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Scott BB, Winograd JM, Redmond RW. Surgical Approaches for Prevention of Neuroma at Time of Peripheral Nerve Injury. Front Surg 2022; 9:819608. [PMID: 35832494 PMCID: PMC9271873 DOI: 10.3389/fsurg.2022.819608] [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: 11/21/2021] [Accepted: 05/24/2022] [Indexed: 11/30/2022] Open
Abstract
Painful neuroma is a frequent sequela of peripheral nerve injury which can result in pain and decreased quality of life for the patient, often necessitating surgical intervention. End neuromas are benign neural tumors that commonly form after nerve transection, when axons from the proximal nerve stump regenerate in a disorganized manner in an attempt to recreate nerve continuity. Inflammation and collagen remodeling leads to a bulbous end neuroma which can become symptomatic and result in decreased quality of life. This review covers surgical prophylaxis of end neuroma formation at time of injury, rather than treatment of existing neuroma and prevention of recurrence. The current accepted methods to prevent end neuroma formation at time of injury include different mechanisms to inhibit the regenerative response or provide a conduit for organized regrowth, with mixed results. Approaches include proximal nerve stump capping, nerve implantation into bone, muscle and vein, various pharmacologic methods to inhibit axonal growth, and mechanisms to guide axonal growth after injury. This article reviews historical treatments that aimed to prevent end neuroma formation as well as current and experimental treatments, and seeks to provide a concise, comprehensive resource for current and future therapies aimed at preventing neuroma formation.
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Affiliation(s)
- Benjamin B. Scott
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Correspondence: Benjamin B. Scott
| | - Jonathan M. Winograd
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Robert W. Redmond
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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A Photosealed Cap Prevents Disorganized Axonal Regeneration and Neuroma following Nerve Transection in Rats. Plast Reconstr Surg Glob Open 2022; 10:e4168. [PMID: 35265445 PMCID: PMC8901221 DOI: 10.1097/gox.0000000000004168] [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: 11/15/2021] [Accepted: 01/04/2022] [Indexed: 11/26/2022]
Abstract
Neuroma is a common sequela of traumatic peripheral nerve injury that can result in pain and decreased quality of life for patients. Neuromas result from axonal outgrowth in an attempt to reestablish continuity with the disrupted distal nerve end. Photosealing is a light-activated technique whereby tissues can be securely isolated in a strong and secure manner. This study investigated whether photosealing of autologous vein and crosslinked human amniotic membrane (xHAM) to cap the proximal stump of transected sciatic nerve would prevent disorganized axonal regeneration and neuroma in a rat model.
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Kim YJ, Kim KJ, Lee JH, Park SU, Cho SY. Effect of herbal extracts on peripheral nerve regeneration after microsurgery of the sciatic nerve in rats. BMC Complement Med Ther 2021; 21:162. [PMID: 34088292 PMCID: PMC8178854 DOI: 10.1186/s12906-021-03335-w] [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] [Received: 11/17/2020] [Accepted: 05/24/2021] [Indexed: 12/03/2022] Open
Abstract
Background Recent experimental studies using herbal extracts have shown the possibility of peripheral nerve regeneration. This study aimed to investigate the effects of herbal extracts on peripheral nerve regeneration in a rat sciatic nerve injury model. Methods A total of 53 rats were randomly assigned to a control group or one of four experimental groups. In all rats, the sciatic nerve was completely severed and microscopic epineural end-to-end neurorrhaphy was performed. Normal saline (2 mL) was topically applied to the site of nerve repair in the control group, whereas four different herbal extracts – 2 mL each of Astragalus mongholicus Bunge, Coptis japonica (Thunb.) Makino, Aconitum carmichaelii Debeaux, or Paeonia lactiflora Pall. – were topically applied to the site of nerve repair in each experimental group. Nerve conduction studies were performed at an average of 11.9 weeks after the operation, and conduction velocity and proximal and distal amplitudes were measured. Biopsies were performed at an average of 13.2 weeks after the initial neurorrhaphy. The quality of nerve anastomosis and perineural adhesion to the surrounding soft tissues was macroscopically evaluated. The neuroma size at the site of the neurorrhaphy was microscopically measured, whereas the size of the scar tissue was evaluated relative to the diameter of the repaired nerve. Results The nerve conduction study results showed the highest nerve conduction velocity in the experimental group that used the Coptis japonica (Thunb.) Makino extract and the highest proximal and distal amplitudes in the experimental group that used the Aconitum carmichaelii Debeaux extract. Macroscopic evaluations after the second operation showed that grade 2 perineural adhesion was found in 70.8% of rats. The mean neuroma size in the Coptis japonica (Thunb.) Makino, Aconitum carmichaelii Debeaux, and Paeonia lactiflora Pall. groups showed statistically significant decreases relative to the control group. The mean scar tissue formation index in the Paeonia lactiflora Pall. group showed a statistically significant decrease relative to the control group. Conclusions The peripheral nerve regeneration effect of the herbal extracts was confirmed through decreased neuroma and scar tissue formation. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-021-03335-w.
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Affiliation(s)
- Young Jun Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Kyu Jin Kim
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Department of Orthopedic Surgery, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Seong-Uk Park
- Department of Cardiology and Neurology, Kyung Hee University Hospital at Gangdong, College of Korean Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea.,Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, Kyung Hee University Hospital at Gangdong, College of Korean Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea. .,Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.
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Long Acellular Nerve Allografts Cap Transected Nerve to Arrest Axon Regeneration and Alter Upstream Gene Expression in a Rat Neuroma Model. Plast Reconstr Surg 2021; 148:32e-41e. [PMID: 34014904 DOI: 10.1097/prs.0000000000008051] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Treatments to manage painful neuroma are needed. An operative strategy that isolates and controls chaotic axonal growth could prevent neuroma. Using long acellular nerve allograft to "cap" damaged nerve could control axonal regeneration and, in turn, regulate upstream gene expression patterns. METHODS Rat sciatic nerve was transected, and the distal nerve end was reversed and ligated to generate a model end-neuroma. Three groups were used to assess their effects immediately following this nerve injury: no treatment (control), traction neurectomy, or 5-cm acellular nerve allograft cap attached to the proximal nerve. Regeneration of axons from the injured nerve was assessed over 5 months and paired with concurrent measurements of gene expression from upstream affected dorsal root ganglia. RESULTS Both control and traction neurectomy groups demonstrated uncontrolled axon regeneration revealed using Thy1-GFP rat axon imaging and histomorphometric measures of regenerated axons within the most terminal region of regenerated tissue. The acellular nerve allograft group arrested axons within the acellular nerve allograft, where no axons reached the most terminal region even after 5 months. At 5 months, gene expression associated with regeneration and pain sensitization, including Bdnf, cfos, and Gal, was decreased within dorsal root ganglia obtained from the acellular nerve allograft group compared to control or traction neurectomy group dorsal root ganglia. CONCLUSIONS Long acellular nerve allografts to cap a severed nerve arrested axon regeneration within the acellular nerve allograft. This growth arrest corresponded with changes in regenerative and pain-related genes upstream. Acellular nerve allografts may be useful for surgical intervention of neuroma.
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Zennifer A, Senthilvelan P, Sethuraman S, Sundaramurthi D. Key advances of carboxymethyl cellulose in tissue engineering & 3D bioprinting applications. Carbohydr Polym 2021; 256:117561. [PMID: 33483063 DOI: 10.1016/j.carbpol.2020.117561] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/07/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022]
Abstract
Carboxymethyl cellulose (CMC) is a water-soluble derivative of cellulose and a major type of cellulose ether prepared by the chemical attack of alkylating reagents on the activated non-crystalline regions of cellulose. It is the first FDA approved cellulose derivative which can be targeted for desired chemical modifications. In this review, the properties along with current advances in the physical and chemical modifications of CMC are discussed. Further, CMC and modified CMC could be engineered to fabricate scaffolds for tissue engineering applications. In recent times, CMC and its derivatives have been developed as smart bioinks for 3D bioprinting applications. From these perspectives, the applications of CMC in tissue engineering and current knowledge on peculiar features of CMC in 3D and 4D bioprinting applications are elaborated in detail. Lastly, future perspectives of CMC for wider applications in tissue engineering and 3D/4D bioprinting are highlighted.
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Affiliation(s)
- Allen Zennifer
- Tissue Engineering & Additive Manufacturing (TEAM) Lab, Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613401, India
| | - Praseetha Senthilvelan
- Tissue Engineering & Additive Manufacturing (TEAM) Lab, Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613401, India
| | - Swaminathan Sethuraman
- Tissue Engineering & Additive Manufacturing (TEAM) Lab, Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613401, India
| | - Dhakshinamoorthy Sundaramurthi
- Tissue Engineering & Additive Manufacturing (TEAM) Lab, Centre for Nanotechnology & Advanced Biomaterials (CeNTAB), ABCDE Innovation Centre, School of Chemical & Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu 613401, India.
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Entekhabi E, Haghbin Nazarpak M, Shafieian M, Mohammadi H, Firouzi M, Hassannejad Z. Fabrication and in vitro evaluation of 3D composite scaffold based on collagen/hyaluronic acid sponge and electrospun polycaprolactone nanofibers for peripheral nerve regeneration. J Biomed Mater Res A 2021; 109:300-312. [PMID: 32490587 DOI: 10.1002/jbm.a.37023] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 04/02/2020] [Accepted: 04/19/2020] [Indexed: 11/11/2022]
Abstract
Replacement of peripheral nerve autografts with tissue engineered nerve grafts will potentially resolve the lack of nerve tissue especially in patients with severe concomitant soft tissue injuries. This study attempted to fabricate a tissue engineered nerve graft composed of electrospun PCL conduit filled with collagen-hyaluronic acid (COL-HA) sponge with different COL-HA weight ratios including 100:0, 98:2, 95:5 and 90:10. The effect of HA addition on the sponge porosity, mechanical properties, water absorption and degradation rate was assessed. A good cohesion between the electrospun PCL nanofibers and COL-HA sponges were seen in all sponges with different HA contents. Mechanical properties of PCL nanofibrous layer were similar to the rat sciatic nerve; the ultimate tensile strength was 2.23 ± 0.35 MPa at the elongation of 35%. Additionally, Schwann cell proliferation and morphology on three dimensional (3D) composite scaffold were evaluated by using MTT and SEM assays, respectively. Rising the HA content resulted in higher water absorption as well as greater pore size and porosity, while a decrease in Schwann cell proliferation compared to pure collagen sponge, although reduction in cell proliferation was not statistically significant. The lower Schwann cell proliferation on the COL-HA was attributed to the greater degradation rate and pore size of the COL-HA sponges. Also, dorsal root ganglion assay showed that the engineered 3D construct significantly increases axon growth. Taken together, these results suggest that the fabricated 3D composite scaffold provide a permissive environment for Schwann cells proliferation and maturation and can encourage axon growth.
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Affiliation(s)
- Elahe Entekhabi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Masoumeh Haghbin Nazarpak
- New Technologies Research Center (NTRC), Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Mehdi Shafieian
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Haniye Mohammadi
- Department of Biomedical Engineering, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Masoumeh Firouzi
- Tissue Repair Laboratory, Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
| | - Zahra Hassannejad
- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Ghorbani F, Zamanian A, Kermanian F, Shamoosi A. A bioinspired 3D shape olibanum‐collagen‐gelatin scaffolds with tunable porous microstructure for efficient neural tissue regeneration. Biotechnol Prog 2019; 36:e2918. [DOI: 10.1002/btpr.2918] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 07/14/2019] [Accepted: 09/17/2019] [Indexed: 01/23/2023]
Affiliation(s)
- Farnaz Ghorbani
- Department of Orthopedics, Shanghai Pudong HospitalFudan University Pudong Medical Center Shanghai China
| | - Ali Zamanian
- Department of Nanotechnology and Advanced MaterialsMaterials and Energy Research Center Karaj Iran
| | - Fatemeh Kermanian
- Department of Anatomy, School of MedicineAlborz University of Medical Sciences Karaj Iran
| | - Atefeh Shamoosi
- Department of Anatomy, School of MedicineAlborz University of Medical Sciences Karaj Iran
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Lotfi L, Khakbiz M, Moosazadeh Moghaddam M, Bonakdar S. A biomaterials approach to Schwann cell development in neural tissue engineering. J Biomed Mater Res A 2019; 107:2425-2446. [DOI: 10.1002/jbm.a.36749] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/08/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Leila Lotfi
- Department of Life Science Engineering, Faculty of New Sciences and TechnologiesUniversity of Tehran Tehran Iran
| | - Mehrdad Khakbiz
- Department of Life Science Engineering, Faculty of New Sciences and TechnologiesUniversity of Tehran Tehran Iran
| | | | - Shahin Bonakdar
- National Cell Bank DepartmentPasteur Institute of Iran Tehran Iran
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Colonna MR, Fazio A, Costa AL, Galletti F, Lo Giudice R, Galletti B, Galletti C, Lo Giudice G, Dell'Aversana Orabona G, Papalia I, Ronchi G, Geuna S. The Use of a Hypoallergenic Dermal Matrix for Wrapping in Peripheral Nerve Lesions Regeneration: Functional and Quantitative Morphological Analysis in an Experimental Animal Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4750624. [PMID: 31317030 PMCID: PMC6601684 DOI: 10.1155/2019/4750624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 05/20/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The aim of this research was to test, in an animal model, the nerve regeneration technique with a hypoallergenic acellular dermal matrix used to wrap the microsurgical neural suture. MATERIALS AND METHODS Two groups of rats received the cut of limb right median nerves. The regeneration technique considers for both groups an end-to-end nerve suture. In the experimental group (A) was used also a wrapping protocol by a conduit of collagen matrix currently used in oral surgery. The animals underwent functional grasping tests (at 1, 3, 5, and 7 months) and a histological and quantitative analysis of distal nerve was performed at the end of experimental time. RESULT After seven months, the grasping test reveals functional recovery in each tested animal; this improvement is more evident in Group A. The fibers appear well organized with restored myelin sheaths in both groups. Group A showed a great quantity of connective tissue surrounding the nerve. The quantitative morphology analysis in both groups shows a similar fibers density, fiber diameter, and myelin thickness. The differences between the groups in axon mean diameter are significant. In Group A M/d, D/d, and g-ratio is significantly higher compared to control group. CONCLUSIONS Histological and functional assessments show a functional recovery of the injured nerve in the test groups, stressed by the results of the grasping tests and the meaningful increasing in fiber diameter and higher g-ratio. Moreover, a connective tissue cuff distinguishes the distal portion of the injured nerve. Considering the easy availability and handling of the material used in this study we can conclude that this experimental technique can be considered as a valid alternative to protect nerves in nerve wrap surgery.
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Affiliation(s)
| | - Antonina Fazio
- Department of Human Pathology, University of Messina, Italy
| | | | | | - Roberto Lo Giudice
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Bruno Galletti
- Department of Human Pathology, University of Messina, Italy
| | | | - Giorgio Lo Giudice
- Department of Maxillofacial Surgery, School of Medicine, University of Naples “Federico II”, Italy
| | | | - Igor Papalia
- Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Turin, Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Turin, Italy
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Ghorbani S, Eyni H, Bazaz SR, Nazari H, Asl LS, Zaferani H, Kiani V, Mehrizi AA, Soleimani M. Hydrogels Based on Cellulose and its Derivatives: Applications, Synthesis, and Characteristics. POLYMER SCIENCE SERIES A 2019. [DOI: 10.1134/s0965545x18060044] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Scar Tissue Causing Saphenous Nerve Entrapment: Percutaneous Scar Release and Fat Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1495. [PMID: 29062660 PMCID: PMC5640366 DOI: 10.1097/gox.0000000000001495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022]
Abstract
Painful neuropathies can be caused by nerve compression or neuromas. Nerve compressions can arise from scar adhesions causing painful posttraumatic entrapment of nerve branches via fibrosis. The classical treatment methods include neurolysis and nerve transposition. In this case, we present the treatment of recurrent scar entrapment of the saphenous nerve with percutaneous neurolysis and lipofilling in a patient who had previously undergone an open neurolysis procedure. Resolution of the condition without any complications was noted during the 2-month clinical follow-up. Percutaneous neurolysis and lipofilling are shown to be safe and reproducible methods for the treatment of neuropathic compressive scars.
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Benga A, Zor F, Korkmaz A, Marinescu B, Gorantla V. The neurochemistry of peripheral nerve regeneration. Indian J Plast Surg 2017; 50:5-15. [PMID: 28615804 PMCID: PMC5469235 DOI: 10.4103/ijps.ijps_14_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Peripheral nerve injuries (PNIs) can be most disabling, resulting in the loss of sensitivity, motor function and autonomic control in the involved anatomical segment. Although injured peripheral nerves are capable of regeneration, sub-optimal recovery of function is seen even with the best reconstruction. Distal axonal degeneration is an unavoidable consequence of PNI. There are currently few strategies aimed to maintain the distal pathway and/or target fidelity during regeneration across the zone of injury. The current state of the art approaches have been focussed on the site of nerve injury and not on their distal muscular targets or representative proximal cell bodies or central cortical regions. This is a comprehensive literature review of the neurochemistry of peripheral nerve regeneration and a state of the art analysis of experimental compounds (inorganic and organic agents) with demonstrated neurotherapeutic efficacy in improving cell body and neuron survival, reducing scar formation and maximising overall nerve regeneration.
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Affiliation(s)
- Andreea Benga
- Department of Plastic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Fatih Zor
- Department of Plastic and Reconstructive Surgery, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
| | - Ahmet Korkmaz
- Department of Physiology, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
| | - Bogdan Marinescu
- Department of Plastic Surgery, Dr. Carol Davila Central Military Emergency University Hospital, Bucharest, Romania
| | - Vijay Gorantla
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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