1
|
Ederer IA, Mayer JA, Heinzel J, Kolbenschlag J, Daigeler A, Wahler T. Outcome After Reconstruction of 43 Digital Nerve Defects With Muscle-in-Vein Conduits. J Hand Surg Am 2023; 48:948.e1-948.e9. [PMID: 35400539 DOI: 10.1016/j.jhsa.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 12/16/2021] [Accepted: 02/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Muscle-in-vein conduits provide an alternative for bridging digital nerve defects when tension-free suture is not possible. Low donor site morbidity and absence of additional costs are favorable advantages compared with autografts or conduits. METHODS We retrospectively reviewed 37 patients with 43 defects of proper palmar digital nerves. Primary repair by muscle-in-vein conduits was performed in 22 cases, whereas 21 cases underwent secondary reconstruction. Recovery of sensibility was assessed using static and moving 2-point discrimination and Semmes-Weinstein monofilament testing. Results were compared with the contralateral side serving as a control. Outcome data were stratified according to international guidelines and evaluated for differences in terms of age, gap length, time of reconstruction, and concomitant injuries. RESULTS The median gap length was 20 mm (range, 9-60 mm). After a median follow-up of 25.0 months (interquartile range, 29.0 months), the median static and moving 2-point discrimination were 7.0 mm and 5.0 mm (interquartile range, 3.0 mm), respectively. The evaluation with Semmes-Weinstein monofilament revealed a median reduction of sensibility of 2 levels compared with the contralateral side. According to the American Society for Surgery of the Hand guidelines, 81.4% of the results were classified as excellent or good, whereas fair and poor results were noted in 9.3% of the cases each. The modified Highet and Sander's criteria rated complete clinical recovery in 13 cases; 23 results were regarded as S3+. CONCLUSIONS Muscle-in-vein conduits can be considered for primary and secondary reconstruction of digital nerves. Successful sensory recovery in terms of measurable 2-point discrimination was achieved in 91% of all cases. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Ines Ana Ederer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany; Department of Plastic and Aesthetic, Reconstructive and Hand Surgery, Agaplesion Markus Hospital, Frankfurt, Germany.
| | - Johannes A Mayer
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany; Department of Plastic, Aesthetic and Reconstructive Surgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Johannes Heinzel
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Jonas Kolbenschlag
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Adrien Daigeler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Theodora Wahler
- Department of Hand, Plastic and Reconstructive Surgery, BG Trauma Center, Eberhard Karls University Tuebingen, Tuebingen, Germany; Department of Hand, Plastic and Aesthetic Surgery, Medius Hospital Nuertingen, Nuertingen, Germany
| |
Collapse
|
2
|
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.
Collapse
|
3
|
Bonnet M, Guiraudie-Capraz G, Marqueste T, Garcia S, Jaloux C, Decherchi P, Féron F. Immediate or Delayed Transplantation of a Vein Conduit Filled with Nasal Olfactory Stem Cells Improves Locomotion and Axogenesis in Rats after a Peroneal Nerve Loss of Substance. Int J Mol Sci 2020; 21:E2670. [PMID: 32290426 PMCID: PMC7215801 DOI: 10.3390/ijms21082670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 02/02/2023] Open
Abstract
Over the recent years, several methods have been experienced to repair injured peripheral nerves. Among investigated strategies, the use of natural or synthetic conduits was validated for clinical application. In this study, we assessed the therapeutic potential of vein guides, transplanted immediately or two weeks after a peroneal nerve injury and filled with olfactory ecto-mesenchymal stem cells (OEMSC). Rats were randomly allocated to five groups. A3 mm peroneal nerve loss was bridged, acutely or chronically, with a 1 cm long femoral vein and with/without OEMSCs. These four groups were compared to unoperated rats (Control group). OEMSCs were purified from male olfactory mucosae and grafted into female hosts. Three months after surgery, nerve repair was analyzed by measuring locomotor function, mechanical muscle properties, muscle mass, axon number, and myelination. We observed that stem cells significantly (i) increased locomotor recovery, (ii) partially maintained the contractile phenotype of the target muscle, and (iii) augmented the number of growing axons. OEMSCs remained in the nerve and did not migrate in other organs. These results open the way for a phase I/IIa clinical trial based on the autologous engraftment of OEMSCs in patients with a nerve injury, especially those with neglected wounds.
Collapse
Affiliation(s)
- Maxime Bonnet
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Parc Scientifique et Technologique de Luminy, Faculté des Sciences du Sport de Marseille, CEDEX 09, F-13288 Marseille, France; (M.B.); (T.M.); (P.D.)
- Aix Marseille Univ, CNRS, INP, UMR 7051, Institut de Neuropathophysiologie, Equipe Nasal Olfactory Stemness and Epigenesis (NOSE), CEDEX 15, F-13344 Marseille, France; (G.G.-C.); (C.J.)
| | - Gaëlle Guiraudie-Capraz
- Aix Marseille Univ, CNRS, INP, UMR 7051, Institut de Neuropathophysiologie, Equipe Nasal Olfactory Stemness and Epigenesis (NOSE), CEDEX 15, F-13344 Marseille, France; (G.G.-C.); (C.J.)
| | - Tanguy Marqueste
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Parc Scientifique et Technologique de Luminy, Faculté des Sciences du Sport de Marseille, CEDEX 09, F-13288 Marseille, France; (M.B.); (T.M.); (P.D.)
| | - Stéphane Garcia
- APHM, Laboratoire d’Anatomie Pathologique, Hôpital Nord, Chemin des Bourrely, CEDEX 20, F-13915 Marseille, France;
| | - Charlotte Jaloux
- Aix Marseille Univ, CNRS, INP, UMR 7051, Institut de Neuropathophysiologie, Equipe Nasal Olfactory Stemness and Epigenesis (NOSE), CEDEX 15, F-13344 Marseille, France; (G.G.-C.); (C.J.)
- APHM, Unité de Culture et Thérapie Cellulaire, Hôpital de la Conception, F-13006 Marseille, France
| | - Patrick Decherchi
- Aix Marseille Univ, CNRS, ISM, UMR 7287, Institut des Sciences du Mouvement: Etienne-Jules MAREY, Equipe Plasticité des Systèmes Nerveux et Musculaire (PSNM), Parc Scientifique et Technologique de Luminy, Faculté des Sciences du Sport de Marseille, CEDEX 09, F-13288 Marseille, France; (M.B.); (T.M.); (P.D.)
| | - François Féron
- Aix Marseille Univ, CNRS, INP, UMR 7051, Institut de Neuropathophysiologie, Equipe Nasal Olfactory Stemness and Epigenesis (NOSE), CEDEX 15, F-13344 Marseille, France; (G.G.-C.); (C.J.)
- APHM, Unité de Culture et Thérapie Cellulaire, Hôpital de la Conception, F-13006 Marseille, France
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Quan Q, Meng H, Chang B, Hong L, Li R, Liu G, Cheng X, Tang H, Liu P, Sun Y, Peng J, Zhao Q, Wang Y, Lu S. Novel 3-D helix-flexible nerve guide conduits repair nerve defects. Biomaterials 2019; 207:49-60. [DOI: 10.1016/j.biomaterials.2019.03.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/17/2019] [Accepted: 03/24/2019] [Indexed: 12/25/2022]
|
6
|
Quan Q, Meng HY, Chang B, Liu GB, Cheng XQ, Tang H, Wang Y, Peng J, Zhao Q, Lu SB. Aligned fibers enhance nerve guide conduits when bridging peripheral nerve defects focused on early repair stage. Neural Regen Res 2019; 14:903-912. [PMID: 30688277 PMCID: PMC6375037 DOI: 10.4103/1673-5374.249239] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Nerve conduits enhance nerve regeneration in the repair of long-distance peripheral nerve defects. To help optimize the effectiveness of nerve conduits for nerve repair, we developed a multi-step electrospinning process for constructing nerve guide conduits with aligned nanofibers. The alignment of the nerve guide conduits was characterized by scanning electron microscopy and fast Fourier transform. The mechanical performance of the nerve guide conduits was assessed by testing for tensile strength and compression resistance. The biological performance of the aligned fibers was examined using Schwann cells, PC12 cells and dorsal root ganglia in vitro. Immunohistochemistry was performed for the Schwann cell marker S100 and for the neurofilament protein NF200 in PC12 cells and dorsal root ganglia. In the in vivo experiment, a 1.5-cm defect model of the right sciatic nerve in adult female Sprague-Dawley rats was produced and bridged with an aligned nerve guide conduit. Hematoxylin-eosin staining and immunohistochemistry were used to observe the expression of ATF3 and cleaved caspase-3 in the regenerating matrix. The recovery of motor function was evaluated using the static sciatic nerve index. The number of myelinated fibers, axon diameter, fiber diameter, and myelin thickness in the distal nerve were observed by electron microscopy. Gastrocnemius muscle mass ratio was also determined. The analyses revealed that aligned nanofiber nerve guide conduits have good mechanical properties and can induce Schwann cells, PC12 cells and dorsal root ganglia to aggregate along the length of the nanofibers, and promote the growth of longer axons in the latter two (neuronal) cell types. The aligned fiber nerve conduits increased the expression of ATF3 and cleaved caspase-3 at the middle of the regenerative matrix and at the distal nerve segment, improved sciatic nerve function, increased muscle mass of the gastrocnemius muscle, and enhanced recovery of distal nerve ultrastructure. Collectively, the results show that highly aligned nanofibers improve the performance of the nerve conduit bridge, and enhance its effectiveness in repairing peripheral nerve defects.
Collapse
Affiliation(s)
- Qi Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Hao-Ye Meng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital; School of Materials Science and Engineering, University of Science & Technology Beijing, Beijing, China
| | - Biao Chang
- Department of Laser Medicine, Chinese PLA General Hospital, Beijing, China
| | - Guang-Bo Liu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Xiao-Qing Cheng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - He Tang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yu Wang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing; Neural Regeneration Co-innovation Center of Jiangsu Province, Nantong, Jiangsu Province, China
| | - Jiang Peng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing; Neural Regeneration Co-innovation Center of Jiangsu Province, Nantong, Jiangsu Province, China
| | - Qing Zhao
- Neural Regeneration Co-innovation Center of Jiangsu Province, Nantong, Jiangsu Province; Department of Orthopedic Surgery, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Shi-Bi Lu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
7
|
Siemionow M, Cwykiel J, Uygur S, Kwiecien G, Oztürk C, Szopinski J, Madajka M. Application of epineural sheath conduit for restoration of 6-cm long nerve defects in a sheep median nerve model. Microsurgery 2018; 39:332-339. [PMID: 30512213 DOI: 10.1002/micr.30393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/12/2018] [Accepted: 10/05/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Due to limited number of studies, we tested feasibility of autologous epineural sheath conduit (ESC) in repair of 6-cm median nerve gaps in a sheep-the large animal model. MATERIALS AND METHODS Eight ewes, 6-8 months old, 30-35 kg, were divided into three experimental groups: group 1-no defect repair (n = 4 nerves/group), group 2-autograft controls (n = 6 nerves/group), group 3-autologous ESC filled with saline (n = 6 nerves/group). ESC was constructed from a 6-cm long segment of sheep median nerve and tested for expression of laminin B, Glial fibrillary acidic protein (GFAP), S-100 and CD31 using immunofluorescent staining. At 6 months after nerve repair, nerve conduction velocity and somatosensory evoked potentials (SSEP) assessed neurosensory recovery, while histomorphometry tested nerve regeneration. RESULTS Ex vivo characterization of ESC, before in vivo nerve gap repair, showed high laminin B expression, which supports axonal growth. At 6 months post-repair, structural integrity of ESC was preserved. ESC was well-vascularized and tissue adhesions were comparable to autograft controls. The maximal conduction velocities (29.80 ± 5.85 ms vs. 32.28 ± 6.75 ms; p = .44), action potential amplitudes (32.68 ± 17.44 mV vs. 44.14 ± 23.10 mV; p = .38) and SSEP amplitude values (6.18 ± 5.84 mV vs. 4.68 ± 2.53 mV; p = .28) were comparable between autograft and ESC groups. Presence of regenerating axons was confirmed in the distal segment of ESC at 6 months after repair. CONCLUSION The feasibility of ESC in restoration of 6-cm long nerve defects in a sheep median nerve model was confirmed by nerve conduction assessments and correlated with axonal regeneration tested by histomorphometry. We confirmed ESC potential in support of regeneration of long nerve defects.
Collapse
Affiliation(s)
- Maria Siemionow
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.,Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joanna Cwykiel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois.,Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Safak Uygur
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois
| | | | - Can Oztürk
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jacek Szopinski
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio.,Department of General Surgery, Hepatobiliary Surgery and Transplant Surgery, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Maria Madajka
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
8
|
Riccio M, Marchesini A, Pugliese P, Francesco F. Nerve repair and regeneration: Biological tubulization limits and future perspectives. J Cell Physiol 2018; 234:3362-3375. [DOI: 10.1002/jcp.27299] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Andrea Marchesini
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Pierfrancesco Pugliese
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| | - Francesco Francesco
- Department of Reconstructive Surgery and Hand Surgery AOU “Ospedali Riuniti,” Ancona Italy
| |
Collapse
|
9
|
Zhao Y, Zhang Q, Zhao L, Gan L, Yi L, Zhao Y, Xue J, Luo L, Du Q, Geng R, Sun Z, Benkirane-Jessel N, Chen P, Li Y, Chen Y. Enhanced Peripheral Nerve Regeneration by a High Surface Area to Volume Ratio of Nerve Conduits Fabricated from Hydroxyethyl Cellulose/Soy Protein Composite Sponges. ACS OMEGA 2017; 2:7471-7481. [PMID: 30023554 PMCID: PMC6044839 DOI: 10.1021/acsomega.7b01003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/19/2017] [Indexed: 05/05/2023]
Abstract
Multichannel nerve guide conduits (MCNGCs) have been widely studied and exhibited outstanding nerve repair function. However, the effect of the geometric structure of MCNGCs on the nerve repair function was still not clear. Herein, we postulated that MCNGCs with different inner surface area-to-volume ratios (ISA/V) of the channels inside the nerve guide conduits (NGCs) would show different nerve repair functions. Therefore, in current work, we constructed a series of hydroxyethyl cellulose/soy protein sponge-based nerve conduit (HSSN) with low, medium, and high ISA/V from hydroxyethyl cellulose (HEC)/soy protein isolate (SPI) composite sponges, which were abbreviated as HSSN-L, HSSN-M and HSSN-H, respectively. These NGCs were applied to bridge and repair a 10 mm long sciatic nerve defect in a rat model. Finally, the influence of ISA/V on nerve repair function was evaluated by electrophysiological assessment, histological investigation, and in vivo biodegradability testing. The results of electrophysiological assessment and histological investigation showed that the regenerative nerve tissues bridged with HSSN-H and HSSN-M had higher compound muscle action potential amplitude ratio, higher percentage of positive NF200 and S100 staining, larger axon diameter, lower G-ratio, and greater myelination thickness. Furthermore, the regenerative nerve tissues bridged with HSSN-H also showed higher density of regenerated myelinated nerve fibers and more number of myelin sheath layers. On the whole, the repair efficiency of the peripheral nerve in HSSN-H and HSSN-M groups might be better than that in HSSN-L. These results indicated that higher ISA/V based on HEC/SPI composite sponge may result in greater nerve repair functions. The conclusion provided a probable guiding principle for the structural designs of NGCs in the future.
Collapse
Affiliation(s)
- Yanteng Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- Department
of Transfusion, The First Affiliated Hospital
of Zhengzhou University, Zhengzhou 450052, China
| | - Qiang Zhang
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Lei Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Li Gan
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- Department
of Cell Biology, School of Medicine, Wuhan
University of Science and Technology, Wuhan 430065, China
| | - Li Yi
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yanan Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Jingling Xue
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Lihua Luo
- Laboratory
of Stem Cells and Tissue Engineering, School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325027, China
| | - Qiaoyue Du
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Rongxin Geng
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Zhihong Sun
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Nadia Benkirane-Jessel
- INSERM
(French National Institute of Health and Medical Research), Osteoarticular
and Dental Regenerative Nanomedicine Laboratory, UMR 1109, Faculté
de Médecine, Strasbourg F-67000, France
- Université
de Strasbourg, Faculté de Chirurgie Dentaire, 1 place de l’Hôpital, Strasbourg F-67000, France
| | - Pu Chen
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yinping Li
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- E-mail: (Y.L.)
| | - Yun Chen
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- E-mail: (Y.C.)
| |
Collapse
|
10
|
Oruç M, Ozer K, Çolak Ö, Kankaya Y, Koçer U. Does crossover innervation really affect the clinical outcome? A comparison of outcome between unilateral and bilateral digital nerve repair. Neural Regen Res 2016; 11:1499-1505. [PMID: 27857757 PMCID: PMC5090856 DOI: 10.4103/1673-5374.191226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/13/2022] Open
Abstract
Digital nerve injuries are the mostly detected nerve injury in the upper extremity. However, since the clinical phenomenon of crossover innervation at some degree from uninjured digital nerve to the injured side occurs after digital nerve injuries is sustained, one could argue that this concept might even result in the overestimation of the outcome of the digital nerve repair. With this knowledge in mind, this study aimed to present novel, pure, focused and valuable clinical data by comparing the outcomes of bilateral and unilateral digital nerve repair. A retrospective review of 28 fingers with unilateral or bilateral digital nerve repair using end-to-end technique in 19 patients within 2 years was performed. Weber's two-point discrimination, sharp/dull discrimination, warm/cold sensation and Visual Analog Scale scoring were measured at final 12-month follow ups in all patients. There was no significant difference in recovery of sensibility after unilateral and bilateral digital nerve repairs. Though there is crossover innervation microscopically, it is not important in the clinical evaluation period. According to clinical findings from this study, crossover innervations appear to be negligible in the estimation of outcomes of digital neurorrhaphy.
Collapse
Affiliation(s)
- Melike Oruç
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Kadri Ozer
- Aydin State Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Aydin, Turkey
| | - Özlem Çolak
- Istanbul Okmeydani Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Istanbul, Turkey
| | - Yüksel Kankaya
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| | - Uğur Koçer
- Ankara Training and Research Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Ankara, Turkey
| |
Collapse
|
11
|
Gopinathan J, Quigley AF, Bhattacharyya A, Padhye R, Kapsa RMI, Nayak R, Shanks RA, Houshyar S. Preparation, characterisation, andin vitroevaluation of electrically conducting poly(ɛ-caprolactone)-based nanocomposite scaffolds using PC12 cells. J Biomed Mater Res A 2015; 104:853-65. [DOI: 10.1002/jbm.a.35620] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Janarthanan Gopinathan
- Advanced Textile and Polymer Research Lab, PSG Institute of Advanced Studies; Coimbatore India
| | - Anita F. Quigley
- Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital; Victoria 3065 Australia
- ARC Centre of Excellence for Electromaterials Science; Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong; New South Wales 2500 Australia
- Department of Medicine; University of Melbourne; 3065 Australia
| | - Amitava Bhattacharyya
- Advanced Textile and Polymer Research Lab, PSG Institute of Advanced Studies; Coimbatore India
| | - Rajiv Padhye
- College of Design and Social Context; Centre for Advanced Materials and Performance Textiles, School of Fashion and Textiles, RMIT University; Melbourne 3056 Australia
| | - Robert M. I. Kapsa
- Centre for Clinical Neurosciences and Neurological Research, St. Vincent's Hospital; Victoria 3065 Australia
- ARC Centre of Excellence for Electromaterials Science; Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong; New South Wales 2500 Australia
- Department of Medicine; University of Melbourne; 3065 Australia
| | - Rajkishore Nayak
- College of Design and Social Context; Centre for Advanced Materials and Performance Textiles, School of Fashion and Textiles, RMIT University; Melbourne 3056 Australia
| | - Robert A. Shanks
- College of Science, Engineering and Health, School of Applied Sciences, RMIT University; Melbourne 3000 Australia
| | - Shadi Houshyar
- College of Design and Social Context; Centre for Advanced Materials and Performance Textiles, School of Fashion and Textiles, RMIT University; Melbourne 3056 Australia
| |
Collapse
|
12
|
Hosseinian MA, Gharibi Loron A, Nemati B, Khandaghy M. Comparison of a distal end-to-side neurorrhaphy with a proximal–distal end-to-side neurorrhaphy: in a rat model. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1261-4. [DOI: 10.1007/s00590-015-1699-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
|
13
|
Carriel V, Alaminos M, Garzón I, Campos A, Cornelissen M. Tissue engineering of the peripheral nervous system. Expert Rev Neurother 2014; 14:301-18. [DOI: 10.1586/14737175.2014.887444] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
14
|
Sakar M, Korkusuz P, Demirbilek M, Cetinkaya DU, Arslan S, Denkbaş EB, Temuçin ÇM, Bilgiç E, Hazer DB, Bozkurt G. The effect of poly(3-hydroxybutyrate-co-3- hydroxyhexanoate) (PHBHHx) and human mesenchymal stem cell (hMSC) on axonal regeneration in experimental sciatic nerve damage. Int J Neurosci 2014; 124:685-96. [PMID: 24350993 DOI: 10.3109/00207454.2013.876636] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study is designed to evaluate the treatment effect of poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBHHx) and human mesenchymal stem cells (hMSC) on axonal regeneration in experimental rat sciatic nerve damage, and compare the results of this modality with autologous nerve grafting. In Spraque-Dawley albino rats, 10-mm-long experimental nerve gaps were created. Three groups were constituted, the gap was repaired with autologous nerve graft (autograft group), PHBHHx nerve graft alone (PHBHHx alone group), and PHBHHx nerve graft with hMSCs inside (PHBHHx with hMSC group), respectively. The results were evaluated with functional recovery, electrophysiological evaluation, and histological evaluation either with light microscopy and transmission electron microscopy for axonal regeneration and myelin formation. In functional evaluation, autograft and PHBHHx with hMSC groups showed functional improvement with time, whereas PHBHHx alone group did not. Electrophysiological evaluation showed better results in autograft and PHBHHx with hMSC groups when compared to PHBHHx alone group. There was no statistical difference between autograft and PHBHHx with hMSC groups. Histological evaluation showed regenerated axons in each group. Autograft group was better than the others, and PHBHHx with hMSC group was better than PHBHHx alone group both for axonal regeneration and myelin formation. This study showed that the nerve grafts which were prepared from PHBHHx with oriented nanofiber three-dimensional surfaces aided to nerve regeneration, either used alone or with hMSC. PHBHHx provided better nerve regeneration when used with hMSCs inside than alone, and reached the same statistical treatment effect in functional evaluation and electrophysiological evaluation when compared to autografting.
Collapse
|
15
|
Meek MF, Coert JH. Recovery of two-point discrimination function after digital nerve repair in the hand using resorbable FDA- and CE-approved nerve conduits. J Plast Reconstr Aesthet Surg 2013; 66:1307-15. [DOI: 10.1016/j.bjps.2013.04.058] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/17/2013] [Accepted: 04/23/2013] [Indexed: 11/25/2022]
|
16
|
The incidence of symptomatic neuroma in amputation and neurorrhaphy patients. J Plast Reconstr Aesthet Surg 2013; 66:1330-4. [PMID: 23845907 DOI: 10.1016/j.bjps.2013.06.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/03/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE The incidence of symptomatic neuroma in finger nerve injuries varies widely in the literature. In this retrospective study, we evaluated the incidence of symptomatic neuroma after repair of digital nerve injuries (neurorrhaphy) and after amputation of one or more fingers. We also determined the need for re-operation on symptomatic neuroma patients. METHODS In a retrospective study, we collected data from medical files. All patients who were treated for a hand trauma in the emergency department during the last 10 years were included. We gathered data on the presence of symptomatic neuroma and re-operation of the patients. RESULTS In our database, 583 people had a peripheral nerve injury of whom 177 people had an amputation. The incidence of digital nerve injury without amputation followed by neurorrhaphy was 1%. In digital nerve injuries with amputation the incidence was 7.8%, which is significantly higher than after digital nerve injuries without amputation. CONCLUSIONS People with an amputation injury have significantly more symptomatic neuroma than people who undergo neurorrhaphy. People who have a symptomatic neuroma after digital nerve injuries have been operated significantly more than people who have a non-symptomatic neuroma or no neuroma at all. This information can be of help when treating digital nerve injuries. TYPE OF STUDY/LEVEL OF EVIDENCE (LOE): Prognostic.
Collapse
|
17
|
What is evidence based in the reconstruction of digital nerves? A systematic review. J Plast Reconstr Aesthet Surg 2013; 66:151-64. [DOI: 10.1016/j.bjps.2012.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 06/11/2012] [Accepted: 08/27/2012] [Indexed: 01/10/2023]
|
18
|
Kettle SJA, Starritt NE, Glasby MA, Hems TEJ. End-to-side nerve repair in a large animal model: how does it compare with conventional methods of nerve repair? J Hand Surg Eur Vol 2013; 38:192-202. [PMID: 22570321 DOI: 10.1177/1753193412445119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A large animal (sheep) model was used to compare nerve axon regeneration and return of muscle function after a median-to-ulnar nerve end-to-side neurorrhaphy technique with conventional, clinically established, methods of nerve repair and untreated controls. Three groups of sheep were allocated to end-to-side repair (12 animals), a conventional method of nerve repair (18 animals), or a control group (eight animals). After a year nerve repairs were assessed electrophysiologically and histologically, and the muscles supplied by the repaired nerves were assessed physiologically. There were no significant differences in the outcomes of nerve repair between different conventional techniques. Half of the end-to-side nerve repairs supported nerve regeneration. The functional outcomes of the end-to-side repairs were inferior to conventional techniques which were, in turn, inferior to controls. End-to-side neurorrhaphy supported nerve regeneration, but the reliability of this technique is called into question and its use as a clinical tool can only be recommended as a salvage procedure.
Collapse
Affiliation(s)
- S J A Kettle
- Peripheral Nerve Research Group, Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Edinburgh, UK.
| | | | | | | |
Collapse
|
19
|
Cao J, Xiao Z, Jin W, Chen B, Meng D, Ding W, Han S, Hou X, Zhu T, Yuan B, Wang J, Liang W, Dai J. Induction of rat facial nerve regeneration by functional collagen scaffolds. Biomaterials 2012; 34:1302-10. [PMID: 23122676 DOI: 10.1016/j.biomaterials.2012.10.031] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 10/10/2012] [Indexed: 12/31/2022]
Abstract
Nerve conduit provides a promising strategy for nerve regeneration, and the proper microenvironment in the lumen could improve the regeneration. Our previous work had demonstrated that linear ordered collagen scaffold (LOCS) could effectively guide the oriented growth of axons. Laminin is known as an important nerve growth promoting factor and can facilitate the growth cone formation. In addition, ciliary neurotrophic factor (CNTF) and brain-derived neurotrophic factor (BDNF) can effectively improve the nerve regeneration after nerve injuries. However, in practice, diffusion caused by the body fluids is the major obstacle in their applications. To retain CNTF or BDNF on the scaffolds, we produced collagen binding CNTF (CBD-CNTF), collagen binding BDNF (CBD-BDNF) and laminin binding CNTF (LBD-CNTF), laminin binding BDNF (LBD-BDNF) respectively. In this work, we developed laminin modified LOCS fibers (L × LOCS) by chemical cross-linking LOCS fibers with laminin. Collagen binding or laminin binding neurotrophic factors were combined with LOCS or L × LOCS, and then filled them into the collagen nerve conduit. They were found to guide the ordered growth of axons, and improve the nerve functional recovery in the rat facial nerve transection model. The combination of CNTF and BDNF greatly enhanced the facial nerve regeneration and functional recovery.
Collapse
Affiliation(s)
- Jiani Cao
- State Key Laboratory of Molecular Developmental Biology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 3 Nanyitiao, Zhongguancun, Beijing 100190, China
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Tim H J Nijhuis
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
BACKGROUND Optimal surgical management of digital nerve lesions remains uncertain despite the publication of numerous studies. The purposes of this review were primarily to analyze whether there is a superior surgical technique for digital nerve repair and secondarily to statistically verify the variables to be predictors of sensory recovery. METHODS A literature search was performed using PubMed including citation from MEDLINE. Studies were included if they involved patients with digital nerve lacerations in whom end-to-end neurorrhaphy, nerve grafts, conduits, or end-to-side neurorrhaphy were performed. Further, the sensory outcome had to be assessed according to the modified American Society for Surgery of the Hand guidelines to stratify for two-point discrimination in millimeters. The variables age, follow-up, delay in repair, type of trauma, and gap length were extracted. The association between each predictor and response was assessed using a linear mixed model and corrected for heterogeneity between studies. Significance was considered present at p ≤ 0.05. RESULTS Of the 34 articles found, 14 articles were included giving appropriate individual data for 191 nerves. There was no statistically significant difference in outcome between operation techniques. Age and follow-up were verified predictors of sensory recovery. CONCLUSION In this review, the type of operation for digital nerve repair does not influence sensory outcome. However, we verified outcome to be influenced by the patient's age and the follow-up period. To add more scientific evidence to our results, larger cohort prospective studies need to be done with better detailed description of data.
Collapse
|
22
|
FDA approved guidance conduits and wraps for peripheral nerve injury: a review of materials and efficacy. Injury 2012; 43:553-72. [PMID: 21269624 DOI: 10.1016/j.injury.2010.12.030] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 12/27/2010] [Indexed: 02/02/2023]
Abstract
Several nerve guidance conduits (NGCs) and nerve protectant wraps are approved by the US Food and Drug Administration (FDA) for clinical use in peripheral nerve repair. These devices cover a wide range of natural and synthetic materials, which may or may not be resorbable. This review consolidates the data pertaining to all FDA approved materials into a single reference, which emphasizes material composition alongside pre-clinical and clinical safety and efficacy (where possible). This article also summarizes the key advantages and limitations for each material as noted in the literature (with respect to the indication considered). In this context, this review provides a comprehensive reference for clinicians which may facilitate optimal material/device selection for peripheral nerve repair. For materials scientists, this review highlights predicate devices and evaluation methodologies, offering an insight into current deficiencies associated with state-of-the-art materials and may help direct new technology developments and evaluation methodologies thereof.
Collapse
|
23
|
Dornseifer U, Fichter AM, Leichtle S, Wilson A, Rupp A, Rodenacker K, Ninkovic M, Biemer E, Machens HG, Matiasek K, Papadopulos NA. Peripheral nerve reconstruction with collagen tubes filled with denatured autologous muscle tissue in the rat model. Microsurgery 2011; 31:632-41. [PMID: 22072584 DOI: 10.1002/micr.20926] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 04/24/2011] [Accepted: 04/29/2011] [Indexed: 12/17/2022]
Abstract
Conventional nerve conduits lack cellular and extracellular guidance structures critical for bridging larger defects. In this study, an exogenous matrix for axonal regeneration was provided by pretreated muscle tissue. In 24 rats, 14-mm sciatic nerve segments were resected and surgically reconstructed using one of the following methods: autograft (AG); bovine type I collagen conduit; (MDM) collagen tube filled with modified denatured autologous muscle tissue. For 8 weeks, functional regeneration was evaluated by footprint and video gait analysis. Evaluation was complemented by electrophysiology, as well as qualitative and quantitative structural assessment of nerves and target muscles. Group AG was superior both structurally and functionally, showing higher axon counts, a more normal gait pattern, and less severe muscle atrophy. Fiber quality (fiber size and myelin thickness) was highest in group MDM, possibly related to the myelin-producing effect of muscular laminin. However, axon count was lowest in this group, and ultrastructural analysis of the denatured muscle tissue showed areas of incomplete denaturation that had acted as a mechanical barrier for regenerating axons. In light of these results, the often advocated use of muscular exogenous matrix for peripheral nerve reconstruction is reviewed in the literature, and its clinical application is critically discussed. In conclusion, combined muscle tubes may have a positive influence on nerve fiber maturation. However, muscle pretreatment is not without risks, and denaturation processes need to be further refined.
Collapse
Affiliation(s)
- Ulf Dornseifer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Academic Hospital Bogenhausen, Munich 81925, Germany
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Amado S, Armada-da-Silva PAS, João F, Maurício AC, Luís AL, Simões MJ, Veloso AP. The sensitivity of two-dimensional hindlimb joint kinematics analysis in assessing functional recovery in rats after sciatic nerve crush. Behav Brain Res 2011; 225:562-73. [PMID: 21875621 DOI: 10.1016/j.bbr.2011.08.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 08/08/2011] [Accepted: 08/13/2011] [Indexed: 12/26/2022]
Abstract
Walking analysis in the rat is increasingly used to assess functional recovery after peripheral nerve injury. Here we assess the sensitivity and specificity of hindlimb joint kinematics measures during the rat gait early after sciatic nerve crush injury (DEN), after twelve weeks of recovery (REINN) and in sham-operated controls (Sham) using discriminant analysis. The analysis addressed gait spatiotemporal variables and hip, knee and ankle angle and angular velocity measures during the entire walking cycle. In DEN animals, changes affected all studied joints plus spatiotemporal parameters of gait. Both the spatiotemporal and ankle kinematics parameters recovered to normality within twelve weeks. At this time point, some hip and knee kinematics values were still abnormal when compared to sham controls. Discriminant models based on hip, knee and ankle kinematics displayed maximal sensitivity to identify DEN animals. However, the discriminant models based on spatiotemporal and ankle kinematics data showed a poor performance when assigning animals to the REINN and Sham groups. Models using hip and knee kinematics during walking showed the best sensitivity to recognize the reinnervated animals. The model construed on the basis of hip joint kinematics was the one combining highest sensitivity with robustness and high specificity. It is concluded that ankle joint kinematics fails in detecting minor functional deficits after long term recovery from sciatic nerve crush and extending the kinematic analysis during walking to the hip and knee joints improves the sensitivity of this functional test.
Collapse
Affiliation(s)
- Sandra Amado
- Faculty of Human Kinetics and Neuromechanics of Human Movement Group, CIPER, Technical University of Lisbon, Portugal
| | | | | | | | | | | | | |
Collapse
|
25
|
The use of laminin modified linear ordered collagen scaffolds loaded with laminin-binding ciliary neurotrophic factor for sciatic nerve regeneration in rats. Biomaterials 2011; 32:3939-48. [DOI: 10.1016/j.biomaterials.2011.02.020] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 02/09/2011] [Indexed: 11/19/2022]
|
26
|
Abstract
The last 15 years have seen a growing interest regarding a technique for nerve repair named end-to-side coaptation. Since 2000, we have carried out experimental studies on end-to-side nerve repair as well as employed this technique to a series of selected clinical cases. Here we report on the results of this experience.For experimental studies, we have used the model represented by median nerve repair by end-to-side coaptation either on the ulnar (agonistic) or the radial (antagonistic) nerve. For time course assessment of median nerve functional recovery we used the grasping test, a test which permits to assess voluntary control of muscle function. Repaired nerves were processed for resin embedding to allow nerve fibre stereology and electron microscopy. Results showed that, in either experimental group, end-to-side-repaired median nerves were repopulated by axons regenerating from ulnar and radial donor nerves, respectively. Moreover, contrary to previously published data, our results showed that voluntary motor control of the muscles innervated by the median nerve was progressively recovered also when the antagonistic radial nerve was the donor nerve.As regards our clinical experience, results were not so positive. We have treated by end-to-side coaptation patients with both sensory (n = 7, collateral digital nerves) and mixed (n = 8, plexus level) nerve lesions. Results were good, as in other series, in sensory nerves whilst they were very difficult to investigate in mixed nerves at the plexus level.Take together, these results suggest that clinical employment of end-to-side coaptation should still be considered at the moment as the ultima ratio in cases in which no other repair technique can be attempted. Yet, it is clear that more basic research is needed to explain the reasons for the different results between laboratory animal and humans and, especially, to find out how to ameliorate the outcome of end-to-side nerve repair by adequate treatment and rehabilitation.
Collapse
|
27
|
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.
Collapse
|
28
|
di Summa PG, Kingham PJ, Raffoul W, Wiberg M, Terenghi G, Kalbermatten DF. Adipose-derived stem cells enhance peripheral nerve regeneration. J Plast Reconstr Aesthet Surg 2009; 63:1544-52. [PMID: 19828391 DOI: 10.1016/j.bjps.2009.09.012] [Citation(s) in RCA: 259] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 07/26/2009] [Accepted: 09/10/2009] [Indexed: 12/17/2022]
Abstract
Traumatic injuries resulting in peripheral nerve lesions often require a graft to bridge the gap. Although autologous nerve auto-graft is still the first-choice strategy in reconstructions, it has the severe disadvantage of the sacrifice of a functional nerve. Cell transplantation in a bioartificial conduit is an alternative strategy to create a favourable environment for nerve regeneration. We decided to test new fibrin nerve conduits seeded with various cell types (primary Schwann cells and adult stem cells differentiated to a Schwann cell-like phenotype) for repair of sciatic nerve injury. Two weeks after implantation, the conduits were removed and examined by immunohistochemistry for axonal regeneration (evaluated by PGP 9.5 expression) and Schwann cell presence (detected by S100 expression). The results show a significant increase in axonal regeneration in the group of fibrin seeded with Schwann cells compared with the empty fibrin conduit. Differentiated adipose-derived stem cells also enhanced regeneration distance in a similar manner to differentiated bone marrow mesenchymal stem cells. These observations suggest that adipose-derived stem cells may provide an effective cell population, without the limitations of the donor-site morbidity associated with isolation of Schwann cells, and could be a clinically translatable route towards new methods to enhance peripheral nerve repair.
Collapse
Affiliation(s)
- P G di Summa
- Chirurgie Plastique et Reconstructive CHUV, Université de Lausanne, Rue de Bugnon 46, 1005 Lausanne, CH, Switzerland
| | | | | | | | | | | |
Collapse
|
29
|
Zacchigna S, Giacca M. Chapter 20 Gene Therapy Perspectives for Nerve Repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:381-92. [DOI: 10.1016/s0074-7742(09)87020-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
30
|
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]
|
31
|
Siemionow M, Brzezicki G. Chapter 8: Current techniques and concepts in peripheral nerve repair. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:141-72. [PMID: 19682637 DOI: 10.1016/s0074-7742(09)87008-6] [Citation(s) in RCA: 277] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Despite the progress in understanding the pathophysiology of peripheral nervous system injury and regeneration, as well as advancements in microsurgical techniques, peripheral nerve injuries are still a major challenge for reconstructive surgeons. Thorough knowledge of anatomy, pathophysiology, and surgical reconstruction is a prerequisite of proper peripheral nerve injury management. This chapter reviews the currently available surgical treatment options for different types of nerve injuries in clinical conditions. In overview of direct nerve repair, various end-to-end coaptation techniques and the role of end-to-side repair for proximal nerve injuries is described. When primary repair cannot be performed without undue tension, nerve grafting or tubulization techniques are required. Current gold standard for bridging nerve gaps is nerve autografting. However, disadvantages of this approach, such as donor site morbidity and limited length of available graft material encouraged the search for alternative means of nerve gap reconstruction. Nerve allografting was introduced for repair of extensive nerve injuries. Tubulization techniques with natural or artificial conduits are applicable as an alternative for bridging short nerve defects without the morbidities associated with harvesting of autologous nerve grafts. Achieving better outcomes depends both on the advancements in microsurgical techniques and introduction of molecular biology discoveries into clinical practice. The field of peripheral nerve research is dynamically developing and concentrates on more sophisticated approaches tested at the basic science level. Future directions in peripheral nerve reconstruction including, tolerance induction and minimal immunosuppression for nerve allografting, cell based supportive therapies and bioengineering of nerve conduits are also reviewed in this chapter.
Collapse
Affiliation(s)
- Maria Siemionow
- Cleveland Clinic, Department of Plastic Surgery, Cleveland, Ohio 44195, USA
| | | |
Collapse
|
32
|
Abstract
To bring some light into the ongoing controversy concerning end-to-side coaptation in brachial plexus surgery, the authors organized a symposium in 2006 titled How To Improve Peripheral Nerve Surgery. The authors sought the participation of experienced surgeons and researchers who had made personal contributions to the field. This article contains information collected at this symposium and presents the authors' clinical results and ideas illustrating the potential of nerve fiber transfer by end-to-side coaptation.
Collapse
Affiliation(s)
- Hanno Millesi
- Millesi Center, Vienna Private Clinic, Pelikangasse 15, A-1090 Vienna, Austria.
| | | |
Collapse
|