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Wong GC, Chung KC. Bioengineered Nerve Conduits and Wraps. Hand Clin 2024; 40:379-387. [PMID: 38972682 DOI: 10.1016/j.hcl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Peripheral nerve injuries are prevalent and their treatments present significant challenges. Among the various reconstructive options, nerve conduits and wraps are popular choices. Advances in bioengineering and regenerative medicine have led to the development of new biocompatible materials and implant designs that offer the potential for enhanced neural recovery. Cost, nerve injury type, and implant size must be considered when deciding on the ideal reconstructive option.
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Affiliation(s)
- Gordon C Wong
- University of Michigan Comprehensive Hand Center, Michigan Medicine, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA
| | - Kevin C Chung
- University of Michigan Comprehensive Hand Center, Michigan Medicine, 1500 East Medical Center Drive, 2130 Taubman Center, SPC 5340, Ann Arbor, MI 48109, USA.
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Leis A, Smetana BS, Strohl AB, Styron JF. Comparative Effectiveness Systematic Review and Meta-analysis of Peripheral Nerve Repair Using Direct Repair and Connector-assisted Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5927. [PMID: 38983950 PMCID: PMC11233104 DOI: 10.1097/gox.0000000000005927] [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: 01/29/2024] [Accepted: 05/01/2024] [Indexed: 07/11/2024]
Abstract
Background This clinical literature systematic review and meta-analysis were performed to assess differences in outcomes between nerves repaired with direct repair (DR) and connector-assisted repair (CAR). Methods A systematic literature review for DR and CAR was performed. Studies from 1980 through August 2023 were included if DR or CAR repairs were performed in upper extremities with nerve gaps less than 5 mm and reported sensory Medical Research Council Classification (MRCC) outcomes or equivalent. Comparative analyses were planned for meaningful recovery (MR) rate (at both S3 and S3+ or better), postsurgical neuroma, cold intolerance, altered sensation, pain, and revision rate. Results There were significant differences in MR rates for CAR and DR. At the MRCC S3 threshold, 96.1% of CAR and 81.3% of DR achieved MR (P < 0.0001). At the MRCC S3+ threshold, 87.1% of CAR and 54.2% of DR achieved this higher threshold of MR (P < 0.0001). There were no differences in neuroma rate or pain scores in our dataset. Altered sensation (dysesthesia, paresthesia, hyperesthesia, or hypersensitivity) was not discussed in any CAR studies, so no analysis could be performed. The revision rate for both procedures was 0%. The proportion of patients with cold intolerance was 46.2% in the DR studies, which was significantly higher than the 10.7% of patients in the CAR group. Conclusions Significantly more patients achieved sensory MR and fewer had cold intolerance when the CAR technique, instead of the DR technique, was performed to repair peripheral nerve injuries.
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Affiliation(s)
- Amber Leis
- From UCI Health, Orange, Calif
- Indiana Hand to Shoulder Center, Indianapolis, Ind
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Roncati L, Marra C, Gravina D, Di Massa G, Della Rosa N, Adani R. Ultramicronized Palmitoylethanolamide and Luteolin: Drug Candidates in Post-COVID-19 Critical Illness Neuropathy and Positioning-Related Peripheral Nerve Injury of the Upper Extremity. J Hand Microsurg 2024; 16:100028. [PMID: 38855524 PMCID: PMC11144630 DOI: 10.1055/s-0043-1764161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium and patients with serious infection can stay in intensive care unit (ICU) for weeks in a clinical scenario of systemic inflammatory response syndrome, likely related to the subsequent development of critical illness polyneuropathy (CIP). It is in fact now accepted that COVID-19 ICU surviving patients can develop CIP; moreover, prone positioning-related stretch may favor the onset of positioning-related peripheral nerve injuries (PNI). Therefore, the urgent need to test drug candidates for the treatment of these debilitating sequelae is emerged even more. For the first time in medical literature, we have successfully treated after informed consent a 71-year-old Italian man suffering from post-COVID-19 CIP burdened with positioning-related PNI of the left upper extremity by means of ultramicronized palmitoylethanolamide 400 mg plus ultramicronized luteolin 40 mg (Glìalia), two tablets a day 12 hours apart for 6 months. In the wake of our pilot study, a larger clinical trial to definitively ascertain the advantages of this neuroprotective, neurotrophic, and anti-inflammatory therapy is advocated.
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Affiliation(s)
- Luca Roncati
- Department of Surgery, Medicine, Dentistry, and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, Institute of Pathology, University of Modena and Reggio Emilia, Polyclinic Hospital, Modena, Italy
| | - Caterina Marra
- Department of General Surgery and Surgical Specialties, Unit of Plastic and Reconstructive Surgery, University Hospital of Modena, Modena, Italy
| | - Davide Gravina
- Department of Musculoskeletal System, Unit of Orthopedics and Traumatology, University Hospital of Modena, Modena, Italy
| | - Gianluca Di Massa
- Department of Surgery, Medicine, Dentistry, and Morphological Sciences with interest in Transplantation, Oncology and Regenerative Medicine, Institute of Pathology, University of Modena and Reggio Emilia, Polyclinic Hospital, Modena, Italy
| | - Norman Della Rosa
- Department of Musculoskeletal System, Unit of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Roberto Adani
- Department of Musculoskeletal System, Unit of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Zhang Y, Hou N, Zhang J, Xie B, Liang J, Chang X, Wang K, Tang X. Treatment options for digital nerve injury: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:675. [PMID: 37700356 PMCID: PMC10496177 DOI: 10.1186/s13018-023-04076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Surgical treatment of finger nerve injury is common for hand trauma. However, there are various surgical options with different functional outcomes. The aims of this study are to compare the outcomes of various finger nerve surgeries and to identify factors associated with the postsurgical outcomes via a systematic review and meta-analysis. METHODS The literature related to digital nerve repairs were retrieved comprehensively by searching the online databases of PubMed from January 1, 1965, to August 31, 2021. Data extraction, assessment of bias risk and the quality evaluation were then performed. Meta-analysis was performed using the postoperative static 2-point discrimination (S2PD) value, moving 2-point discrimination (M2PD) value, and Semmes-Weinstein monofilament testing (SWMF) good rate, modified Highet classification of nerve recovery good rate. Statistical analysis was performed using the R (V.3.6.3) software. The random effects model was used for the analysis. A systematic review was also performed on the other influencing factors especially the type of injury and postoperative complications of digital nerve repair. RESULTS Sixty-six studies with 2446 cases were included in this study. The polyglycolic acid conduit group has the best S2PD value (6.71 mm), while the neurorrhaphy group has the best M2PD value (4.91 mm). End-to-side coaptation has the highest modified Highet's scoring (98%), and autologous nerve graft has the highest SWMF (91%). Age, the size of the gap, and the type of injury were factors that may affect recovery. The type of injury has an impact on the postoperative outcome of neurorrhaphy. Complications reported in the studies were mainly neuroma, cold sensitivity, paresthesia, postoperative infection, and pain. CONCLUSION Our study demonstrated that the results of surgical treatment of digital nerve injury are generally satisfactory; however, no nerve repair method has absolute advantages. When choosing a surgical approach to repair finger nerve injury, we must comprehensively consider various factors, especially the gap size of the nerve defect, and postoperative complications. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Yi Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Nianzong Hou
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Bing Xie
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Jiahui Liang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Xiaohu Chang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
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Carta G, Fornasari BE, Fregnan F, Ronchi G, De Zanet S, Muratori L, Nato G, Fogli M, Gambarotta G, Geuna S, Raimondo S. Neurodynamic Treatment Promotes Mechanical Pain Modulation in Sensory Neurons and Nerve Regeneration in Rats. Biomedicines 2022; 10:biomedicines10061296. [PMID: 35740318 PMCID: PMC9220043 DOI: 10.3390/biomedicines10061296] [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: 05/13/2022] [Revised: 05/24/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Somatic nerve injuries are a rising problem leading to disability associated with neuropathic pain commonly reported as mechanical allodynia (MA) and hyperalgesia. These symptoms are strongly dependent on specific processes in the dorsal root ganglia (DRG). Neurodynamic treatment (NDT), consisting of selective uniaxial nerve repeated tension protocols, effectively reduces pain and disability in neuropathic pain patients even though the biological mechanisms remain poorly characterized. We aimed to define, both in vivo and ex vivo, how NDT could promote nerve regeneration and modulate some processes in the DRG linked to MA and hyperalgesia. Methods: We examined in Wistar rats, after unilateral median and ulnar nerve crush, the therapeutic effects of NDT and the possible protective effects of NDT administered for 10 days before the injury. We adopted an ex vivo model of DRG organotypic explant subjected to NDT to explore the selective effects on DRG cells. Results: Behavioural tests, morphological and morphometrical analyses, and gene and protein expression analyses were performed, and these tests revealed that NDT promotes nerve regeneration processes, speeds up sensory motor recovery, and modulates mechanical pain by affecting, in the DRG, the expression of TACAN, a mechanosensitive receptor shared between humans and rats responsible for MA and hyperalgesia. The ex vivo experiments have shown that NDT increases neurite regrowth and confirmed the modulation of TACAN. Conclusions: The results obtained in this study on the biological and molecular mechanisms induced by NDT will allow the exploration, in future clinical trials, of its efficacy in different conditions of neuropathic pain.
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Affiliation(s)
- Giacomo Carta
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Rehabilitation, ASST (Azienda Socio Sanitaria Territoriali) Nord Milano, Sesto San Giovanni Hospital, Sesto San Giovanni, 20099 Milano, Italy
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Federica Fregnan
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Correspondence: ; Tel.: +39-(0)1-1670-5433; Fax: +39-(0)1-1903-8639
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefano De Zanet
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
| | - Luisa Muratori
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Giulia Nato
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Life Sciences and Systems Biology, University of Torino, 10124 Torino, Italy
| | - Marco Fogli
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
- Department of Life Sciences and Systems Biology, University of Torino, 10124 Torino, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, University of Torino, 10043 Torino, Italy; (G.C.); (B.E.F.); (G.R.); (S.D.Z.); (L.M.); (G.G.); (S.G.); (S.R.)
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, 10043 Torino, Italy; (G.N.); (M.F.)
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Braga Silva J, Leal BLM, Magnus GA, de Souza Stanham V, Mattiello R, Wolff CG. Comparison of nerve conduits and nerve graft in digital nerve regeneration: A systematic review and meta-analysis. HAND SURGERY & REHABILITATION 2021; 40:715-721. [PMID: 34425267 DOI: 10.1016/j.hansur.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022]
Abstract
The goal of this systematic review and meta-analysis was to compare nerve conduits and nerve graft for peripheral nerve regeneration. This type of lesion frequently causes disability due to pain, paresthesia and motor deficit. On the PICO process, "P" corresponded to patients with peripheral digital nerve lesions of any age, gender or ethnicity, "I" to interventions with nerve conduits or nerve graft, "C" to the control group with no treatment, placebo or receiving other treatment, and "O" to outcome assessment of nerve regeneration. Initial search found in 3859 studies, including 2001 duplicates. The remaining 1858 studies were selected by title and/or abstract; 1798 articles were excluded, leaving 60 articles for full-text review. Thirty-nine of these 60 reports were excluded as not meeting our inclusion criteria, and 21 articles were ultimately included in the systematic review. For patients older than 40 years, there was a greater mean improvement on S2PD and M2PD tests with grafting, which seemed to be the better surgical technique, positively impacting prognosis. On the M2PD test, there was significantly greater improvement in 11-17.99 mm defects with grafting (P < 0.001); this finding should guide surgical strategy in peripheral nerve regeneration, to ensure better outcomes.
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Affiliation(s)
- J Braga Silva
- Service of Hand Surgery and Reconstructive Microsurgery, São Lucas Hospital, Centro Clinico PUCRS, Av. Ipiranga, 6690, Suite 216, Porto Alegre, RS 90610-000, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil.
| | - B L M Leal
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil
| | - G A Magnus
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil
| | - V de Souza Stanham
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil
| | - R Mattiello
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil
| | - C G Wolff
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga, 6681 - Partenon, Porto Alegre, RS 90619-900, Brazil
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Fornasari BE, Carta G, Gambarotta G, Raimondo S. Natural-Based Biomaterials for Peripheral Nerve Injury Repair. Front Bioeng Biotechnol 2020; 8:554257. [PMID: 33178670 PMCID: PMC7596179 DOI: 10.3389/fbioe.2020.554257] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/23/2020] [Indexed: 01/18/2023] Open
Abstract
Peripheral nerve injury treatment is a relevant problem because of nerve lesion high incidence and because of unsatisfactory regeneration after severe injuries, thus resulting in a reduced patient's life quality. To repair severe nerve injuries characterized by substance loss and to improve the regeneration outcome at both motor and sensory level, different strategies have been investigated. Although autograft remains the gold standard technique, a growing number of research articles concerning nerve conduit use has been reported in the last years. Nerve conduits aim to overcome autograft disadvantages, but they must satisfy some requirements to be suitable for nerve repair. A universal ideal conduit does not exist, since conduit properties have to be evaluated case by case; nevertheless, because of their high biocompatibility and biodegradability, natural-based biomaterials have great potentiality to be used to produce nerve guides. Although they share many characteristics with synthetic biomaterials, natural-based biomaterials should also be preferable because of their extraction sources; indeed, these biomaterials are obtained from different renewable sources or food waste, thus reducing environmental impact and enhancing sustainability in comparison to synthetic ones. This review reports the strengths and weaknesses of natural-based biomaterials used for manufacturing peripheral nerve conduits, analyzing the interactions between natural-based biomaterials and biological environment. Particular attention was paid to the description of the preclinical outcome of nerve regeneration in injury repaired with the different natural-based conduits.
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Affiliation(s)
- Benedetta E Fornasari
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi, University of Turin, Turin, Italy
| | - Giacomo Carta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi, University of Turin, Turin, Italy
| | - Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi, University of Turin, Turin, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,Neuroscience Institute Cavalieri Ottolenghi, University of Turin, Turin, Italy
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Kasper M, Deister C, Beck F, Schmidt CE. Bench-to-Bedside Lessons Learned: Commercialization of an Acellular Nerve Graft. Adv Healthc Mater 2020; 9:e2000174. [PMID: 32583574 DOI: 10.1002/adhm.202000174] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/11/2020] [Indexed: 12/19/2022]
Abstract
Peripheral nerve injury can result in debilitating outcomes including loss of function and neuropathic pain. Although nerve repair research and therapeutic development are widely studied, translation of these ideas into clinical interventions has not occurred at the same rate. At the turn of this century, approaches to peripheral nerve repair have included microsurgical techniques, hollow conduits, and autologous nerve grafts. These methods provide satisfactory results; however, they possess numerous limitations that can prevent effective surgical treatment. Commercialization of Avance, a processed nerve allograft, sought to address limitations of earlier approaches by providing an off-the-shelf alternative to hollow conduits while maintaining many proregenerative properties of autologous grafts. Since its launch in 2007, Avance has changed the landscape of the nerve repair market and is used to treat tens of thousands of patients. Although Avance has become an important addition to surgeon and patient clinical options, the product's journey from bench to bedside took over 20 years with many research and commercialization challenges. This article reviews the events that have brought a processed nerve allograft from the laboratory bench to the patient bedside. Additionally, this review provides a perspective on lessons and considerations that can assist in translation of future medical products.
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Affiliation(s)
- Mary Kasper
- J. Crayton Pruitt Family Department of Biomedical EngineeringUniversity of Florida Gainesville FL 32611 USA
| | | | | | - Christine E. Schmidt
- J. Crayton Pruitt Family Department of Biomedical EngineeringUniversity of Florida Gainesville FL 32611 USA
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Herman ZJ, Ilyas AM. Sensory Outcomes in Digital Nerve Repair Techniques: An Updated Meta-analysis and Systematic Review. Hand (N Y) 2020; 15:157-164. [PMID: 31043071 PMCID: PMC7076611 DOI: 10.1177/1558944719844346] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Injuries to digital nerves are common with trauma to the hand, often requiring surgery. Surgical management of these injuries can be performed using several techniques: direct repair (neurorrhaphy), autograft, allograft, and conduit repair. In light of increasing the availability and use of various digital nerve repair techniques, a new systematic review and meta-analysis was undertaken to comparatively review the available evidence to determine any differences in outcomes to better guide treatment in cases with digital nerve gaps. Methods: Current literature on sensory outcomes of various digital nerve repair techniques was reviewed using static 2-point discrimination (S2PD), moving 2-point discrimination (M2PD), Semmes-Weinstein monofilament testing (SWMF), and complication rates as outcomes of interest. After inclusion and exclusion criteria were applied, 15 articles were reviewed and 625 nerve repairs were analyzed. Results: The average gap length for allograft repair, autograft repair, and conduit repair was 15.4, 24.7, and 13.4 mm, respectively. For S2PD outcomes, autograft repair was statistically superior to all other forms of repair. Allograft trended higher than neurorrhaphy and conduit repair, but results were not statistically significant. For SWMF outcomes, autograft repair was statistically superior to conduit repair and neurorrhaphy; it was statistically comparable with allograft repair. Allograft performed statistically superior to conduit repair relative to M2PD. Conclusions: Based on the current updated meta-analysis using newer data and techniques, we found that all available techniques have reasonable outcomes. Yet when managing a digital nerve injury with a gap, thereby excluding direct neurorrhaphy, both autograft and allograft performed comparably and were superior to conduit repair.
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Affiliation(s)
- Zachary J. Herman
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA,Zachary J. Herman, Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street #100, Philadelphia, PA 19107, USA.
| | - Asif M. Ilyas
- Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
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Takeuchi H, Ikeguchi R, Aoyama T, Oda H, Yurie H, Mitsuzawa S, Tanaka M, Ohta S, Akieda S, Miyazaki Y, Nakayama K, Matsuda S. A scaffold-free Bio 3D nerve conduit for repair of a 10-mm peripheral nerve defect in the rats. Microsurgery 2019; 40:207-216. [PMID: 31724780 DOI: 10.1002/micr.30533] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/13/2019] [Accepted: 10/25/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A Bio 3D printed nerve conduit was reported to promote nerve regeneration in a 5 mm nerve gap model. The purpose of this study was to fabricate Bio 3D nerve conduits suitable for a 10 mm nerve gap and to evaluate their capacity for nerve regeneration in a rat sciatic nerve defect model. MATERIALS AND METHODS Eighteen F344 rats with immune deficiency (9-10 weeks old; weight, 200-250 g) were divided into three groups: a Bio 3D nerve conduit group (Bio 3D, n = 6), a nerve graft group (NG, n = 6), and a silicon tube group (ST, n = 6). A 12-mm Bio 3D nerve conduit or silicon tube was transplanted into the 10-mm defect of the right sciatic nerve. In the nerve graft group, reverse autografting was performed with an excised 10-mm nerve segment. Assessments were performed at 8 weeks after the surgery. RESULTS In the region distal to the suture site, the number of myelinated axons in the Bio 3D group were significantly larger compared with the silicon group (2,548 vs. 950, p < .05). The myelinated axon diameter (MAD) and the myelin thickness (MT) of the regenerated axons in the Bio 3D group were significantly larger compared with those of the ST group (MAD: 3.09 vs. 2.36 μm; p < .01; MT: 0.59 vs. 0.40 μm, p < .01). CONCLUSIONS This study indicates that a Bio 3D nerve conduit can enhance peripheral nerve regeneration even in a 10 mm nerve defect model.
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Affiliation(s)
- Hisataka Takeuchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryosuke Ikeguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoki Aoyama
- Department of Physical Therapy, Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Oda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirofumi Yurie
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sadaki Mitsuzawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mai Tanaka
- Department of Physical Therapy, Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Souichi Ohta
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | - Koichi Nakayama
- Department of Regenerative Medicine and Biomedical Engineering Faculty of Medicine, Saga University, Saga, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Outcome of human peripheral nerve repair interventions using conduits: a systematic review. J Neurol Sci 2019; 396:18-24. [DOI: 10.1016/j.jns.2018.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/02/2023]
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Braga Silva J, Marchese GM, Cauduro CG, Debiasi M. Nerve conduits for treating peripheral nerve injuries: A systematic literature review. HAND SURGERY & REHABILITATION 2017; 36:71-85. [PMID: 28325431 DOI: 10.1016/j.hansur.2016.10.212] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/22/2016] [Accepted: 10/26/2016] [Indexed: 01/16/2023]
Abstract
Peripheral nerve injuries are a major public health problem. Nerve conduits have been developed in the recent years, although it is still not clear if they should replace nerve grafting and neurorrhaphy. This systematic review aims to gather evidence regarding the use of nerve conduits for peripheral nerve repair. The following electronic databases were searched: MEDLINE, Cochrane Library (CENTRAL) and Embase. Study selection and data extraction followed the PRISMA guidelines. The systematic review of the literature retrieved 6767 articles. Only 27 studies were retained accounting for 1022 patients: 10 randomized controlled trials, 15 case series and 2 cohort studies. Ten different types of tubes were described and a variety of evaluation methods were used to assess outcomes in terms of efficacy (motor and sensory recovery) and complications. The Semmes-Weinstein monofilament test and the static and moving 2-point discrimination test were the most commonly applied tests to evaluate nerve recovery. In general, outcomes showed no significant difference between groups. Synthetic conduits had more complications. Despite major methodological limitations in the studies, we can conclude that use of nerve conduits is preferable over suture repair and nerve grafting, as the functional recovery rates are above 80%. The choice of conduit is based on the surgeon's expertise, but use of synthetic conduits is discouraged due to their higher complication rates.
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Affiliation(s)
- J Braga Silva
- PUCRS School of Medicine, Ipiranga Avenue, 6681 Partenon - Building 60, 90610-000 Porto Alegre, RS, Brazil.
| | - G M Marchese
- PUCRS School of Medicine, Ipiranga Avenue, 6681 Partenon - Building 60, 90610-000 Porto Alegre, RS, Brazil
| | - C G Cauduro
- PUCRS School of Medicine, Ipiranga Avenue, 6681 Partenon - Building 60, 90610-000 Porto Alegre, RS, Brazil
| | - M Debiasi
- Latin American Cooperative Oncology Group (LACOG), Ipiranga Avenue, 6681 Partenon - Building 99A/office 806, 90610-000 Porto Alegre, RS, Brazil
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Ducic I, Safa B, DeVinney E. Refinements of nerve repair with connector-assisted coaptation. Microsurgery 2016; 37:256-263. [DOI: 10.1002/micr.30151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/03/2016] [Accepted: 12/16/2016] [Indexed: 01/12/2023]
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Reichenberger MA, Mueller W, Hartmann J, Diehm Y, Lass U, Koellensperger E, Leimer U, Germann G, Fischer S. ADSCs in a fibrin matrix enhance nerve regeneration after epineural suturing in a rat model. Microsurgery 2015; 36:491-500. [DOI: 10.1002/micr.30018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/14/2015] [Accepted: 12/08/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Matthias A. Reichenberger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Wolf Mueller
- University Hospital Leipzig, Department of Neuropathology; University of Leipzig; Leipzig Germany
| | - Jennifer Hartmann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Yannick Diehm
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
| | - Ulrike Lass
- Clinical Cooperation Unit Neuropathology; German Cancer Research Center; Heidelberg Germany
| | - Eva Koellensperger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Uwe Leimer
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Günter Germann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Sebastian Fischer
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
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Gnavi S, Fornasari BE, Tonda-Turo C, Laurano R, Zanetti M, Ciardelli G, Geuna S. The Effect of Electrospun Gelatin Fibers Alignment on Schwann Cell and Axon Behavior and Organization in the Perspective of Artificial Nerve Design. Int J Mol Sci 2015; 16:12925-42. [PMID: 26062130 PMCID: PMC4490479 DOI: 10.3390/ijms160612925] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/26/2015] [Accepted: 05/29/2015] [Indexed: 01/11/2023] Open
Abstract
Electrospun fibrous substrates mimicking extracellular matrices can be prepared by electrospinning, yielding aligned fibrous matrices as internal fillers to manufacture artificial nerves. Gelatin aligned nano-fibers were prepared by electrospinning after tuning the collector rotation speed. The effect of alignment on cell adhesion and proliferation was tested in vitro using primary cultures, the Schwann cell line, RT4-D6P2T, and the sensory neuron-like cell line, 50B11. Cell adhesion and proliferation were assessed by quantifying at several time-points. Aligned nano-fibers reduced adhesion and proliferation rate compared with random fibers. Schwann cell morphology and organization were investigated by immunostaining of the cytoskeleton. Cells were elongated with their longitudinal body parallel to the aligned fibers. B5011 neuron-like cells were aligned and had parallel axon growth when cultured on the aligned gelatin fibers. The data show that the alignment of electrospun gelatin fibers can modulate Schwann cells and axon organization in vitro, suggesting that this substrate shows promise as an internal filler for the design of artificial nerves for peripheral nerve reconstruction.
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Affiliation(s)
- Sara Gnavi
- Department of Clinical and Biological Sciences, University of Torino, Orbassano 10043, Italy.
- Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano 10043, Italy.
| | - Benedetta Elena Fornasari
- Department of Clinical and Biological Sciences, University of Torino, Orbassano 10043, Italy.
- Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano 10043, Italy.
| | - Chiara Tonda-Turo
- Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino 10100, Italy.
| | - Rossella Laurano
- Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino 10100, Italy.
| | - Marco Zanetti
- Nanostructured Interfaces and Surfaces, Department of Chemistry, University of Torino, Torino 10100, Italy.
| | - Gianluca Ciardelli
- Department of Mechanical and Aerospace Engineering, Politecnico of Torino, Torino 10100, Italy.
- Department for Materials and Devices of the National Research Council, Institute for the Cehmical and Physical Processes (CNR-IPCF UOS), Pisa 56124, Italy.
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Torino, Orbassano 10043, Italy.
- Neuroscience Institute of the Cavalieri-Ottolenghi Foundation, University of Torino, Orbassano 10043, Italy.
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