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Mayrhofer-Schmid M, Klemm TT, Aman M, Kneser U, Eberlin KR, Harhaus L, Boecker AH. Shielding the Nerve: A Systematic Review of Nerve Wrapping to Prevent Adhesions in the Rat Sciatic Nerve Model. J Pers Med 2023; 13:1431. [PMID: 37888042 PMCID: PMC10607771 DOI: 10.3390/jpm13101431] [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: 09/04/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Peripheral nerve pathology is frequently encountered in clinical practice among peripheral nerve and extremity surgeons. One major factor limiting nerve regeneration and possibly leading to revision surgeries is the development of traumatic or postoperative adhesions and scarring around nerves. In experimental models, different materials have been studied to limit scar tissue formation when wrapped around nerves. METHODS A systematic review of studies describing nerve-wrapping materials in a non-transectional rat sciatic nerve model was performed following the PRISMA guidelines. Literature describing nerve-wrapping methods for the prevention of peripheral nerve scarring in rat sciatic nerve models was identified using PubMed and Web of Science, scanned for relevance and analyzed. RESULTS A total of 15 original articles describing 23 different materials or material combinations for nerve wrapping were included. The heterogeneity of the methods used did not allow a meta-analysis, thus, a systematic review was performed. Out of 28 intervention groups, 21 demonstrated a preventive effect on scar tissue formation in at least one qualitative or quantitative assessment method. CONCLUSIONS The analyzed literature describes a variety of materials from different origins to limit peripheral nerve scarring and adhesions. Thus, a scar-preventive effect by wrapping peripheral nerves as adhesion prophylaxis seems likely. However, a quantitative comparison of the studies to identify the optimal material or technique is not possible with the diversity of used models and study designs. Therefore, further research needs to be performed to identify the optimal nerve wraps to be used routinely in clinical practice.
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Affiliation(s)
- Maximilian Mayrhofer-Schmid
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Tess T. Klemm
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Martin Aman
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
| | - Kyle R. Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
- Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Arne H. Boecker
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany
- Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
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Pahlavani A, Hosseini Nejad Mir N, Karimi Rouzbahani A, Mahmoudvand G, Rezaei P, Pahlevani A, Shahmoradi MK. Electrodiagnostic Evaluation of Prognostic Factors Influencing the Surgical Outcomes of Upper Extremity Nerve Injuries Caused by Penetrating Trauma: A Cross-sectional Study. World J Plast Surg 2023; 12:90-100. [PMID: 38130381 PMCID: PMC10732289 DOI: 10.52547/wjps.12.2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/10/2023] [Indexed: 12/23/2023] Open
Abstract
Background Peripheral nerve damage is a major cause of disability, which can lead to serious limitations in daily and occupational activities. Although primary repair can restore the function of the damaged organ remarkably, factors predicting the prognosis of nerve repair are a topic of constant debate. We aimed to investigate the factors affecting the outcomes of primary nerve repair in patients afflicted by upper extremity nerve injuries following penetrating trauma. Methods This cross-sectional study was conducted on 51 patients referred to Shohada-ye Ashayer Hospital in Khorramabad, Iran, from 2016 to 2021. Data including the patient's age, gender, education, type, severity, and mechanism of injury, the damaged nerve, time and of method repair, the surgeon's specialty, as well as the electrodiagnostic findings, were collected and analyzed using SPSS software version 22. Results The mean age of the patients was 30.41 ± 12.63 years, and the majority of them (84.3%) were men. A significant relationship was found between the sensory amplitude with education (P=0.002), the type of damaged nerve (P=0.048), and the severity of injury (P=0.012). The positive sharp wave was significantly associated with the surgeon's specialty (P=0.034). Besides, the motor amplitude was considerably related to the patient's age (P=0.040) and the surgeon's specialty (P=0.035). Conclusion Factors determining the outcome of peripheral nerve repair following penetrating trauma to the upper extremity include age, education, the type of damaged nerve, the severity of the injury, and the surgeon's specialty.
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Affiliation(s)
- Amin Pahlavani
- Department of General Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- These authors contributed equally to the study
| | - Nahid Hosseini Nejad Mir
- Department of Internal Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- These authors contributed equally to the study
| | - Arian Karimi Rouzbahani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Golnaz Mahmoudvand
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Pardis Rezaei
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ali Pahlevani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Kazem Shahmoradi
- Department of General Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
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