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Casal D, Casimiro MH, Ferreira LM, Leal JP, Rodrigues G, Lopes R, Moura DL, Gonçalves L, Lago JB, Pais D, Santos PMP. Review of Piezoelectrical Materials Potentially Useful for Peripheral Nerve Repair. Biomedicines 2023; 11:3195. [PMID: 38137416 PMCID: PMC10740581 DOI: 10.3390/biomedicines11123195] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
It has increasingly been recognized that electrical currents play a pivotal role in cell migration and tissue repair, in a process named "galvanotaxis". In this review, we summarize the current evidence supporting the potential benefits of electric stimulation (ES) in the physiology of peripheral nerve repair (PNR). Moreover, we discuss the potential of piezoelectric materials in this context. The use of these materials has deserved great attention, as the movement of the body or of the external environment can be used to power internally the electrical properties of devices used for providing ES or acting as sensory receptors in artificial skin (e-skin). The fact that organic materials sustain spontaneous degradation inside the body means their piezoelectric effect is limited in duration. In the case of PNR, this is not necessarily problematic, as ES is only required during the regeneration period. Arguably, piezoelectric materials have the potential to revolutionize PNR with new biomedical devices that range from scaffolds and nerve-guiding conduits to sensory or efferent components of e-skin. However, much remains to be learned regarding piezoelectric materials, their use in manufacturing of biomedical devices, and their sterilization process, to fine-tune their safe, effective, and predictable in vivo application.
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Affiliation(s)
- Diogo Casal
- Departamento de Anatomia, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (L.G.); (D.P.)
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar Universitário de Lisboa Central, Rua José António Serrano, 1169-045 Lisbon, Portugal
| | - Maria Helena Casimiro
- Centro de Ciências e Tecnologias Nucleares (C2TN), Instituto Superior Técnico (IST), Universidade de Lisboa, 2695-066 Bobadela, Portugal; (M.H.C.); (P.M.P.S.)
| | - Luís M. Ferreira
- Departamento de Engenharia e Ciências Nucleares (DECN), Instituto Superior Técnico (IST), Universidade de Lisboa, 2695-066 Bobadela, Portugal;
| | - João Paulo Leal
- Centro de Química Estrutural (CQE), Institute of Molecular Sciences (IMS), Instituto Superior Técnico (IST), Universidade de Lisboa, 2695-066 Bobadela, Portugal;
| | - Gabriela Rodrigues
- Centro de Ecologia, Evolução e Alterações Ambientais (cE3c) & CHANGE—Global Change and Sustainability Institute, Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa (FCUL), 1749-016 Lisboa, Portugal;
| | - Raquel Lopes
- Gynaecology and Obstetrics Department, Maternidade Alfredo da Costa, Centro Hospitalar Universitário de Lisboa Central, R. Viriato 1, 2890-495 Lisboa, Portugal;
| | - Diogo Lino Moura
- Anatomy Institute and Orthopedics Department, Faculty of Medicine, University of Coimbra, 3004-504 Coimbra, Portugal;
- Spine Unit, Orthopedics Department, Coimbra University Hospital, 3000-602 Coimbra, Portugal
| | - Luís Gonçalves
- Departamento de Anatomia, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (L.G.); (D.P.)
| | - João B. Lago
- Departamento de Biologia Animal, Faculdade de Ciências, Universidade de Lisboa (FCUL), 1749-016 Lisboa, Portugal;
| | - Diogo Pais
- Departamento de Anatomia, NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM), Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (L.G.); (D.P.)
| | - Pedro M. P. Santos
- Centro de Ciências e Tecnologias Nucleares (C2TN), Instituto Superior Técnico (IST), Universidade de Lisboa, 2695-066 Bobadela, Portugal; (M.H.C.); (P.M.P.S.)
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Advances of Direct Peripheral Nerve Repair Techniques: Do We Already Have Enough Scientific Evidence? Indian J Orthop 2022; 57:189-202. [PMID: 36777121 PMCID: PMC9880092 DOI: 10.1007/s43465-022-00791-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Purpose To systematically review the evidence of direct peripheral nerve repair techniques and to determine any differences in outcomes that would guide rational treatment. Additionally, we compare the results and outcomes of these studies and find future directions for peripheral nerve repair techniques. Methods We searched PubMed, Virtual Health Library, and Embase databases to identify articles involving direct peripheral nerve techniques. We analyzed and compared the results and outcomes of these techniques. We also aimed to look for the differences in outcomes that would guide the current and future treatments. Results We identified 1390 articles, and 19 met our criteria with evidence ranging from level I to level IV. The nerve repair techniques included direct repair, epineural repair, fascicular repair, and group fascicular repair. These nerve techniques are based on the surgeons' personal experience. The results and the outcome of these studies were based on prognostic factors and not on surgical techniques. Few studies compared the surgical techniques and found no significant difference in nerve repair techniques. Conclusions Analyzing all direct peripheral nerve techniques and literature of all levels of evidence, our data show no significant difference between different suturing techniques. Currently, there is a lack of scientific evidence on the best direct peripheral nerve repair techniques. Therefore, we need more research to understand the rational treatment methods for peripheral nerve injuries. Level of evidence IV.
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Wang Z, Zhang D, Yi XZ, Zhao Y, Yu A. Effects of regenerative peripheral nerve interface on dorsal root ganglia neurons following peripheral axotomy. Front Neurosci 2022; 16:914344. [PMID: 36161173 PMCID: PMC9489947 DOI: 10.3389/fnins.2022.914344] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 08/15/2022] [Indexed: 12/05/2022] Open
Abstract
Background Long-term delayed reconstruction of injured peripheral nerves always results in poor recovery. One important reason is retrograde cell death among injured sensory neurons of dorsal root ganglia (DRG). A regenerative peripheral nerve interface (RPNI) was capable of generating new synaptogenesis between the proximal nerve stump and free muscle graft. Meanwhile, sensory receptors within the skeletal muscle can also be readily reinnervated by donor sensory axons, which allows the target muscles to become sources of sensory information for function reconstruction. To date, the effect of RPNI on injured sensory neurons is still unclear. Here, we aim to investigate the potential neuroprotective role of RPNI on sensory DRG neurons after sciatic axotomy in adult rats. Materials and methods The sciatic nerves of sixty rats were transected. The rats were randomly divided into three groups following this nerve injury: no treatment (control group, n = 20), nerve stump implantation inside a fully innervated muscle (NSM group, n = 20), or nerve stump implantation inside a free muscle graft (RPNI group, n = 20). At 8 weeks post-axotomy, ipsilateral L4 and L5 DRGs were harvested in each group. Toluidine blue staining was employed to quantify the neuronal densities in DRGs. The neuronal apoptosis index was quantified with TUNEL assay. Western blotting was applied to measure the expressions of Bax, Bcl-2, and neurotrophins (NTs) in ipsilateral DRGs. Results There were significantly higher densities of neurons in ipsilateral DRGs of RPNI group than NSM and control groups at 8 weeks post-axotomy (p < 0.01). Meanwhile, neuronal apoptosis index and the expressions of pro-apoptotic Bax within the ipsilateral DRGs were significantly lower in the RPNI group than those in the control and NSM groups (p < 0.05), while the opposite result was observed in the expression of pro-survival Bcl-2. Furthermore, the expressions of NGF, NT-3, BDNF, and GDNF were also upregulated in the ipsilateral DRGs in the RPNI group (p < 0.01). Conclusion The present results demonstrate that RPNI could prevent neuronal loss after peripheral axotomy. And the neuroprotection effect has a relationship with the upregulation of NTs in DRGs, such as NGF, NT-3, BDNF, and GDNF. These findings provide an effective therapy for neuroprotection in the delayed repair of the peripheral nerve injury.
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Pinet R, Raimbeau G, Saint-Cast Y, Fouque PA, Rabarin F. Vein conduit with microsurgical suture repair of superficial branch of the radial nerve injuries at the wrist. HAND SURGERY & REHABILITATION 2018; 37:S2468-1229(18)30088-4. [PMID: 29858165 DOI: 10.1016/j.hansur.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 11/24/2022]
Abstract
The superficial branch of the radial nerve (SBRN) at the wrist is susceptible to trauma and lacerations. These lesions can develop into painful neuromas with debilitating consequences. The aim of our study was to demonstrate the effectiveness of systematic use of vein conduits associated with microsurgical suture repair in SBRN injuries to prevent the occurrence of these neuromas. Our study was retrospective and performed at a single site. An independent examiner performed the clinical assessment. The study included 33 patients and the mean follow-up was 63 months. We looked for a so-called "trigger point". None of the patients developed a painful neuroma or experienced any pain. All the patients were either satisfied or very satisfied with their treatment. Systematic use of vein conduit in SBRN injuries at the wrist helps prevent the occurrence of painful neuroma and the disorder's inherent consequences, which can be severe not only clinically, but also socially and professionally.
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Affiliation(s)
- R Pinet
- Centre hospitalo-universitaire (CHU) d'Angers, 4, rue Larrey, 49100 Angers, France.
| | - G Raimbeau
- Centre de la Main d'Angers, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - Y Saint-Cast
- Centre de la Main d'Angers, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - P-A Fouque
- Centre de la Main d'Angers, 47, rue de la Foucaudière, 49000 Trélazé, France
| | - F Rabarin
- Centre de la Main d'Angers, 47, rue de la Foucaudière, 49000 Trélazé, France
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Casal D, Mota-Silva E, Iria I, Alves S, Farinho A, Pen C, Lourenço-Silva N, Mascarenhas-Lemos L, Silva-Ferreira J, Ferraz-Oliveira M, Vassilenko V, Videira PA, Goyri-O’Neill J, Pais D. Reconstruction of a 10-mm-long median nerve gap in an ischemic environment using autologous conduits with different patterns of blood supply: A comparative study in the rat. PLoS One 2018; 13:e0195692. [PMID: 29659600 PMCID: PMC5902043 DOI: 10.1371/journal.pone.0195692] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 03/27/2018] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate in the Wistar rat the efficacy of various autologous nerve conduits with various forms of blood supply in reconstructing a 10-mm-long gap in the median nerve (MN) under conditions of local ischemia. A 10-mm-long median nerve defect was created in the right arm. A loose silicone tube was placed around the nerve gap zone, in order to simulate a local ischemic environment. Rats were divided in the following experimental groups (each with 20 rats): the nerve Graft (NG) group, in which the excised MN segment was reattached; the conventional nerve flap (CNF) and the arterialized neurovenous flap (ANVF) groups in which the gap was bridged with homonymous median nerve flaps; the prefabricated nerve flap (PNF) group in which the gap was reconstructed with a fabricated flap created by leaving an arteriovenous fistula in contact with the sciatic nerve for 5 weeks; and the two control groups, Sham and Excision groups. In the latter group, the proximal stump of the MN nerve was ligated and no repair was performed. The rats were followed for 100 days. During this time, they did physiotherapy. Functional, electroneuromyographic and histological studies were performed. The CNF and ANVF groups presented better results than the NG group in the following assessments: grasping test, nociception, motor stimulation threshold, muscle weight, and histomorphometric evaluation. Radial deviation of the operated forepaw was more common in rats that presented worse results in the other outcome variables. Overall, CNFs and ANVFs produced a faster and more complete recovery than NGs in the reconstruction of a 10-mm-long median nerve gap in an ischemic environment in the Wistar rat. Although, results obtained with CNFs were in most cases were better than ANVFs, these differences were not statistically significant for most of the outcome variables.
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Affiliation(s)
- Diogo Casal
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduarda Mota-Silva
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Inês Iria
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Sara Alves
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Ana Farinho
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Cláudia Pen
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | | | - Luís Mascarenhas-Lemos
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - José Silva-Ferreira
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Mário Ferraz-Oliveira
- Pathology Department, Centro Hospitalar de Lisboa Central–Hospital de São José, Lisbon, Portugal
| | - Valentina Vassilenko
- LIBPhys, Physics Department, Faculdade de Ciências e Tecnologias, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Paula Alexandra Videira
- UCIBIO, Life Sciences Department, Faculty of Sciences and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- CEDOC, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - João Goyri-O’Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pais
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
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Casal D, Pais D, Mota-Silva E, Pelliccia G, Iria I, Videira PA, Mendes MM, Goyri-O'Neill J, Mouzinho MM. Reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap in a teenager: A case report and literature review. Microsurgery 2017; 38:209-217. [PMID: 29094390 PMCID: PMC5836878 DOI: 10.1002/micr.30265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/06/2017] [Accepted: 10/20/2017] [Indexed: 12/04/2022]
Abstract
There is evidence that nerve flaps are superior to nerve grafts for bridging long nerve defects. Moreover, arterialized neurovenous flaps (ANVFs) have multiple potential advantages over traditional nerve flaps in this context. This paper describes a case of reconstruction of a long defect of the ulnar artery and nerve with an arterialized neurovenous free flap and presents a literature review on this subject. A 16‐year‐old boy sustained a stab wound injury to the medial aspect of the distal third of his right forearm. The patient was initially observed and treated at another institution where the patient was diagnosed with a flexor carpis ulnaris muscle and an ulnar artery section. The artery was ligated and the muscle was sutured. Four months later, the patient was referred to our institution with complaints of ulnar nerve damage, as well as hand pain and cold intolerance. Physical examination and ancillary tests supported the diagnosis of ulnar artery and nerve complete section. Surgery revealed an 8 cm hiatus of the ulnar artery and a 5 cm defect of the ulnar nerve. These gaps were bridged with a flow through ANVF containing the sural nerve and the lesser saphenous vein. The postoperative course was uneventful. Two years postoperatively, the patient had regained normal trophism and M5 strength in all previously paralyzed muscles according to the Medical Research Council Scale. Thermography revealed good perfusion in the right ulnar angiosome. The ANVF may be an expedite, safe and efficient option to reconstruct a long ulnar nerve and artery defect.
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Affiliation(s)
- Diogo Casal
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Diogo Pais
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduarda Mota-Silva
- Physics Department, Faculdade de Ciências e Tecnologia, LIBPhys, Caparica, Portugal
| | - Giovanni Pelliccia
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal.,Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Inês Iria
- Molecular Microbiology and Biotechnology Unit
- Drug Discovery Area; Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal
| | - Paula A Videira
- UCIBIO, Life Sciences Department, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Maria Manuel Mendes
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - João Goyri-O'Neill
- Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria Manuel Mouzinho
- Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
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Cruz Villagrán C, Schumacher J, Donnell R, Dhar MS. A Novel Model for Acute Peripheral Nerve Injury in the Horse and Evaluation of the Effect of Mesenchymal Stromal Cells Applied In Situ on Nerve Regeneration: A Preliminary Study. Front Vet Sci 2016; 3:80. [PMID: 27695697 PMCID: PMC5023688 DOI: 10.3389/fvets.2016.00080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/31/2016] [Indexed: 12/16/2022] Open
Abstract
Transplantation of mesenchymal stromal cells (MSCs) to sites of experimentally created nerve injury in laboratory animals has shown promising results in restoring nerve function. This approach for nerve regeneration has not been reported in horses. In this study, we first evaluated the in vitro ability of equine bone marrow-derived MSCs (EBM-MSCs) to trans-differentiate into Schwann-like cells and subsequently tested the MSCs in vivo for their potential to regenerate a transected nerve after implantation. The EBM-MSCs from three equine donors were differentiated into SCLs for 7 days, in vitro, in the presence of specialized differentiation medium and evaluated for morphological characteristics, by using confocal microscopy, and for protein characteristics, by using selected Schwann cell markers (GFAP and S100b). The EBM-MSCs were then implanted into the fascia surrounding the ramus communicans of one fore limb of three healthy horses after a portion of this nerve was excised. The excised portion of the nerve was examined histologically at the time of transection, and stumps of the nerve were examined histologically at day 45 after transplantation. The EBM-MSCs from all donors demonstrated morphological and protein characteristics of those of Schwann cells 7 days after differentiation. Nerves implanted with EBM-MSCs after nerve transection did not show evidence of nerve regeneration at day 45. Examination of peripheral nerves collected 45 days after injury and stem cell treatment revealed no histological differences between nerves treated with MSCs and those treated with isotonic saline solution (controls). The optimal delivery of MSCs and the model suitable to study the efficacy of MSCs in nerve regeneration should be investigated.
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Affiliation(s)
- Claudia Cruz Villagrán
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Jim Schumacher
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Robert Donnell
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Madhu S Dhar
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
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Salles MB, Gehrke SA, Koo S, Allegrini S, Rogero SO, Ikeda TI, Cruz ÁS, Shinohara EH, Yoshimoto M. An alternative to nerve repair using an antioxidant compound: a histological study in rats. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2015; 26:5340. [PMID: 25578694 DOI: 10.1007/s10856-014-5340-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/31/2014] [Indexed: 06/04/2023]
Abstract
The fascicular composition and organisation of the inferior alveolar nerve (IAN) were determined to confirm the microarchitecture of the IAN bundles into each of the mandibular teeth, including the composition of the mental nerve. The aim of this study was to evaluate peripheral nerve repair after the application of an antioxidant compound to the damaged nerve tissue to elevate the concentration and bioavailability of elements capable of favouring tissue repair. Twenty-five Wistar rats were divided into groups: The Control 1 (Ctl 1) (n = 5) animals had the ischiatic nerve exposed with no suture injury and were sacrificed at 30 days post-operatively. The Control 2 (Ctl 2) (n = 10) animals had the ischiatic nerve exposed, and the nerve was injured using suture in three distinct regions. In the experimental (Exp) animals (n = 10), an antioxidant organic compound was applied to the nerve injury site. The animals with nerve injury (Ctl2 and Exp group) were sacrificed at 15 and 30 days post-operatively. The histological analysis showed less degeneration in the Exp group at 15 and 30 days post-operatively. Nerve neoformation forming a connection between the distal and proximal suture sites was observed in the experimental group. This study presented an alternative to nerve repair using an antioxidant compound.
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Affiliation(s)
- Marcos B Salles
- Department of Health Sciences - School of Dentistry, 9 de Julho University, São Paulo, SP, Brazil
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Hundepool CA, Ultee J, Nijhuis TH, Houpt P, Hovius SE, Jaquet J, Spauwen P, Hofman A, Ritt M, Kon M. Prognostic factors for outcome after median, ulnar, and combined median–ulnar nerve injuries: A prospective study. J Plast Reconstr Aesthet Surg 2015; 68:1-8. [DOI: 10.1016/j.bjps.2014.09.043] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 08/29/2014] [Accepted: 09/15/2014] [Indexed: 11/29/2022]
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Semere A, Morand B, Loury J, Vuillerme N, Bettega G. [Repair of a facial nerve substance loss by interposition of a collagen neurotube]. ANN CHIR PLAST ESTH 2014; 59:273-5. [PMID: 24698336 DOI: 10.1016/j.anplas.2014.03.001] [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: 01/06/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
Abstract
We are exposing the case of a 22 year-old patient presenting a wound of the right cheek, with a palsy of the right corner of the mouth. He has been sent to us 6 days after the trauma for secondary exploration. A section of the buccal branch of the right facial nerve with a 1cm gap has been brought out. We have bypassed the loss of substance with a collagen absorbable biological conduit. The 6-months clinical and electromyographic follow-up has shown a clear improvement of the function of the orbicularis oris, as well as its reinnervation by the buccal branch of the right facial nerve.
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Affiliation(s)
- A Semere
- Service de chirurgie de la main et des brûlés, hôpital Michallon, BP 217, 38043 Grenoble cedex 9, France.
| | - B Morand
- Service de chirurgie plastique maxillo-faciale, hôpital Michallon, BP 217, 38043 Grenoble cedex 9, France
| | - J Loury
- Clinique des Cèdres, 21, rue Albert-Londres, 38432 Echirolles, France
| | - N Vuillerme
- Laboratoire AGIM (AGeing Imaging, Modeling) Lab, faculté de médecine, Bât-Jean-Roget, 38706 La Tronche cedex, France
| | - G Bettega
- Service de chirurgie plastique maxillo-faciale, hôpital Michallon, BP 217, 38043 Grenoble cedex 9, France
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Zhao X, Yao GS, Liu Y, Wang J, Satkunendrarajah K, Fehlings M. The role of neural precursor cells and self assembling peptides in nerve regeneration. J Otolaryngol Head Neck Surg 2013; 42:60. [PMID: 24351041 PMCID: PMC3878249 DOI: 10.1186/1916-0216-42-60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 11/23/2013] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Cranial nerve injury involves loss of central neural cells in the brain stem and surrounding support matrix, leading to severe functional impairment. Therapeutically targeting cellular replacement and enhancing structural support may promote neural regeneration. We examined the combinatorial effect of neural precursor cells (NPC) and self assembling peptide (SAP) administration on nerve regeneration. METHODS Nerve injury was induced by clip compression of the rodent spinal cord. SAPs were injected immediately into the injured cord and NPCs at 2 weeks post-injury. Behavioral analysis was done weekly and rats were sacrificed at 11 weeks post injury. LFB-H&E staining was done on cord tissue to assess cavitation volume. Motor evoked potentials (MEP) were measured at week 11 to assess nerve conduction and Kaplan Meier curves were created to compare survival estimates. RESULTS NPCs and SAPs were distributed both caudal and rostral to the injury site. Behavioral analysis showed that SAP + NPC transplantation significantly improved locomotor score p <0.03) and enhanced survival (log rank test, p = 0.008) compared to control. SAP + NPC treatment also improved nerve conduction velocity (p = 0.008) but did not affect cavitation volume (p = 0.73). CONCLUSION Combinatorial NPC and SAP injection into injured nerve tissue may enhance neural repair and regeneration.
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Affiliation(s)
| | | | | | | | | | - Michael Fehlings
- Department of Genetics and Development, Toronto Western Research Institute and Spinal Program, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada.
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Delhom A, Baptista C, Gay A, Legré R. [Rupture by attrition of the median nerve found during a carpal tunnel release procedure]. ACTA ACUST UNITED AC 2013; 32:350-3. [PMID: 24035684 DOI: 10.1016/j.main.2013.07.007] [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: 05/13/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Abstract
We report the finding of a subtotal rupture of the median nerve caused by a "bridge" or"easel" erosion due to a sequela of childhood wrist fracture. This unpublished observation was made during a carpal tunnel release procedure on an 80-year-old patient who was operated on for recurrence of a severe carpal tunnel syndrome 30 years after a previous neurolysis. If the flexor tendon ruptures are widely described, as well as nerve sections following high energy trauma, the median nerve rupture caused by its erosion over a bony projection has never been published at the best of our knowledge.
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Affiliation(s)
- A Delhom
- Service de chirurgie de la main et chirurgie reconstructrice des membres, hôpital de la Conception, 147, boulevard Baille, 13385 Marseille, France.
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Wagels M, Rowe D, Senewiratne S, Theile DR. History of lower limb reconstruction after trauma. ANZ J Surg 2012; 83:348-53. [PMID: 22989362 DOI: 10.1111/j.1445-2197.2012.06271.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The principles guiding reconstruction of the lower limb after trauma have become established over 300 years through advances in technology and studies of epidemiology. This paper reviews how these principles came about and why they are important. METHODS This is a structured review of historical and recent literature pertinent to lower limb reconstruction. The outcomes assessed in the pre-modern era were wound mortality, amputation mortality and amputation rate. In the modern era, infection and non-union emerged as measures of outcome, which are morbidity- rather than mortality-based. Indications for amputation published during the eras are taken to reflect the reconstructive practices of the time. RESULTS Amputation and wound mortality fell throughout the pre-modern era, from 70% and 20% to 1.8% and 1.8%, respectively. Amputation rates peaked in the American Civil War (53%) but have remained less than 20% since then. Infection and non-union rates in the modern era have fluctuated between 5% and 45%. CONCLUSIONS Priority areas for research include refinement of soft tissue reconstruction, injury classification, standardization of outcome measures and primary prevention. The impact of débridement and antisepsis on outcomes should not be forgotten as progress is made.
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Affiliation(s)
- Michael Wagels
- Department of Plastic and Reconstructive Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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14
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Clément B, Decherchi P, Féron F, Bertin D, Gigmes D, Trimaille T, Marqueste T. Poly(D,L-Lactide)-block-Poly(2-Hydroxyethyl Acrylate) Block Copolymers as Potential Biomaterials for Peripheral Nerve Repair: in vitro and in vivo Degradation Studies. Macromol Biosci 2011; 11:1175-84. [DOI: 10.1002/mabi.201100067] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/20/2011] [Indexed: 11/10/2022]
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Bauchet L, Lonjon N, Perrin FE, Gilbert C, Privat A, Fattal C. Strategies for spinal cord repair after injury: a review of the literature and information. Ann Phys Rehabil Med 2011; 52:330-51. [PMID: 19886026 DOI: 10.1016/j.annrmp.2008.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Thanks to the Internet, we can now have access to more information about spinal cord repair. Spinal cord injured (SCI) patients request more information and hospitals offer specific spinal cord repair medical consultations. OBJECTIVE Provide practical and relevant elements to physicians and other healthcare professionals involved in the care of SCI patients in order to provide adequate answers to their questions. METHOD Our literature review was based on English and French publications indexed in PubMed and the main Internet websites dedicated to spinal cord repair. RESULTS A wide array of research possibilities including notions of anatomy, physiology, biology, anatomopathology and spinal cord imaging is available for the global care of the SCI patient. Prevention and repair strategies (regeneration, transplant, stem cells, gene therapy, biomaterials, using sublesional uninjured spinal tissue, electrical stimulation, brain/computer interface, etc.) for the injured spinal cord are under development. It is necessary to detail the studies conducted and define the limits of these new strategies and benchmark them to the realistic medical and rehabilitation care available to these patients. CONCLUSION Research is quickly progressing and clinical trials will be developed in the near future. They will have to answer to strict methodological and ethical guidelines. They will first be designed for a small number of patients. The results will probably be fragmented and progress will be made through different successive steps.
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Affiliation(s)
- L Bauchet
- Centre mutualiste neurologique Propara, 34195 Montpellier, France.
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16
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Wu Y, Sui T, Cao X, Lv X, Zeng S, Sun P. Confocal imaging reveals three-dimensional fine structure difference between ventral and dorsal nerve roots. JOURNAL OF BIOMEDICAL OPTICS 2011; 16:050502. [PMID: 21639558 DOI: 10.1117/1.3575167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Peripheral nerve injury repair is one of the most challenging problems in neurosurgery, partially due to lack of knowledge of three-dimensional (3-D) fine structure and organization of peripheral nerves. In this paper, we explored the structures of nerve fibers in ventral and dorsal nerves with a laser scanning confocal microscopy. Thick tissue staining results suggested that nerve fibers have a different 3-D structure in ventral and dorsal nerves, and reconstruction from serial sectioning images showed that in ventral nerves the nerve fibers travel in a winding form, while in dorsal nerves, the nerve fibers form in a parallel cable pattern. These structural differences could help surgeons to differentiate ventral and dorsal nerves in peripheral nerve injury repair, and also facilitate scientists to get a deeper understanding about nerve fiber organization.
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Affiliation(s)
- Yuxiang Wu
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Wuhan 430074, China
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Alluin O, Feron F, Desouches C, Dousset E, Pellissier JF, Magalon G, Decherchi P. Metabosensitive Afferent Fiber Responses after Peripheral Nerve Injury and Transplantation of an Acellular Muscle Graft in Association with Schwann Cells. J Neurotrauma 2006; 23:1883-94. [PMID: 17184196 DOI: 10.1089/neu.2006.23.1883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Studies dedicated to the repair of peripheral nerve focused almost exclusively on motor or mechanosensitive fiber regeneration. Poor attention has been paid to the metabosensitive fibers from group III and IV (also called ergoreceptor). Previously, we demonstrated that the metabosensitive response from the tibialis anterior muscle was partially restored when the transected nerve was immediately sutured. In the present study, we assessed motor and metabosensitive responses of the regenerated axons in a rat model in which 1 cm segment of the peroneal nerve was removed and immediately replaced by an autologous nerve graft or an acellular muscle graft. Four groups of animals were included: control animals (C, no graft), transected animals grafted with either an autologous nerve graft (Gold Standard-GS) or an acellular muscle filled with Schwann Cells (MSC) or Culture Medium (MCM). We observed that (1) the tibialis anterior muscle was atrophied in GS, M(SC) and M(CM) groups, with no significant difference between grafted groups; (2) the contractile properties of the reinnervated muscles after nerve stimulation were similar in all groups; (3) the metabosensitive afferent responses to electrically induced fatigue was smaller in M(SC) and MCM groups; and (4) the metabosensitive afferent responses to two chemical agents (KCl and lactic acid) was decreased in GS, M(SC) and M(CM) groups. Altogether, these data indicate a motor axonal regeneration and an immature metabosensitive afferent fiber regrowth through acellular muscle grafts. Similarities between the two groups grafted with acellular muscles suggest that, in our conditions, implanted Schwann cells do not improve nerve regeneration. Future studies could include engineered conduits that mimic as closely as possible the internal organization of uninjured nerve.
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Affiliation(s)
- Olivier Alluin
- Laboratoire des Déterminants Physiologiques de l'Activité Physique (UPRES EA 3285), Institut Fédératif de Recherche (IFR) 107, Faculté des Sciences du Sport, Université de la Méditerranée, Marseille, France
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