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Muscle-in-Vein Conduits for the Treatment of Symptomatic Neuroma of Sensory Digital Nerves. J Pers Med 2022; 12:jpm12091514. [PMID: 36143300 PMCID: PMC9503054 DOI: 10.3390/jpm12091514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Considering the debilitating burden of neuroma resulting in a significant loss of function and excruciating pain, the use of muscle-in-vein conduits (MVCs) for the reconstruction of painful neuroma of sensory nerves of the fingers was assessed. Methods: We retrospectively analyzed 10 patients who underwent secondary digital nerve repair by MVCs. The recovery of sensibility was evaluated by static and moving two-point discrimination (2PDs, 2PDm) and Semmes-Weinstein monofilament testing (SWM). The minimum follow-up was set 12 months after the operation. Results: The median period between trauma and nerve repair was 13.4 weeks (IQR 53.5). After neuroma resection, defects ranged from 10–35 mm (mean 17.7 mm, SD 0.75). The successful recovery of sensibility was achieved in 90% of patients after a median follow-up of 27.0 months (IQR 31.00). The mean 2PDs and 2PDm was 8.1 mm (SD 3.52) and 5.2 mm (SD 2.27), respectively. Assessment by SWM resulted in a mean value of 3.54 (SD 0.69). Reduction in pain was achieved among all patients; eight patients reported the complete relief of neuropathic pain. There was no recurrence of neuroma in any patient. Conclusions: Muscle-in-vein conduits provide an effective treatment for painful neuroma of digital nerves, resulting in satisfactory restoration of sensory function and relief of pain.
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2
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Siemionow M, Strojny MM, Kozlowska K, Brodowska S, Grau-Kazmierczak W, Cwykiel J. Application of Human Epineural Conduit Supported with Human Mesenchymal Stem Cells as a Novel Therapy for Enhancement of Nerve Gap Regeneration. Stem Cell Rev Rep 2021; 18:642-659. [PMID: 34787795 PMCID: PMC8930890 DOI: 10.1007/s12015-021-10301-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 12/18/2022]
Abstract
Various therapeutic methods have been suggested to enhance nerve regeneration. In this study, we propose a novel approach for enhancement of nerve gap regeneration by applying human epineural conduit (hEC) supported with human mesenchymal stem cells (hMSC), as an alternative to autograft repair. Restoration of 20 mm sciatic nerve defect with hEC created from human sciatic nerve supported with hMSC was tested in 4 experimental groups (n = 6 each) in the athymic nude rat model (Crl:NIH-Foxn1rnu): 1 - No repair control, 2 - Autograft control, 3 - Matched diameter hEC filled with 1 mL saline, 4 - Matched diameter hEC supported with 3 × 106 hMSC. Assessments included: functional tests: toe-spread and pinprick, regeneration assessment by immunofluorescence staining: HLA-1, HLA-DR, NGF, GFAP, Laminin B, S-100, VEGF, vWF and PKH26 labeling; histomorphometric analysis of myelin thickness, axonal density, fiber diameter and myelinated nerve fibers percentage; Gastrocnemius Muscle Index (GMI) and muscle fiber area ratio. Best sensory and motor function recovery, as well as GMI and muscle fiber area ratio, were observed in the autograft group, and were comparable to the hEC with hMSC group (p = 0.038). Significant improvements of myelin thickness (p = 0.003), fiber diameter (p = 0.0296), and percentage of myelinated fibers (p < 0.0001) were detected in hEC group supported with hMSC compared to hEC with saline controls. At 12-weeks after nerve gap repair, hEC combined with hMSC revealed increased expression of neurotrophic and proangiogenic factors, which corresponded with improvement of function comparable with the autograft control. Application of our novel hEC supported with hMSC provides a potential alternative to the autograft nerve repair.
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Affiliation(s)
- Maria Siemionow
- Poznan University of Medical Sciences, Poznan, Poland. .,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA.
| | - Marcin Michal Strojny
- Poznan University of Medical Sciences, Poznan, Poland.,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Katarzyna Kozlowska
- Poznan University of Medical Sciences, Poznan, Poland.,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Sonia Brodowska
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Joanna Cwykiel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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3
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A systematic review and meta-analysis of studies comparing muscle-in-vein conduits with autologous nerve grafts for nerve reconstruction. Sci Rep 2021; 11:11691. [PMID: 34083605 PMCID: PMC8175734 DOI: 10.1038/s41598-021-90956-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022] Open
Abstract
The gold-standard method for reconstruction of segmental nerve defects, the autologous nerve graft, has several drawbacks in terms of tissue availability and donor site morbidity. Therefore, feasible alternatives to autologous nerve grafts are sought. Muscle-in-vein conduits have been proposed as an alternative to autologous nerve grafts almost three decades ago, given the abundance of both tissues throughout the body. Based on the anti-inflammatory effects of veins and the proregenerative environment established by muscle tissue, this approach has been studied in various preclinical and some clinical trials. There is still no comprehensive systematic summary to conclude efficacy and feasibility of muscle-in-vein conduits for reconstruction of segmental nerve defects. Given this lack of a conclusive summary, we performed a meta-analysis to evaluate the potential of muscle-in-vein conduits. This work’s main findings are profound discrepancies regarding the results following nerve repair by means of muscle-in-vein conduits in a preclinical or clinical setting. We identified differences in study methodology, inter-species neurobiology and the limited number of clinical studies to be the main reasons for the still inconclusive results. In conclusion, we advise for large animal studies to elucidate the feasibility of muscle-in-vein conduits for repair of segmental defects of critical size in mixed nerves.
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4
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Costa AL, Papadopulos N, Porzionato A, Natsis K, Bassetto F, Tiengo C, Giunta R, Soldado F, Bertelli JA, Baeza AR, Battiston B, Titolo P, Tos P, Radtke C, Aszmann O, Moschella F, Cordova A, Toia F, Perrotta RE, Ronchi G, Geuna S, Colonna MR. Studying nerve transfers: Searching for a consensus in nerve axons count. J Plast Reconstr Aesthet Surg 2021; 74:2731-2736. [PMID: 33962889 DOI: 10.1016/j.bjps.2021.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
Axonal count is the base for efficient nerve transfer; despite its capital importance, few studies have been published on human material, most research approaches being performed on experimental animal models of nerve injury. Thus, standard analysis methods are still lacking. Quantitative data obtained have to be reproducible and comparable with published data by other research groups. To share results with the scientific community, the standardization of quantitative analysis is a fundamental step. For this purpose, the experiences of the Italian, Austrian, German, Greek, and Iberian-Latin American groups have been compared with each other and with the existing literature to reach a consensus in the fiber count and draw up a protocol that can make future studies from different centers comparable. The search for a standardization of the methodology was aimed to reduce all the factors that are associated with an increase in the variability of the results. All the preferential methods to be used have been suggested. On the other hand, alternative methods and different methods have been identified to achieve the same goal, which in our experience are completely comparable; therefore, they can be used indifferently by the different centers according to their experience and availability.
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Affiliation(s)
- Alfio Luca Costa
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy.
| | - Nikolaos Papadopulos
- Department of Plastic Surgery and Burns, Alexandroupoli University Hospital, Democritus University of Thace, Alexandroupoli, Greece
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Konstantinos Natsis
- Department of Anatomy and Surgical Anatomy, (Chairperson: Professor Dr. K. NATSIS), Medical School, Aristotle University of Thessaloniki, Greece
| | - Franco Bassetto
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Cesare Tiengo
- Clinic of Plastic Surgery, Padova University Hospital, Padova, Italy
| | - Riccardo Giunta
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University (LMU), Pettenkoferstraße. 8a, 80336 Munich, Germany
| | - Francisco Soldado
- Pediatric Upper Extremity Surgery and Microsurgery, Vithas San Jose Hospital, Vitoria and Hospital HM nens, Barcelona, Spain
| | - Jayme Augusto Bertelli
- Department of Orthopedic Surgery, Governador Celso Ramos Hospital, Florianópolis, Brazil
| | - Alfonso Rodrìguez Baeza
- Unit of Human Anatomy and Embryology, Department of Morphological Sciences, Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, 08193 Barcelona, Spain
| | - Bruno Battiston
- Human Anatomy Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Titolo
- Human Anatomy Unit, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pierluigi Tos
- Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino, Depatment of Traumatology, Turin, Italy
| | - Christine Radtke
- Hand Surgery and Reconstructive Microsurgery Unit, ASST G Pini-CTO, Milano, Italy
| | - Oscar Aszmann
- Hand Surgery and Reconstructive Microsurgery Unit, ASST G Pini-CTO, Milano, Italy
| | - Francesco Moschella
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Adriana Cordova
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Francesca Toia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Rosario Emanuele Perrotta
- Section of Plastic and Reconstructive Surgery. Department of Surgical, Oncological and Oral Sciences. University of Palermo, Italy
| | - Guilia Ronchi
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania 95100, Italy; Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Stefano Geuna
- Department of Plastic and Reconstructive Surgery, University of Catania, Catania 95100, Italy
| | - Michele Rosario Colonna
- Department of Human Pathology of the Adult, the Child and the Adolescent, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy
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5
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Manthou ME, Gencheva D, Sinis N, Rink S, Papamitsou T, Abdulla D, Bendella H, Sarikcioglu L, Angelov DN. Facial Nerve Repair by Muscle-Vein Conduit in Rats: Functional Recovery and Muscle Reinnervation. Tissue Eng Part A 2020; 27:351-361. [PMID: 32731808 DOI: 10.1089/ten.tea.2020.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The facial nerve is the most frequently damaged nerve in head and neck traumata. Repair of interrupted nerves is generally reinforced by fine microsurgical techniques; nevertheless, regaining all functions is the exception rather than the rule. The so-called "postparalytic syndrome," which includes synkinesia and altered blink reflexes, follows nerve injury. The purpose of this study was to examine if nerve-gap repair using an autologous vein filled with skeletal muscle would improve axonal regeneration, reduce neuromuscular junction polyinnervation, and improve the recovery of whisking in rats with transected and sutured right buccal branches of the facial nerve. Vibrissal motor performance was studied with the use of a video motion analysis. Immunofluorescence was used to visualize and analyze target muscle reinnervation. The results taken together indicate a positive effect of muscle-vein-combined conduit (MVCC) on the improvement of the whisking function after reparation of the facial nerve in rats. The findings support the recent suggestion that a venal graft with implantation of a trophic source, such as autologous denervated skeletal muscle, may promote the monoinnervation degree and ameliorate coordinated function of the corresponding muscles.
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Affiliation(s)
- Maria Eleni Manthou
- Department of Histology and Embryology, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Department of Anatomy I, University of Cologne, Cologne, Germany
| | - Dilyana Gencheva
- Department of Anatomy I, University of Cologne, Cologne, Germany
| | - Nektarios Sinis
- Privatklinik für Plastische- und Ästhetische Chirurgie, Berlin Wilmersdorf, Germany
| | - Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral Medicine, University of Cologne, Cologne, Germany
| | - Theodora Papamitsou
- Department of Histology and Embryology, Medical Faculty, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Diana Abdulla
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Habib Bendella
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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6
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Reconstruction of a long defect of the median nerve with a free nerve conduit flap. Arch Plast Surg 2020; 47:187-193. [PMID: 32203996 PMCID: PMC7093277 DOI: 10.5999/aps.2019.00654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/18/2019] [Indexed: 01/25/2023] Open
Abstract
Upper limb nerve damage is a common condition, and evidence suggests that functional recovery may be limited following peripheral nerve repair in cases of delayed reconstruction or reconstruction of long nerve defects. A 26-year-old man presented with traumatic injury from a wide, blunt wound of the right forearm caused by broken glass, with soft tissue loss, complete transection of the radial and ulnar arteries, and a large median nerve gap. The patient underwent debridement and subsequent surgery with a microsurgical free radial fasciocutaneous flap to provide a direct blood supply to the hand; the cephalic vein within the flap was employed as a venous vascularized chamber to wrap the sural nerve graft and to repair the wide gap (14 cm) in the median nerve. During the postoperative period, the patient followed an intensive rehabilitation program and was monitored for functional performance over 5 years of follow-up. Our assessment demonstrated skin tropism and sufficient muscle power to act against strong resistance (M5) in the muscles previously affected by paralysis, as well as a good localization of stimuli in the median nerve region and an imperfect recovery of two-point discrimination (S3+). We propose a novel and efficient procedure to repair >10-cm peripheral nerve gap injuries related to upper limb trauma.
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7
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Chen ZX, Lu HB, Jin XL, Feng WF, Yang XN, Qi ZL. Skeletal muscle-derived cells repair peripheral nerve defects in mice. Neural Regen Res 2020; 15:152-161. [PMID: 31535664 PMCID: PMC6862419 DOI: 10.4103/1673-5374.264462] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Skeletal muscle-derived cells have strong secretory function, while skeletal muscle-derived stem cells, which are included in muscle-derived cells, can differentiate into Schwann cell-like cells and other cell types. However, the effect of muscle-derived cells on peripheral nerve defects has not been reported. In this study, 5-mm-long nerve defects were created in the right sciatic nerves of mice to construct a peripheral nerve defect model. Adult female C57BL/6 mice were randomly divided into four groups. For the muscle-derived cell group, muscle-derived cells were injected into the catheter after the cut nerve ends were bridged with a polyurethane catheter. For external oblique muscle-fabricated nerve conduit and polyurethane groups, an external oblique muscle-fabricated nerve conduit or polyurethane catheter was used to bridge the cut nerve ends, respectively. For the sham group, the sciatic nerves on the right side were separated but not excised. At 8 and 12 weeks post-surgery, distributions of axons and myelin sheaths were observed, and the nerve diameter was calculated using immunofluorescence staining. The number, diameter, and thickness of myelinated nerve fibers were detected by toluidine blue staining and transmission electron microscopy. Muscle fiber area ratios were calculated by Masson’s trichrome staining of gastrocnemius muscle sections. Sciatic functional index was recorded using walking footprint analysis at 4, 8, and 12 weeks after operation. The results showed that, at 8 and 12 weeks after surgery, myelin sheaths and axons of regenerating nerves were evenly distributed in the muscle-derived cell group. The number, diameter, and myelin sheath thickness of myelinated nerve fibers, as well as gastrocnemius muscle wet weight and muscle area ratio, were significantly higher in the muscle-derived cell group compared with the polyurethane group. At 4, 8, and 12 weeks post-surgery, sciatic functional index was notably increased in the muscle-derived cell group compared with the polyurethane group. These criteria of the muscle-derived cell group were not significantly different from the external oblique muscle-fabricated nerve conduit group. Collectively, these data suggest that muscle-derived cells effectively accelerated peripheral nerve regeneration. This study was approved by the Animal Ethics Committee of Plastic Surgery Hospital, Chinese Academy of Medical Sciences (approval No. 040) on September 28, 2016.
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Affiliation(s)
- Zi-Xiang Chen
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Hai-Bin Lu
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Xiao-Lei Jin
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Wei-Feng Feng
- Yu Tian Cheng Plastic Surgery Clinic, Shanghai, China
| | - Xiao-Nan Yang
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
| | - Zuo-Liang Qi
- The 16th Department, Plastic Surgery Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, China
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8
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Crosio A, Fornasari BE, Gambarotta G, Geuna S, Raimondo S, Battiston B, Tos P, Ronchi G. Chitosan tubes enriched with fresh skeletal muscle fibers for delayed repair of peripheral nerve defects. Neural Regen Res 2019; 14:1079-1084. [PMID: 30762022 PMCID: PMC6404480 DOI: 10.4103/1673-5374.250628] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Nerve regeneration after delayed nerve repair is often unsuccessful. Indeed, the expression of genes associated with regeneration, including neurotrophic and gliotrophic factors, is drastically reduced in the distal stump of chronically transected nerves; moreover, Schwann cells undergo atrophy, losing their ability to sustain regeneration. In the present study, to provide a three-dimensional environment and trophic factors supporting Schwann cell activity and axon re-growth, we combined the use of an effective conduit (a chitosan tube) with a promising intraluminal structure (fresh longitudinal skeletal muscle fibers). This enriched conduit was used to repair a 10-mm rat median nerve gap after 3-month delay and functional and morphometrical analyses were performed 4 months after nerve reconstruction. Our data show that the enriched chitosan conduit is as effective as the hollow chitosan conduit in promoting nerve regeneration, and its efficacy is not statistically different from the autograft, considered the "gold standard" technique for nerve reconstruction. Since hollow tubes not always lead to good results after long defects (> 20 mm), we believe that the conduit enriched with fresh muscle fibers could be a promising strategy to repair longer gaps, as muscle fibers create a favorable three-dimensional environment and release trophic factors. All procedures were approved by the Bioethical Committee of the University of Torino and by the Italian Ministry of Health (approval number: 864/2016/PR) on September 14, 2016.
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Affiliation(s)
- Alessandro Crosio
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
| | - Bruno Battiston
- Department of Orthopedics and Traumatology II - Surgery for Hand and Upper Limb - AOU Città della Salute e della Scienza di Torino - CTO Hospital, Torino, Italy
| | - Pierluigi Tos
- UO Microchirurgia e Chirurgia della Mano, Ospedale Gaetano Pini, Milano, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences; Neuroscience Institute Cavalieri Ottolenghi, University of Torino, Torino, Italy
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9
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Ghnenis AB, Czaikowski RE, Zhang ZJ, Bushman JS. Toluidine Blue Staining of Resin-Embedded Sections for Evaluation of Peripheral Nerve Morphology. J Vis Exp 2018. [PMID: 30035773 DOI: 10.3791/58031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Peripheral nerves extend throughout the body, innervating target tissues with motor or sensory axons. Due to widespread distribution, peripheral nerves are frequently damaged because of trauma or disease. As methods and strategies have been developed to assess peripheral nerve injury in animal models, function and regeneration, analyzing the morphometry of the peripheral nerve has become an essential terminal outcome measurement. Toluidine blue staining of nerve cross sections obtained from resin embedded nerve sections is a reproducible method for qualitative and quantitative assessments of peripheral nerves, enabling visualization of morphology number of axons and degree of myelination. This technique, as with many other histological methods, can be difficult to learn and master using standard written protocols. The intent of this publication is therefore to accentuate written protocols for toluidine blue staining of peripheral nerves with videography of the method, using sciatic nerves harvested from rats. In this protocol, we describe in vivo peripheral nerve fixation and collection of the tissue, and post-fixation with 2% osmium tetroxide, embedding of nerves in epoxy resin, and ultramicrotome sectioning of nerves to 1-2μm thickness. Nerve sections then transferred to a glass slide and stained with toluidine blue, after which they are quantitatively and qualitatively assessed. Examples of the most common problems are shown, as well as steps for mitigating these issues.
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10
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Konczalik W, Sadr AH, Nikkhah D. The Adipofascial Nerve Patch as an Alternative to Grafting in Partial Transection of a Peripheral Nerve. J Hand Microsurg 2017; 9:107-108. [PMID: 28867913 DOI: 10.1055/s-0037-1604291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 06/15/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Wojciech Konczalik
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Amir H Sadr
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London, United Kingdom
| | - Dariush Nikkhah
- Department of Plastic and Reconstructive Surgery, Great Ormond Street Hospital, London, United Kingdom
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11
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Gámez E, Goto Y, Nagata K, Iwaki T, Sasaki T, Matsuda T. Photofabricated Gelatin-Based Nerve Conduits: Nerve Tissue Regeneration Potentials. Cell Transplant 2017; 13:549-64. [PMID: 15565867 DOI: 10.3727/000000004783983639] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
There is a strong demand for development of nerve guide conduit with prompt nerve regeneration potential for injury-induced nerve defect. Prior to study on nerve tissue engineering using Schwann cells or nerve stem cells, the effectiveness of photofabricated scaffolds based on photocurable gelatin was examined. This study describes the evaluation of in vivo nerve tissue regeneration potentials of three custom-designed and -fabricated prostheses (inner diameter, 1.2 mm; outer diameter, 2.4 mm; wall thickness, 0.60 mm; and length, 15 mm) made of photocured gelatin: a plain photocured gelatin tube (model I), a photocured gelatin tube packed with bioactive substances (laminin, fibronectin, and nerve growth factor) coimmobilized in a photocured gelatin rod (model II), and a photocured gelatin tube packed with bioactive substances coimmobilized in multifilament fibers (model III). These prostheses were implanted between the proximal and distal stumps 10 mm of the dissected right sciatic nerve of 70 adult male Lewis rats for up to 1 year. The highest regenerative potentials were found using the model III prosthesis, followed by the model II prosthesis. Markedly retarded neural regeneration was observed using the model I prosthesis. These were evaluated from the viewpoints of functional recovery, electrophysiological responses, and tissue morphological regeneration. The significance of the synergistic cooperative functions of multifilaments, which serve as a platform that provides contact guidance to direct longitudinal cell movement and tissue ingrowth and as a cell adhesive matrix with high surface area, and immobilized bioactive substances, which enhance nerve regeneration via biological stimulation, is discussed.
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Affiliation(s)
- Eduardo Gámez
- Division of Biomedical Engineering, Graduate School of Dental Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka 812-8582, Japan
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12
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Nerve regeneration techniques respecting the special characteristics of the inferior alveolar nerve. J Craniomaxillofac Surg 2016; 44:1381-6. [PMID: 27435058 DOI: 10.1016/j.jcms.2016.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/21/2016] [Accepted: 06/27/2016] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study was to examine the in situ regeneration of the inferior alveolar nerve (IAN) in its bony channel, using autologous tissue in combination with a recombinant human nerve growth factor (rhNGF). MATERIALS AND METHODS A total of 20 New Zealand rabbits were randomly divided into five groups. Following dissection of the IAN, the animals underwent reconstruction either with muscle tissue (groups 1 and 2) or with fat tissue (groups 3 and 4). In group 5 (control), the dissected nerve was resected and reconstructed by placement of the reversed autologous segment. After 2 and 4 weeks, 1 mL rhNGF was locally injected in groups 1 and 3. Nerve function was monitored by measuring the jaw-opening reflex using electromyography for a period of 24 weeks. RESULTS Regeneration of the nerve was achieved in all groups, but preoperative threshold values were not achieved. Comparing the experimental groups to the control, there was a significant difference in favor of the autologous nerve reconstruction. Differences between the experimental groups remained statistically not significant. CONCLUSION Regeneration of the IAN with autologous tissue is possible, but without achieving preoperative thresholds. Additional injection of a growth factor seems to improve the speed of regeneration for fat and muscle grafts.
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13
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Li G, Zhang L, Yang Y. Tailoring of chitosan scaffolds with heparin and γ-aminopropyltriethoxysilane for promoting peripheral nerve regeneration. Colloids Surf B Biointerfaces 2015. [DOI: 10.1016/j.colsurfb.2015.07.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Nijhuis THJ. Venous Conduit as a Model for Nerve Regeneration. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li G, Zhao X, Zhang L, Wang C, Shi Y, Yang Y. Regulating Schwann cells growth by chitosan micropatterning for peripheral nerve regeneration in vitro. Macromol Biosci 2014; 14:1067-75. [PMID: 24757089 DOI: 10.1002/mabi.201400098] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Indexed: 12/13/2022]
Abstract
To address the effect of chitosan micropatterning on nerve regeneration, two sizes of parallel microstripes of chitosan are fabricated on the surface of coverslips using a micromodeling method. The morphology of the prepared polydimethylsiloxane stamps and chitosan micropatterning is observed by scanning electron microscopy and the wettability of the prepared micropatterning is evaluated using water contact-angle measurements. Schwann cell (SC) culture is used to evaluate the effect of chitosan micropatterning on cell behavior. The results show that the stripe-like chitosan micropatterning can be successfully fabricated on coverslip surfaces. SCs on 30/30 μm chitosan micropatterning shows the most obvious cell orientation. Moreover, the secretion of nerve growth factor by SCs indicate that the chitosan micropatterning has no negative influence on the normal physiological function of the cells. Thus, the study suggests that chitosan micropatterning can induce and regulate the growth of SCs well, which may have potential application in peripheral nerve regeneration.
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Affiliation(s)
- Guicai Li
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, 226001, Nantong, P.R. China
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Szarek D, Marycz K, Bednarz P, Tabakow P, Jarmundowicz W, Laska J. Influence of calcium alginate on peripheral nerve regeneration:In vivostudy. Biotechnol Appl Biochem 2013; 60:547-56. [DOI: 10.1002/bab.1096] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 01/08/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Dariusz Szarek
- Department of Neurosurgery; Wroclaw Medical University; Wroclaw Poland
| | - Krzysztof Marycz
- Laboratory of Electron Microscopy Studies; Wroclaw University of Environmental and Life Sciences; Wroclaw Poland
| | - Paulina Bednarz
- Department of Biomaterials; AGH University of Science and Technology; Krakow Poland
| | - Paweł Tabakow
- Department of Neurosurgery; Wroclaw Medical University; Wroclaw Poland
| | | | - Jadwiga Laska
- Department of Biomaterials; AGH University of Science and Technology; Krakow Poland
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García Medrano B, Barrio Sanz P, Simón Pérez C, León Andrino A, Garrosa García M, Martín Ferrero MA, Gayoso Rodríguez MJ. [Regeneration of critical injuries of the peripheral nerve with growth factors]. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013; 57:162-9. [PMID: 23746913 DOI: 10.1016/j.recot.2013.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/23/2013] [Accepted: 03/25/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This project aims to study the regeneration of non-repairable lesions of peripheral nerve by muscle grafts enhanced with growth factors. MATERIAL AND METHODS The experiment was carried out in two phases. The first one compared direct suture of a critical defect in the sciatic nerve of ten rats, with the interposition of autologous muscle graft, denatured by heat, in another ten. The second phase compared ten rats with nerve repair using an acellular muscle graft, with injection of 2cc of IGF-1 (10mg/ml mecasermin, Injectable solution) into the acellular graft of another ten. A clinical and functional follow-up was carried out including, ambulation, footprint measurement, and "grasping test". . The animals were sacrificed at 90-100 days, and samples obtained for macro- and microscopic studies with toluidine blue, haematoxylin-eosin and Masson's trichrome staining. RESULTS The first experiment showed the characteristic findings of nerve tissue in muscle graft level sections. The second was an enhancement of the results: post-surgical clinical improvement, early ambulation, decrease in the rate of pressure ulcers in toes, recovery of the footprint, and increasing the percentage of nerve endings in distal sciatic regeneration (47-62%). CONCLUSIONS In this study the experimental and clinical possibilities of nerve defect repair by denatured muscle are demonstrated, confirming the suitability of the technique. Furthermore, it confirms our hypothesis with clinical and cellular determinations enriched by the addition of growth factors that promote nerve regeneration.
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Affiliation(s)
- B García Medrano
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
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Regeneration of critical injuries of the peripheral nerve with growth factors. Rev Esp Cir Ortop Traumatol (Engl Ed) 2013. [DOI: 10.1016/j.recote.2013.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Yang XN, Jin YQ, Bi H, Wei W, Cheng J, Liu ZY, Shen Z, Qi ZL, Cao Y. Peripheral nerve repair with epimysium conduit. Biomaterials 2013; 34:5606-16. [PMID: 23623227 DOI: 10.1016/j.biomaterials.2013.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/08/2013] [Indexed: 12/18/2022]
Abstract
Autologous tissues such as skeletal muscle have high biocampatibility and can effectively promote nerve regeneration compared to other biological and artificial materials; however, the reasonable and effective application of skeletal muscle requires further study. The purpose of this investigation was to assess the possibility of preparing a hollow nerve conduit, termed the epimysium conduit (EMC), using thin crimps of epimysium with skeletal muscle fibers and evaluate its effectiveness in repairing peripheral nerve defects. We prepared nerve conduits containing lumen with the external oblique muscle of the CAG-EFGP transgenic mice using microsurgical techniques for bridge repair of a 5-mm long sciatic nerve defect in wild-type mice. Systematic histological and functional assessments of the regenerated nerves were performed 8 and 12 weeks after surgery. EMC was found to effectively repair the sciatic nerve defect with significantly greater effectiveness than artificial conduits; however, the repair effect of EMC was lower than that of autologous nerve grafting for some parameters. In addition, our findings showed that some EMC-derived cell components migrated into the region of the regenerated nerves and contributed to reconstruction. Based on these findings, we conclude that a hollow conduit prepared with epimysium and a few skeletal muscle fibers is ideal for repairing peripheral nerve defects, and the cell components in the grafts contribute to nerve regeneration and structural remodeling, which provides an alternative option for the emergency primary repair of peripheral nerve defects in clinical practice.
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Affiliation(s)
- Xiao-Nan Yang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, PR China
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Geuna S, Gnavi S, Perroteau I, Tos P, Battiston B. Tissue Engineering and Peripheral Nerve Reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 108:35-57. [DOI: 10.1016/b978-0-12-410499-0.00002-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Future Perspectives in Nerve Repair and Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:165-92. [DOI: 10.1016/b978-0-12-420045-6.00008-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Jaminet P, Köhler D, Rahmanian-Schwarz A, Lotter O, Mager A, Fornaro M, Ronchi G, Geuna S, Rosenberger P, Schaller HE. Expression patterns and functional evaluation of the UNC5b receptor during the early phase of peripheral nerve regeneration using the mouse median nerve model. Microsurgery 2012. [PMID: 23180484 DOI: 10.1002/micr.22059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION In this study, we evaluated the role of the Netrin-1 receptor UNC5b (Uncoordinated), a neuronal guidance molecule, during peripheral nerve regeneration using the mouse median nerve model. MATERIALS AND METHODS Using Western blot analysis, we examined the expression changes of UNC5b after transection and microsurgical repair of the mouse median nerve distal to the transection site. We evaluated the histomorphometrical changes and functional recovery of the grasping force after median nerve transection and repair in wild-type (WT) mice and UNC5b(+/-) heterozygous mice. RESULTS In Western blot analysis, we could show a high increase of UNC5b in the nerve segment distal to the injury site at day 14. Histomorphometrical analysis did not show any significant differences between WT animals and heterozygous animals. Using the functional grasping test, we could demonstrate that peripheral nerve regeneration is significantly diminished in heterozygous UNC5b(+/-) mice. CONCLUSION By using the mouse median nerve model in transgenic animals, we demonstrate that the Netrin-1 receptor UNC5b plays an important role during peripheral nerve regeneration.
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Affiliation(s)
- Patrick Jaminet
- Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard Karls University of Tübingen, Tübingen, Germany.
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Nijhuis THJ, Bodar CWJ, van Neck JW, Walbeehm ET, Siemionow M, Madajka M, Cwykiel J, Blok JH, Hovius SER. Natural conduits for bridging a 15-mm nerve defect: comparison of the vein supported by muscle and bone marrow stromal cells with a nerve autograft. J Plast Reconstr Aesthet Surg 2012; 66:251-9. [PMID: 23063384 DOI: 10.1016/j.bjps.2012.09.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 07/11/2012] [Accepted: 09/13/2012] [Indexed: 12/23/2022]
Abstract
OBJECT The gold standard for reconstructing large nerve defects, the nerve autograft, results in donor-site morbidity. This detrimental consequence drives the search for alternatives. We used a vein filled with a small piece of fresh muscle to prevent the vein from collapsing and with bone marrow stromal cells (BMSCs) to enhance regeneration. METHODS In 60 rats, a 15-mm sciatic nerve defect was bridged with a nerve autograft, a vein filled with muscle or a vein filled with muscle and BMSCs. Toe spread and pinprick were used to evaluate motor and sensory function. Compound muscle action potentials (CMAPs) and the gastrocnemius muscle index (GMI) were recorded to assess conduction properties and denervation atrophy. Extensive histology was performed to confirm presence of BMSCs and to evaluate regeneration by staining neural tissue for Schwann cells and neural growth factor. RESULTS After 12 weeks, all animals responded with toe spread and pinprick reaction; significant differences were found between groups. Six weeks post grafting no difference was found comparing the GMI between the groups. Group I had a significant increase in GMI at 12 weeks compared to group II and group III. The CMAP measurements showed comparable results at 6 weeks post grafting. Twelve weeks after reconstruction, group I had significantly better results compared to group II and group III. Group III showed a tendency to outperform group II at 12 weeks postoperatively. Immunofluorescence analysis showed an increased number of Schwann cells in group III compared to group II. The BMSCs were visible 6 and 12 weeks postoperatively. CONCLUSIONS This study is a step forward in the search for an alternative to the nerve autograft because it demonstrates the beneficial effect of BMSCs to a conduit. However, our data do not demonstrate sufficient benefit to warrant clinical implementation at this stage.
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Affiliation(s)
- Tim H J Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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Penna V, Stark GB, Wewetzer K, Radtke C, Lang EM. Comparison of Schwann cells and olfactory ensheathing cells for peripheral nerve gap bridging. Cells Tissues Organs 2012; 196:534-42. [PMID: 22699447 DOI: 10.1159/000338059] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Previously, we introduced the biogenic conduit (BC) as a novel autologous nerve conduit for bridging peripheral nerve defects and tested its regenerative capacity in a short- and long-term setting. The aim of the present study was to clarify whether intraluminal application of regeneration-promoting glial cells, including Schwann cells (SC) and olfactory ensheathing cells (OEC), displayed differential effects after sciatic nerve gap bridging. MATERIAL AND METHODS BCs were generated as previously described. The conduits filled with fibrin/SC (n = 8) and fibrin/OEC (n = 8) were compared to autologous nerve transplants (NT; n = 8) in the 15-mm sciatic nerve gap lesion model of the rat. The sciatic functional index was evaluated every 4 weeks. After 16 weeks, histological evaluation followed regarding nerve area, axon number, myelination index and N ratio. RESULTS Common to all groups was a continual improvement in motor function during the observation period. Recovery was significantly better after SC transplantation compared to OEC (p < 0.01). Both cell transplantation groups showed significantly worse function than the NT group (p < 0.01). Whereas nerve area and axon number were correlated to function, being significantly lowest in the OEC group (p < 0.001), both cell groups showed lowered myelination (p < 0.001) and lower N ratio compared to the NT group. DISCUSSION SC-filled BCs led to improved regeneration compared to OEC-filled BCs in a 15-mm-long nerve gap model of the rat.
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Affiliation(s)
- Vincenzo Penna
- Department of Plastic and Hand Surgery, University Medical Center Freiburg, Freiburg, Germany.
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Penna V, Wewetzer K, Munder B, Stark GB, Lang EM. The long-term functional recovery of repair of sciatic nerve transection with biogenic conduits. Microsurgery 2012; 32:377-82. [PMID: 22434585 DOI: 10.1002/micr.21974] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 01/12/2012] [Accepted: 02/01/2012] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate long-term regenerative capacity over a 15-mm nerve gap of an autologous nerve conduit, the biogenic conduit (BC), 16 weeks after sciatic nerve transection in the rat. METHODS A 19-mm long polyvinyl chloride (PVC) tube was implanted parallely to the sciatic nerve. After implantation, a connective tissue cover developed around the PVC-tube, the so-called BC. After removal of the PVC-tube the BCs filled with fibrin (n = 8) were compared to autologous nerve grafts (n = 8). Sciatic functional index (SFI) was evaluated every 4 weeks, histological evaluation was performed at 16 weeks postimplantation. Regenerating axons were visualized by retrograde labelling. RESULTS SFI revealed no significant differences. Nerve area and axon number in the BC group were significantly lower than in the autologous nerve group (P < 0.05; P < 0.01). Analysis of myelin formation showed no significant difference in both groups. Analysis of N-ratio revealed lower values in the BC group (P < 0.001). CONCLUSION This study reveals the suitability of BC for nerve gap bridging over a period of 16 weeks with functional recovery to comparable extent as the autologous nerve graft despite impaired histomorphometric parameters.
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Affiliation(s)
- Vincenzo Penna
- Department of Plastic and Hand Surgery, Albert-Ludwigs University, Freiburg, Germany.
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Tos P, Battiston B, Ciclamini D, Geuna S, Artiaco S. Primary repair of crush nerve injuries by means of biological tubulization with muscle-vein-combined grafts. Microsurgery 2012; 32:358-63. [DOI: 10.1002/micr.21957] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 11/28/2011] [Accepted: 12/05/2011] [Indexed: 01/14/2023]
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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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Penna V, Munder B, Stark GB, Lang EM. An in vivo engineered nerve conduit-fabrication and experimental study in rats. Microsurgery 2011; 31:395-400. [DOI: 10.1002/micr.20894] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 02/01/2011] [Indexed: 11/10/2022]
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Siemionow M, Bozkurt M, Zor F. Regeneration and repair of peripheral nerves with different biomaterials: review. Microsurgery 2011; 30:574-88. [PMID: 20878689 DOI: 10.1002/micr.20799] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Peripheral nerve injury may cause gaps between the nerve stumps. Axonal proliferation in nerve conduits is limited to 10-15 mm. Most of the supportive research has been done on rat or mouse models which are different from humans. Herein we review autografts and biomaterials which are commonly used for nerve gap repair and their respective outcomes. Nerve autografting has been the first choice for repairing peripheral nerve gaps. However, it has been demonstrated experimentally that tissue engineered tubes can also permit lead to effective nerve repair over gaps longer than 4 cm repair that was previously thought to be restorable by means of nerve graft only. All of the discoveries in the nerve armamentarium are making their way into the clinic, where they are, showing great potential for improving both the extent and rate of functional recovery compared with alternative nerve guides.
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Affiliation(s)
- Maria Siemionow
- Department of Plastic Surgery, The Cleveland Clinic, Cleveland, OH 44195, USA.
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Alternative techniques for peripheral nerve repair: conduits and end-to-side neurorrhaphy. HOW TO IMPROVE THE RESULTS OF PERIPHERAL NERVE SURGERY 2011; 100:43-50. [DOI: 10.1007/978-3-211-72958-8_10] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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Flores LP. The use of autogenous veins for microsurgical repair of the sural nerve after nerve biopsy. Neurosurgery 2010; 66:238-43; discussion 243-4. [PMID: 20489512 DOI: 10.1227/01.neu.0000369657.42680.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study evaluates the results of an alternative technique developed to minimize the risk of complications associated with sural nerve biopsy for histopathological analysis. METHODS Twelve subjects underwent sural nerve biopsy and the defect created in the nerve was bridged by a 50-mm-length segment of the saphenous vein; the control group enrolled 23 patients in whom the entire length of the nerve was harvested to be used as autograft for reconstruction of nerves in the upper limb. Sensory reinnervation was quantified by use of the monofilament test and the static 2-point discrimination test, after a follow-up period of 18 months. RESULTS The mean time for recovery of protective sensation was 8.7 months in patients submitted to nerve repair, and 10.3 months in the control group (P > .05). The monofilament test and static 2-point discrimination testing demonstrated a mean value of 3.22 and 8 mm (S3), respectively, in the group who underwent sural nerve repair; and 4.17 and 13 mm (S2), respectively, for the control group (P <.05). CONCLUSION The use of vein as conduits for the repair of the sural nerve did not shorten the time for sensory recovery at the autonomous zone of the nerve; however, the quality of the reinnervation was considered better than the control group. This study suggests that empty veins could be used as conduits to bridge gaps with a length up to 50 mm in cases of injuries of the sural nerve and, possibly, for injuries of other pure sensory nerves as well.
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Affiliation(s)
- Leandro Pretto Flores
- Unit of Neurosurgery, Hospital de Base do Distrito Federal Brasília, Distrito Federal, Brazil.
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Gu X, Ding F, Yang Y, Liu J. Construction of tissue engineered nerve grafts and their application in peripheral nerve regeneration. Prog Neurobiol 2010; 93:204-30. [PMID: 21130136 DOI: 10.1016/j.pneurobio.2010.11.002] [Citation(s) in RCA: 416] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 11/02/2010] [Accepted: 11/23/2010] [Indexed: 01/01/2023]
Abstract
Surgical repair of severe peripheral nerve injuries represents not only a pressing medical need, but also a great clinical challenge. Autologous nerve grafting remains a golden standard for bridging an extended gap in transected nerves. The formidable limitations related to this approach, however, have evoked the development of tissue engineered nerve grafts as a promising alternative to autologous nerve grafts. A tissue engineered nerve graft is typically constructed through a combination of a neural scaffold and a variety of cellular and molecular components. The initial and basic structure of the neural scaffold that serves to provide mechanical guidance and optimal environment for nerve regeneration was a single hollow nerve guidance conduit. Later there have been several improvements to the basic structure, especially introduction of physical fillers into the lumen of a hollow nerve guidance conduit. Up to now, a diverse array of biomaterials, either of natural or of synthetic origin, together with well-defined fabrication techniques, has been employed to prepare neural scaffolds with different structures and properties. Meanwhile different types of support cells and/or growth factors have been incorporated into the neural scaffold, producing unique biochemical effects on nerve regeneration and function restoration. This review attempts to summarize different nerve grafts used for peripheral nerve repair, to highlight various basic components of tissue engineered nerve grafts in terms of their structures, features, and nerve regeneration-promoting actions, and finally to discuss current clinical applications and future perspectives of tissue engineered nerve grafts.
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Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Nantong University, 19 Qixiu Road, Nantong, JS 226001, PR China.
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Muscle-in-vein nerve guide for secondary reconstruction in digital nerve lesions. J Hand Surg Am 2010; 35:1418-26. [PMID: 20807618 DOI: 10.1016/j.jhsa.2010.05.019] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2010] [Revised: 05/15/2010] [Accepted: 05/25/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE Although vein conduits filled with fresh skeletal muscle have been used to bridge nerve defects both experimentally and clinically with good results, this approach has never been considered a valuable tool for reconstruction of nerve defects, and the technique has been abandoned. The purpose of this study was to evaluate the application of muscle-in-vein conduits for secondary digital nerves reconstruction, with particular emphasis on the surgical technique and results. METHODS We present a retrospectively selected consecutive series of 21 digital nerve defects in 17 patients who were treated with vein conduits filled with fresh skeletal muscle for secondary nerve reconstruction. After a minimum follow-up of 18 months, all patients were studied with static and moving 2-point discrimination, Semmes-Weinstein monofilament testing, Visual Analog Scale, and Disabilities of the Arm, Shoulder, and Hand questionnaire. Outcome data were stratified according to the American Society for Surgery of the Hand guidelines, the modified Highet and Sander's criteria, and the Logic Tree. RESULTS The average nerve gap bridged with the muscle-in-vein conduit was 2.2 cm (range, 1-3.5 cm). We classified 14 of 22 reconstructed nerves as excellent or good according to American Society for Surgery of the Hand guidelines, whereas 17 were between S4 and S3 using modified Highet and Sander's criteria. The Logic Tree yielded results between S4 and S3 in 14 of 21 reconstructed nerves. The average Disabilities of the Arm, Shoulder, and Hand survey scores were 22.5 for the disability/symptoms module and 21.4 and 17 for the sports/music and work subcomponents, respectively. CONCLUSIONS Use of muscle-in-vein conduits should be considered and promoted for sensory nerve reconstruction for a number of reasons: the encouraging results with the technique; the abundant availability of both donor tissues; the flexibility of the conduit resulting from the combination of muscle and vein; the simplicity with which tubes can be fashioned; immunological compatibility; and the absence of adjunctive costs. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Turgut M, Kaplan S, Unal BZ, Bozkurt M, Yürüker S, Yenisey C, Sahin B, Uyanıkgil Y, Baka M. Stereological analysis of sciatic nerve in chickens following neonatal pinealectomy: an experimental study. J Brachial Plex Peripher Nerve Inj 2010; 5:10. [PMID: 20409336 PMCID: PMC2867982 DOI: 10.1186/1749-7221-5-10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 04/21/2010] [Indexed: 11/11/2022] Open
Abstract
Background Although the injury to the peripheral nervous system is a common clinical problem, understanding of the role of melatonin in nerve degeneration and regeneration is incomplete. Methods The current study investigated the effects of neonatal pinealectomy on the sciatic nerve microarchitecture in the chicken. The chickens were divided into two equal groups: unpinealectomized controls and pinealectomized chickens. At the end of the study, biochemical examination of 10 sciatic nerve samples from both groups was performed and a quantitative stereological evaluation of 10 animals in each group was performed. The results were compared using Mann-Whitney test. Results In this study, the results of axon number and thickness of the myelin sheath of a nerve fiber in newly hatched pinealectomy group were higher than those in control group. Similarly, surgical pinealectomy group had significantly larger axonal cross-sectional area than the control group (p < 0.05). In addition, the average hydroxyproline content of the nerve tissue in neonatal pinealectomy group was higher than those found in control group. Our results suggest that melatonin may play a role on the morphologic features of the peripheral nerve tissue and that melatonin deficiency might be a pathophysiological mechanism in some degenerative diseases of peripheral nerves. The changes demonstrated by quantitative morphometric methods and biochemical analysis has been interpreted as a reflection of the effects of melatonin upon nerve tissue. Conclusion In the light of these results from present animal study, changes in sciatic nerve morphometry may be indicative of neuroprotective feature of melatonin, but this suggestion need to be validated in the human setting.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, Aydin, Turkey.
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Di Scipio F, Raimondo S, Tos P, Geuna S. A simple protocol for paraffin-embedded myelin sheath staining with osmium tetroxide for light microscope observation. Microsc Res Tech 2009; 71:497-502. [PMID: 18320578 DOI: 10.1002/jemt.20577] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Experimental investigation of peripheral nerve fiber regeneration is attracting more and more attention among both basic and clinical researchers. Assessment of myelinated nerve fiber morphology is a pillar of peripheral nerve regeneration research. The gold standard for light microscopic imaging of myelinated nerve fibers is toluidine blue staining of resin-embedded semithin sections. However, many researchers are unaware that the dark staining of myelin sheaths typically produced by this procedure is due to osmium tetroxide postfixation and not due to toluidine blue. In this article, we describe a simple pre-embedding protocol for staining myelin sheaths in paraffin-embedded nerve specimens using osmium tetroxide. The method involves immersing the specimen in 2% osmium tetroxide for 2 h after paraformaldehyde fixation, followed by routine dehydration and paraffin embedding. Sections can then be observed directly under the microscope or counterstained using routine histological methods. Particularly good results were obtained with Masson's trichrome counterstain, which permits the imaging of connective structures in nerves that are not detectable in toluidine blue-stained resin sections. Finally, we describe a simple protocol for osmium etching of sections, which makes further immunohistochemical analysis possible on the same specimens. Taken together, our results suggest that the protocol described in this article is a valid alternative to the conventional resin embedding-based protocol: it is much cheaper, can be adopted by any histological laboratory, and allows immunohistochemical analysis to be conducted.
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Affiliation(s)
- Federica Di Scipio
- Dipartimento di Scienze Cliniche e Biologiche, Università di Torino, Ospedale San Luigi Gonzaga, Regione Gonzole 10, Orbassano (TO), Italy
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Battiston B, Raimondo S, Tos P, Gaidano V, Audisio C, Scevola A, Perroteau I, Geuna S. Chapter 11 Tissue Engineering of Peripheral Nerves. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:227-49. [DOI: 10.1016/s0074-7742(09)87011-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Chiono V, Tonda-Turo C, Ciardelli G. Chapter 9: Artificial scaffolds for peripheral nerve reconstruction. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:173-98. [PMID: 19682638 DOI: 10.1016/s0074-7742(09)87009-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Posttraumatic peripheral nerve repair is one of the major challenges in restorative medicine and microsurgery. Despite the recent progresses in the field of tissue engineering, functional recovery after severe nerve lesions is generally partial and unsatisfactory. Autograft is still the best method to treat peripheral nerve lesions, although it has several drawbacks and does not allow complete functional recovery. Full recovery of nerve functionality could ideally be achieved by proper guiding axon regeneration toward the original target tissues, through the use of purposely engineered artificial nerve guidance channels (NGCs). In the last decade, artificial NGCs have been produced using a variety of both natural and synthetic, biodegradable and nonbiodegradable polymers. Several techniques have been developed to obtain porous and nonporous NGCs and to realize and incorporate bioactive fillers for NGCs. Some of the developed products have been approved for clinical applications. Many other NGC typologies have been object of interest and are currently under investigation. The current trend of nerve tissue engineering is the realization of biomimetic NGCs, providing chemotactic, topological, and haptotactic signalling to cells, respectively by surface functionalization with cell binding domains, the use of internal-oriented matrices/fibres and the sustained release of neurotrophic factors. The present contribution provides a balanced integration of the most recent achievements of tissue engineering in the field of peripheral nerve repair. By an accurate evaluation of the status of research, the review delineates the most promising directions to which research should address for consistent progress in the field of peripheral nerve repair.
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Affiliation(s)
- Valeria Chiono
- Department of Mechanics, Politecnico di Torino, Torino, Italy
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Beris AE, Lykissas MG. Chapter 13 Experimental Results in End‐To‐Side Neurorrhaphy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:269-79. [DOI: 10.1016/s0074-7742(09)87013-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Nicolino S, Panetto A, Raimondo S, Gambarotta G, Guzzini M, Fornaro M, Battiston B, Tos P, Geuna S, Perroteau I. Denervation and reinnervation of adult skeletal muscle modulate mRNA expression of neuregulin-1 and ErbB receptors. Microsurgery 2009; 29:464-72. [DOI: 10.1002/micr.20636] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Geuna S. Evaluation Methods in the Assessment of Peripheral Nerve Regeneration. J Neurosurg 2008; 109:360-2; author reply 362. [DOI: 10.3171/jns/2008/109/8/0360] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tang J, Wang XM, Hu J, Luo E, Qi MC. Autogenous standard versus inside-out vein graft to repair facial nerve in rabbits. Chin J Traumatol 2008; 11:104-9. [PMID: 18377714 DOI: 10.1016/s1008-1275(08)60022-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate autogenous vein grafts and inside-out vein grafts as conduits for the defects repair in the rabbit facial nerves. METHODS The 10 mm segments of buccal division of facial nerve were transected for 48 rabbits in this study. Then the gaps were immediately repaired by autogenous vein grafts or inside-out vein grafts in different groups. All the animals underwent the whisker movement test and electrophysiologic test during the following 16 weeks at different time points postoperatively. Subsequently, the histological examination was performed to observe the facial nerve regeneration morphologically. RESULTS At 8 weeks after operation, the facial nerve regeneration has significant difference between the experimental group and the control group in electrophysiologic test and histological observation. However, at the end of this study, 16 weeks after operation, there was no significant difference between inside-out vein grafts and standard vein grafts in enhancing peripheral nerve regeneration. CONCLUSION This study suggest that both kinds of vein grafts play positive roles in facial nerve regeneration after being repaired immediately, but the autogenous inside-out vein grafts might accelerate and facilitate axonal regeneration as compared with control.
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Affiliation(s)
- Jie Tang
- Department of Oral and Maxillofacial Surgery, West China College of Stomatology, Sichuan University, Chengdu 610041, China
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Vein Grafts Used as Nerve Conduits for Obstetrical Brachial Plexus Palsy Reconstruction. Plast Reconstr Surg 2007; 120:1930-1941. [DOI: 10.1097/01.prs.0000287391.12943.00] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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45
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Beris A, Lykissas M, Korompilias A, Mitsionis G. End-to-Side Nerve Repair in Peripheral Nerve Injury. J Neurotrauma 2007; 24:909-16. [PMID: 17518544 DOI: 10.1089/neu.2006.0165] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In peripheral nerve injury, end-to-side neurorrhaphy has been reported as an alternative in cases that the proximal nerve stump is not accessible. Several hypotheses have been proposed to explain peripheral nerve regeneration after end-to-side neurorrhaphy. Recent evidence suggests that nerve regeneration occurs by collateral sprouting. Although a great number of humoral factors have been identified, molecular mechanism of nerve regeneration after end-to-side neurorrhaphy has not been completely clarified yet. The goal of this technique is to provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. End-to-side technique has been investigated in detail in both experimental and clinical studies. Only a limited number of reported cases in clinical practice, until today, can reveal that end-to-side technique may become a viable means of repairing peripheral nerves in certain clinical situations.
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Affiliation(s)
- Alexandros Beris
- Department of Orthopaedics, University of Ioannina, Ioannina, Greece.
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Hess JR, Brenner MJ, Fox IK, Nichols CM, Myckatyn TM, Hunter DA, Rickman SR, Mackinnon SE. Use of cold-preserved allografts seeded with autologous Schwann cells in the treatment of a long-gap peripheral nerve injury. Plast Reconstr Surg 2007; 119:246-259. [PMID: 17255680 DOI: 10.1097/01.prs.0000245341.71666.97] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limitations in autogenous tissue have inspired the study of alternative materials for repair of complex peripheral nerve injuries. Cadaveric allografts are one potential reconstructive material, but their use requires systemic immunosuppression. Cold preservation (> or =7 weeks) renders allografts devoid of antigens, but these acellular substrates generally fail in supporting regeneration beyond 3 cm. In this study, the authors evaluated the reconstruction of extensive nonhuman primate peripheral nerve defects using 7-week cold-preserved allografts repopulated with cultured autologous Schwann cells. METHODS Ten outbred Macaca fascicularis primates were paired based on maximal genetic disparity as measured by similarity index assay. A total of 14 ulnar nerve defects measuring 6 cm were successfully reconstructed using autografts (n = 5), fresh allografts (n = 2), cold-preserved allografts (n = 3), or cold-preserved allografts seeded with autogenous Schwann cells (n = 4). Recipient immunoreactivity was evaluated by means of enzyme-linked immunosorbent spot assay, and nerves were harvested at 6 months for histologic and histomorphometric analysis. RESULTS Cytokine production in response to cold-preserved allografts and cold-preserved allografts seeded with autologous Schwann cells was similar to that observed for autografts. Schwann cell-repopulated cold-preserved grafts demonstrated significantly enhanced fiber counts, nerve density, and percentage nerve (p < 0.05) compared with unseeded cold-preserved grafts at 6 months after reconstruction. CONCLUSIONS Cold-preserved allografts seeded with autologous Schwann cells were well-tolerated in unrelated recipients and supported significant regeneration across 6-cm peripheral nerve defects. Use of cold-preserved allogeneic nerve tissue supplemented with autogenous Schwann cells poses a potentially safe and effective alternative to the use of autologous tissue in the reconstruction of extensive nerve injuries.
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Affiliation(s)
- Jason R Hess
- St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, and Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine
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Tos P, Battiston B, Nicolino S, Raimondo S, Fornaro M, Lee JM, Chirila L, Geuna S, Perroteau I. Comparison of fresh and predegenerated muscle-vein-combined guides for the repair of rat median nerve. Microsurgery 2007; 27:48-55. [PMID: 17211839 DOI: 10.1002/micr.20306] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the last 10 years, we have investigated a particular type of bioengineered nerve guide, the muscle-vein-combined tube, which is made by filling a vein with skeletal muscle. In our previous studies we have always used fresh skeletal muscle to fill vein conduits. In the present study we compared the use of fresh and predegenerated (freeze-thawed) skeletal muscle for muscle-vein-combined nerve guides. In this study, a 10-mm-long rat median nerve defect was repaired using either type of nerve guide. The samples were analyzed 5 and 30 days after surgery by light and electron microscopy. In addition, reverse transcription polymerase chain reaction (RT-PCR) was carried out to investigate the expression of mRNAs coding for glial markers, as well as glial growth factor (NRG1) and its receptors (erbB2 and erbB3). Results showed differences between the two types of nerve guides at postoperative day 5; however, no difference was detected at day 30 suggesting that both types of tissue-engineered conduit are effective for repairing peripheral nerve defects in this experimental model.
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Affiliation(s)
- P Tos
- UOD Reconstructive Microsurgery, Orthopaedic Department, C.T.O. Hospital, Via Zuretti 29, 10100 Turin, Italy
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Geuna S, Nicolino S, Raimondo S, Gambarotta G, Battiston B, Tos P, Perroteau I. Nerve regeneration along bioengineered scaffolds. Microsurgery 2007; 27:429-38. [PMID: 17596863 DOI: 10.1002/micr.20383] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Tissue engineering has recently seen great advancements in many medical fields, including peripheral nerve reconstruction. In the rat median nerve model, we investigated nerve repair by means of bioengineered tissue scaffolds (muscle-vein-combined tubes) focusing on changes in the neuregulin-1/ErbB-receptor system which represents one of the main regulatory systems of axo-glial interaction in peripheral nerves. Repaired nerves were withdrawn at 5, 15, and 30 days postoperative and processed for morphological and retro-transcriptase polymerase chain reaction (RT-PCR) analysis. Results revealed an early and progressive increase in the expression of NRG1alpha isoform only, while the appearance of the beta isoform of NRG1, which is normally present in peripheral nerves, was delayed. In regards to ErbB2 and ErbB3 receptors, their expression increased progressively inside the muscle-vein-combined scaffolds, though with different kinetics. Taken together, these results suggest that variations in neuregulin-1/ErbB system activation play a key role in peripheral nerve regeneration along bioengineered muscle-vein-combined scaffolds. Since similar variations are also detectable in denervated skeletal muscles, it can be hypothesized that the existence of a NRG1's autocrine/paracrine trophic loop shared by both glial and muscle fibers could be responsible for the effectiveness of muscle-vein-combined conduits for repairing nerve defects.
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Affiliation(s)
- S Geuna
- Department of Clinical and Biological Sciences, University of Turin, Orbassano (TO), Italy.
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Bertelli JA, Taleb M, Mira JC, Ghizoni MF. The course of aberrant reinnervation following nerve repair with fresh or denatured muscle autografts. J Peripher Nerv Syst 2005; 10:359-68. [PMID: 16279985 DOI: 10.1111/j.1085-9489.2005.00048.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Denatured muscle grafts obtained by freeze thawing have been proposed to replace losses in the peripheral nerves. In the present report, we compare the performance of such grafts with fresh grafts in the rat median nerve. A long-term effect of muscle interposition on reinnervation was studied by behavioral assessment, muscle ATPase histochemistry, and retrograde labeling of motoneurons. There was no difference in grasping strength recovery between fresh and denatured 10-mm-long muscle grafts. Recovery was delayed and incomplete. Twelve months after surgery, only 50% of the normal grasping strength was attained. Grasping recovery was not observed in the 20-mm-long graft groups. Pathway reinnervation was non-specific with a huge amount of motor fiber misdirection. A decrease in the number of misdirected motor fibers occurred with time and activity recovery. Muscle reinnervation was not specific with disturbance of the mosaic pattern and type-grouping formation. Preference of type I axons for reinnervating deeper zones was observed. Type I aberrant reinnervation was demonstrated in the muscle periphery. The mosaic distribution of type I and II muscle fibers was not stable, and readjustments were observed with time, correlating with grasping improvement. During grasping strength recovery, there was a decrease in the number of type I fibers peripherally located and an increase of those deeply disposed. A time- and activity-related recovery was associated with readjustment in the pathways and muscle fiber rearrangement. We suggest that muscle activity generates specificity.
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Affiliation(s)
- Jayme A Bertelli
- Universidade do Sul de Santa Catarina Unisul, Centro de Ciências Biológicas e da Saúde CCBS, Tubarão, SC, Brazil.
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Battiston B, Geuna S, Ferrero M, Tos P. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005; 25:258-67. [PMID: 15934044 DOI: 10.1002/micr.20127] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nerve repair is usually accomplished by direct suture when the two stumps can be approximated without tension. In the presence of a nerve defect, the placement of an autologous nerve graft is the current gold standard for nerve restoration. However, over the last 20 years, an increasing number of research articles reported on the use of non-nervous tubes (tubulization) for repairing nerve defects. The clinical employment of tubes (both biological and synthetic) as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. In addition, tubulization was proposed as an alternative to direct nerve sutures in order to create optimal conditions for nerve regeneration over the short empty space intentionally left between two nerve stumps. This paper outlines recent important advances in this field. Different tubulization techniques proposed so far are described, focusing in particular on studies that reported on the employment of tubes with patients. Our personal clinical experience on tubulization repair of sensory nerve lesions (digital nerves), using both biological and synthetic tubes, is presented, and the clinical results are compared. In our case series, both types of tubes led to good clinical results. Finally, we speculate about the prospects in the clinical application of tubulization for peripheral nerve repair.
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Affiliation(s)
- Bruno Battiston
- UOD Reconstructive Microsurgery, Department of Orthopedics, C.T.O. Hospital, Turin, Italy.
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