later, retrograde-labeled neurons were counted in the L4-L6 spinal segments and one way ANOVA analysis was performed to compare groups. Neuronal morphology changes were studied by electron microscopy. RESULTS Significant statistical decreases in the mean number of labeled motoneurons were observed in all surgical groups compared to the control group; and in the autograft and the NGC groups compared to epinural suture group (p<0.01). No significant difference in the mean number of motoneurons was observed between the autograft and NGC groups. Chromatin condensation, dilated endoplasmic reticulum and large vacuoles were observed in the autograft and NGC groups. CONCLUSION Regarding the positive effects of PVDF tube containing NGF and Collagen gel on the sciatic nerve regeneration, authors suggest that it may be useful in peripheral nerve repair.
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Affiliation(s)
- Hamdollah Delaviz
- 1. Department of Anatomy, Faculty of Medicine, Yasuj University of Medical Sciences, Cellular and Molecular Research Center, Yasuj, Iran
| | - Abolfazel Faghihi
- 2. Department of Anatomy, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohamad hadi Bahadori
- 4. Department of Anatomy, Faculty of Medicine, Guillan University of Medical Sciences, Guillan, Iran
| | - Jamshid Mohamadi
- 5. Departement of Physiology, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj Iran
| | - Amrollah Roozbehi
- 1. Department of Anatomy, Faculty of Medicine, Yasuj University of Medical Sciences, Cellular and Molecular Research Center, Yasuj, Iran, * Corresponding Address: P.O. Box: 7591994799 Department of Anatomy Faculty of Medicine Yasuj University of Medical
SciencesYasuj Iran
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Jones RHB. The use of vein grafts in the repair of the inferior alveolar nerve following surgery. Aust Dent J 2010; 55:207-13. [DOI: 10.1111/j.1834-7819.2010.01215.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Peripheral nerve lesions are relatively common injuries encountered by hand surgeons. These injuries are notorious for causing significant and potentially long-standing impairment to hand function. Numerous surgical techniques with varying degrees of success have been described to treat this injury. The evolution of peripheral nerve repair has led to the development of the nerve conduit, a surgical technique that functionally bridges the gap between transected nerves. We discuss a brief history and evolution of nerve conduits and offer our preferred technique for peripheral nerve repair with a collagen nerve conduit. In addition, we offer case studies and postoperative rehabilitation goals and present early results associated with this type of repair.
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Affiliation(s)
- John S Taras
- Department of Orthopaedic Surgery, Thomas Jefferson University, The Philadelphia Hand Center, PC, Philadelphia, PA 19107, USA.
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