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Singh S, Srivastava AK, Baranwal AK, Bhatnagar A, Das KK, Jaiswal S, Behari S. Efficacy of Silicone Conduit in the Rat Sciatic Nerve Repair Model: Journey of a Thousand Miles. Neurol India 2021; 69:318-325. [PMID: 33904443 DOI: 10.4103/0028-3886.314576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background A lot of options have been tried for bridging the two ends of the injured nerves. Researchers have used decellularized nerve grafts, artificial materials and even nerve growth factors to augment functional recovery. These materials are either costly or inaccessible in developing world. Objective The study aimed to evaluate the efficacy of the silicone conduit in a rat sciatic nerve injury model. Materials and Methods 24 healthy Sprague-Dawley (SD) rats (250-300 grams; 8-10 weeks) were used and right sciatic nerve was exposed; transected and re-anastomosed by two different methods in 16 rats. In control group, n = 8 (Group I) the sciatic nerve was untouched; Group II (reverse nerve anastomosis, n = 8): 1-centimeter of nerve was cut and re-anastomosed by using 10-0 monofilament suture; Group III (silicone conduit, n = 8) 1-centimeter nerve segment was cut, replaced by silicone conduit and supplemented by fibrin glue]. Evaluation of nerve recovery was done functionally (pain threshold and sciatic functional index) over 3 months and histologically and electron microscopically. Results Functional results showed a trend of clinical improvement in Group III and II but recovery was poor and never reached up to normal. Histopathological and electron microscopic results showed an incomplete axonal regeneration in Groups II and III. Psychological analyses showed that no outwards signs of stress were present and none of the rats showed paw biting and teeth chattering. Conclusion The silicone conduit graft may be an economical and effective alternative to presently available interposition grafts, however for short segments only.
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Affiliation(s)
- Suyash Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, Raebareli, Uttar Pradesh, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Atul K Baranwal
- Veterinary Scientist, Animal House, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Bhatnagar
- Department of Plastic and Reconstruction Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Lee HG, Choi JH, Jang YS, Kim UK, Kim GC, Hwang DS. Non-thermal plasma accelerates the healing process of peripheral nerve crush injury in rats. Int J Med Sci 2020; 17:1112-1120. [PMID: 32410841 PMCID: PMC7211154 DOI: 10.7150/ijms.44041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/13/2020] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to evaluate the effect of non-thermal plasma (NTP) on the healing process of peripheral nerve crush injuries, which can occur during dental implant procedures. For this, a rat model of sciatic nerve crush injury (SNCI) was adopted. The rats were divided into three groups: non-nerve damage (non-ND), nerve damage (ND), and ND+NTP group. To evaluate the sciatic nerve (SN) function, the static sciatic index was calculated, and the muscle and SN tissues were subjected to a histologic analysis. The results showed that NTP effectively accelerated the healing process of SNCI in rats. In contrast to the ND group, which showed approximately 60% recovery in the SN function, the NTP-treated rats showed complete recovery. Histologically, the NTP treatments not only accelerated the muscle healing, but also reduced the edema-like phenotype of the damaged SN tissues. In the ND group, the SN tissues had an accumulation of CD68-positive macrophages, partially destroyed axonal fibers and myelinated Schwann cells. Conversely, in the ND+NTP group, the macrophage accumulation was reduced and an overall regeneration of the damaged axon fibers and the myelin sheath was accomplished. The results of this study indicate that NTP can be used for healing of injured peripheral nerves.
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Affiliation(s)
- Hyeong-Geun Lee
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Jeong-Hae Choi
- Department of Research and Development Center, FEAGLE Corporation, Yangsan, South Korea.,Department of Oral Anatomy and Cell Biology, School of Dentistry, Pusan National University, Yangsan, South Korea
| | - Yoon-Seo Jang
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Uk-Kyu Kim
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University
| | - Gyoo-Cheon Kim
- Department of Research and Development Center, FEAGLE Corporation, Yangsan, South Korea.,Department of Oral Anatomy and Cell Biology, School of Dentistry, Pusan National University, Yangsan, South Korea
| | - Dae-Seok Hwang
- Department of Oral & Maxillofacial Surgery, School of Dentistry, Pusan National University
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Stereologic and ultrastructural comparison of human and rat amniotic membrane wrapping for rat sciatic nerve repair. J Clin Neurosci 2018; 57:157-161. [DOI: 10.1016/j.jocn.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/13/2018] [Accepted: 08/08/2018] [Indexed: 01/28/2023]
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4
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Chen P, Knox CJ, Yao L, Li C, Hadlock TA. The effects of venous ensheathment on facial nerve repair in the rat. Laryngoscope 2017; 127:1558-1564. [PMID: 28224625 DOI: 10.1002/lary.26501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the protective effect of autologous venous ensheathment on sutured rat facial nerve and to test whether the ensheathment could improve the functional recovery of repaired nerve and accuracy of axonal growth. STUDY DESIGN In vivo study. METHODS Forty-six rats were examined, with six rats serving as normal controls and 40 receiving facial nerve transection and suture repair (SR) or transection and suture repair with an additional venous ensheathment (VE). The rats were then subjected to functional testing, histological assessment of nerve specimens, or retrograde tracing, respectively. RESULTS At the postoperative day (POD) 60, the venous ensheathment showed no adhesion at the surrounding tissues. No significant difference in neuroma formation was found between the two surgical manipulations (SR and VE groups) (P < 0.05). Retrogradely labeled motoneurons in facial nuclei were extremely disorganized after the facial nerve undertook surgical manipulation. In all manipulated groups, double retrogradely labeled neurons, indicative of aberrant axonal branching during regeneration, could be observed after peripheral manipulation across all time points. With the two facial surgical manipulations, the average count of double-labeled neurons at POD 60 was significantly less than at POD 21 (P < 0.05). CONCLUSION Autologous venous ensheathment could not help with the functional recovery of facial nerve or improve the accuracy of axonal regeneration. Further studies are warranted to elucidate the effects of venous ensheathment in other motor and sensory nerve models. LEVEL OF EVIDENCE NA. Laryngoscope, 127:1558-1564, 2017.
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Affiliation(s)
- Pei Chen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Christopher J Knox
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linli Yao
- Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chunli Li
- Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A
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Costa MP, Teixeira NH, Longo MVL, Gemperli R, Costa HJZR. Combined polyglycolic acid tube and autografting versus autografting or polyglycolic acid tube alone. A comparative study of peripheral nerve regeneration in rats. Acta Cir Bras 2015; 30:46-53. [PMID: 25627270 DOI: 10.1590/s0102-86502015001000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/18/2014] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To compare sciatic nerve regeneration in rats using three different techniques of repair. METHODS Fifteen isogonics rats were divided into three groups according to the method used to repair a 5-mm long defect created in the sciatic nerve: autogenous graft (Group A), polyglycolic acid tube (PGAt) (Group B), and of the association of PGAt with the graft (Group C). Histological analysis, regenerated myelinated axon number count and functional analysis were used to compare after six weeks. RESULTS There was no difference in fiber diameter and degree of myelinization presented by Groups A, B and C. Group B presented the lowest number of regenerated axons. The groups did not display any significant functional difference after walking track analysis (p<0.05). CONCLUSION No differences between the three groups in terms of functional recovery, although there were histological differences among them.
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Affiliation(s)
| | | | | | - Rolf Gemperli
- Department of Plastic Surgery, Faculty of Medicine, USP, Sao Paulo, SP, Brazil
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Cunha ADS, Costa MP, Silva CFD. Peroneal nerve reconstruction by using glycerol-preserved veins: histological and functional assessment in rats. Acta Cir Bras 2013; 28:94-101. [PMID: 23370921 DOI: 10.1590/s0102-86502013000200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 12/20/2012] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the degree of neural regeneration in rats upon interposition of autologous nerve graft, autogenous vein, glycerol-preserved autogenous vein, and glycerol-preserved allogeneic vein using qualitative and quantitative histological analyses as well as functional assessments. METHODS Peroneal nerves were reconstructed differently in four groups of animals. Functional assessments were performed pre- and postoperatively for a period of six weeks. After six weeks, the animals were sacrificed and histological evaluations were performed. RESULTS Histological patterns of autogenous veins without preservation showed pronounced neoangiogenesis and extensive axonal rarefaction, as confirmed by axonal counting and functional assessments. Glycerol-preserved veins had results similar to the control. CONCLUSIONS Glycerol-preserved autogenous or allogeneic veins showed similar results to autograft results. The autogenous vein (without preservation in glycerol) presented histological and functional outcomes statistically lower than other groups.
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HUANG YICHENG, HUANG YIYOU. TISSUE ENGINEERING FOR NERVE REPAIR. BIOMEDICAL ENGINEERING-APPLICATIONS BASIS COMMUNICATIONS 2012. [DOI: 10.4015/s101623720600018x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nerve regeneration is a complex biological phenomenon. Once the nervous system is impaired, its recovery is difficult and malfunctions in other parts of the body may occur because mature neurons don't undergo cell division. To increase the prospects of axonal regeneration and functional recovery, researches have focused on designing “nerve guidance channels” or “nerve conduits”. For developing tissue engineered nerve conduits, four components come to mind, including a scaffold for axonal proliferation, supporting cells such as Schwann cells, growth factors, and extracelluar matrix. This article reviews the nervous system physiology, the factors that are critical for nerve repair, and the advanced technologies that are explored to fabricate nerve conduits. Furthermore, we also introduce a new method we developed to create longitudinally oriented channels within biodegradable polymers, Chitosan and PLGA, using a combined lyophilizing and wire-heating process. This innovative method using Ni-Cr wires as mandrels to create nerve guidance channels. The process is easy, straightforward, highly reproducible, and could easily be tailored to other polymer and solvent systems. These scaffolds could be useful for guided regeneration after transection injury in either the peripheral nerve or spinal cord.
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Affiliation(s)
- YI-CHENG HUANG
- Institute of Biomedical Engineering, College of Medicine and Engineering, National Taiwan University, Taipei, Taiwan
| | - YI-YOU HUANG
- Institute of Biomedical Engineering, College of Medicine and Engineering, National Taiwan University, Taipei, Taiwan
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Martínez de Albornoz P, Delgado PJ, Forriol F, Maffulli N. Non-surgical therapies for peripheral nerve injury. Br Med Bull 2011; 100:73-100. [PMID: 21429947 DOI: 10.1093/bmb/ldr005] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Non-surgical approaches have been developed to enhance nerve recovery, which are complementary to surgery and are an adjunct to the reinnervation process. SOURCES OF DATA A search of PubMed, Medline, CINAHL, DH data and Embase databases was performed using the keywords 'peripheral nerve injury' and 'treatment'. AREAS OF CONTROVERSY Most of the conservative therapies are focused to control neuropathic pain after nerve tissue damage. Only physical therapy modalities have been studied in humans and their effectiveness is not proved. GROWING POINTS Many modalities have been experimented with to promote nerve healing and restore function in animal models and in vitro studies. Despite this, none have been actually translated into clinical practice. AREAS TIMELY FOR DEVELOPING RESEARCH The hypotheses proved in animals and in vitro should be translated to human clinical practice.
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Affiliation(s)
- Pilar Martínez de Albornoz
- Department of Trauma and Orthopaedic Surgery, FREMAP Hospital, Ctra de Pozuelo 61, 28220 Majadahonda, Madrid, Spain
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S Mcdonald D, Sg Bell M. Peripheral Nerve Gap Repair Facilitated By a Dynamic Tension Device. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2010. [DOI: 10.1177/229255031001800108] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
End-to-end neurorrhaphy remains the gold standard for transected nerve repair. However, the current dogma is that to be successful, nerve repairs must be tension free. Therefore, nerve gaps are most commonly repaired with grafts. While there is evidence that nerves can regenerate successfully after initial approximation under a tensile force, the amount of tension that deters regeneration of human nerves remains unclear. The present paper describes a case in which a favourable functional outcome was obtained following repair of a median nerve gap that was reduced by a dynamic tension device. The case provides some evidence that modest separations between stumps can be overcome by dynamic tension, enabling primary end-to-end repair of nerve gaps.
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Affiliation(s)
| | - Michael Sg Bell
- Department of Surgery, Division of Plastic Surgery, the Ottawa Hospital – Civic Campus, Ottawa, Ontario
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Cui T, Yan Y, Zhang R, Liu L, Xu W, Wang X. Rapid Prototyping of a Double-Layer Polyurethane–Collagen Conduit for Peripheral Nerve Regeneration. Tissue Eng Part C Methods 2009; 15:1-9. [DOI: 10.1089/ten.tec.2008.0354] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Costa MP, Cunha ADS, Silva CFD, Barros Filho TEPD, Costa HJZR, Ferreira MC. Tubo de ácido poliglicólico e GM1 na regeneração de nervos periféricos. ACTA ORTOPEDICA BRASILEIRA 2009. [DOI: 10.1590/s1413-78522009000500007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: A auto-enxertia de nervo é considerada tratamento de escolha nas grandes perdas de tecido neural que não permitam a reparação através de anastomose primária. Nesses casos, o tubo sintético à base de ácido poliglicólico é uma alternativa para enxertia de nervo. Por outro lado, muitos estudos têm enfatizado a importância dos fatores neurotróficos na regeneração neural: o monossialotetraesosilgangliosídeo (GM1), um dos principais glicoesfingolípides do tecido nervoso de mamíferos, é tido como potencializador dos efeitos desses fatores. OBJETIVO: Comparar, em ratos, o grau de regeneração neural, utilizando análise histológica, contagem do número de axônios mielinizados regenerados e análise funcional com a utilização do neurotubo e do GM1. MÉTODOS: Essa avaliação foi obtida com a interposição de enxerto autógeno (grupo A), tubo de ácido poliglicólico (grupo B) e da associação do tubo de ácido poliglicólico à administração de GM1 (grupo C) em defeitos de 5 mm no nervo ciático. RESULTADOS: Foi observada formação de neuroma apenas no grupo A. Os grupos A e C apresentaram padrões histológicos semelhantes, exceto que os axônios regenerados do grupo C apresentavam-se mais organizados e mielinizados que o grupo A. CONCLUSÃO: Na recuperação funcional, não houve diferença estatisticamente significativa entre os três grupos, a despeito das diferenças histológicas qualitativas e quantitativas verificadas.
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Ichihara S, Inada Y, Nakamura T. Artificial nerve tubes and their application for repair of peripheral nerve injury: an update of current concepts. Injury 2008; 39 Suppl 4:29-39. [PMID: 18804584 DOI: 10.1016/j.injury.2008.08.029] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the last 20 years, an increasing number of research articles have reported on the use of artificial nerve tubes to repair nerve defects. The development of an artificial nerve tube as an alternative to autogenous nerve grafting is currently a focus of interest for peripheral nerve repair. The clinical employment of tubes as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. Numerous studies indicate that short-distance defects in humans can be successfully treated by implantation of artificial nerve guides. This review provides a brief overview of various preclinical and clinical trials conducted to evaluate the utility of artificial nerve tubes for the regeneration of peripheral nerves. This review is also intended to help update hand surgeons on the rapid advances in tubulization techniques, and to provide them with indications of the various directions toward which future research can proceed. Future studies need to provide us with as much comparative information as possible on the effectiveness of different tubulization techniques, in order to guide the surgeon in choosing the best indications for their optimal clinical employment. Future progress in implant development can be expected from interdisciplinary approaches involving both materials and life sciences, leading to advances in neuro-tissue engineering that will be needed to effectively treat larger nerve defects.
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Affiliation(s)
- Satoshi Ichihara
- Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
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Vein Grafts Used as Nerve Conduits for Obstetrical Brachial Plexus Palsy Reconstruction. Plast Reconstr Surg 2007; 120:1930-1941. [DOI: 10.1097/01.prs.0000287391.12943.00] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Nerve regeneration is a complex biological phenomenon. Once the nervous system is impaired, its recovery is difficult and malfunctions in other parts of the body may occur because mature neurons do not undergo cell division. To increase the prospects of axonal regeneration and functional recovery, researches have focused on designing "nerve guidance channels" or "nerve conduits." When developing ideal tissue-engineered nerve conduits, several components come to mind. They include a biodegradable and porous channel wall, the ability to deliver bioactive growth factors, incorporation of support cells, an internal oriented matrix to support cell migration, intraluminal channels to mimic the structure of nerve fascicles, and electrical activities. This article reviews the factors that are critical for nerve repair, and the advanced technologies that are explored to fabricate nerve conduits. To more accurately mimic natural repair in the body, recent studies have focused on the use of various advanced approaches to create ideal nerve conduits that combine multiple stimuli in an effort to better mimic the complex signals normally found in the body.
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Affiliation(s)
- Yi-Cheng Huang
- Institute of Biomedical Engineering, College of Engineering, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Costa MP, Cunha ADS, Silva CFD, Barros Filho TEP, Ferreira MC. A utilização do tubo de ácido poliglicólico e FK506 na regeneração de nervos periféricos. ACTA ORTOPEDICA BRASILEIRA 2006. [DOI: 10.1590/s1413-78522006000100005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Grandes perdas de tecido neural não permitem a reparação através de anastomose primária. Nesses casos, a auto-enxertia de nervo é considerada tratamento de escolha. O tubo sintético à base de ácido poliglicólico é uma opção para enxertia de nervo. O FK506 é um imunossupressor que aumenta a taxa de regeneração neural "in vivo" e "in vitro". O objetivo deste trabalho foi comparar, em ratos, o grau de regeneração neural, utilizando análise histológica, contagem do número de axônios mielinizados regenerados e análise funcional, obtida com a interposição de enxerto autógeno (grupo A), tubo de ácido poliglicólico (grupo B) e da associação do tubo de ácido poliglicólico à administração de FK506 (grupo C) em defeitos de 5 mm no nervo ciático. Foi observado a formação de neuroma apenas no grupo A. Os grupos B e C apresentaram padrões histológicos semelhantes. A avaliação quantitativa do número de axônios mielinizados regenerados determinou que: 1) o grupo B apresentou em média um menor número em ralação aos demais grupos; 2) não houve diferença significativa entre o grupo controle A e o grupo C. Na recuperação funcional, não houve diferença estatisticamente significativa entre os três grupos, a despeito das diferenças histológicas qualitativas e quantitativas verificadas.
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M D NK, Cobanoğlu U, Ambarcioğlu O, Topal U, Kutlu N. Effect of amniotic fluid on peri-implant capsular formation. Aesthetic Plast Surg 2005; 29:174-80. [PMID: 15948022 DOI: 10.1007/s00266-004-0135-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Although commonly used biomaterials are physically and chemically stable, nonimmunogenic, and nontoxic, implanted and blood-contact biomaterials trigger a wide variety of unwanted responses, including inflammation, thrombosis, infection, and fibrosis. Peri-implant fibrosis is the response most commonly seen by plastic surgeons. In this study, the authors hypothesized that as hyaluronic acid (HA) reduces scar formation by inhibiting the activity of mononuclear phagocytes and lymphocytes, human amniotic fluid (HAF), which contains high concentrations of HA, HA-stimulating activator (HASA), and other factors, might prevent the formation of fibrous capsules and capsule contracture when applied intraluminally. Two 1 x 1-cm silicone blocks were placed dorsally into separate surgically created pockets underneath the panniculus carnosus muscle, distant from the incisions, in each of the 10 rats in the study. At the time of implant insertion, 2 ml of HAF was instilled into the cranially located pockets in group 1, whereas 2 ml of saline solution was instilled into the caudally located pockets in group 2. After 6 months, intracapsular static and dynamic pressure measurements were made, and then all the peri-implant capsules were excised and fixed in 10% neutral buffered formaldehyde. The thicknesses of the capsules were measured in three different areas of each section, and a mean was calculated. Capsular firmness, according to the static and dynamic pressure readings, was significantly greater in the control group, which had saline solution introduced into the pocket, than in the treatment group, which had HAF used in the same manner. The mean total thickness of the capsules surrounding the implants was 876.7 microm in the control group, as comparied with 466.8 microm in the HAF-treated group. This difference was statistically significant (p < 0.001). Because of its ability to reduce capsular thickness and firmness and also because it can be stored in a freezer if it is prepared in a cell-free manner, HAF would appear to be a useful adjunct in the prevention of capsular contracture formation.
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Ozgenel GY, Filiz G. Effects of human amniotic fluid on peripheral nerve scarring and regeneration in rats. J Neurosurg 2003; 98:371-7. [PMID: 12593625 DOI: 10.3171/jns.2003.98.2.0371] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECT Peripheral nerve repair surgery is still replete with challenges. Despite technical improvements in microsurgery, classic methods of nerve repair have failed to provide satisfactory results. The purpose of this study was to investigate the effects of amniotic fluid from humans on peripheral nerve scarring and regeneration in rats. METHODS Forty adult Sprague-Dawley rats were used in this study. After the right sciatic nerve in each rat was transected and repaired using an epineural suture procedure, the nerves were divided into two groups according to the solution applied around the repair site: experimental group, 0.3 ml human amniotic fluid (HAF); and control group, 0.3 ml saline. Macroscopic and histological evaluations of peripheral nerve scarring were performed 4 weeks postsurgery. Nerves treated with HAF demonstrated a significant reduction in the amount of scar tissue surrounding the repair site (p < 0.05). No evidence of a reaction against HAF was noted. Functional nerve regeneration was measured once every 2 weeks by using a sciatic function index until 12 weeks postsurgery. Functional recovery in nerves treated with amniotic fluid occurred significantly faster than that in nerves treated with saline (p < 0.05). Peripheral nerve regeneration was evaluated histomorphologically at 12 weeks postsurgery. Nerves treated with amniotic fluid showed significant improvement with respect to the indices of fiber maturation (p < 0.05). CONCLUSIONS Preliminary data show that HAF enhances peripheral nerve regeneration. The preventive effect of HAF on epineural scarring and the rich content of neurotrophic and neurite-promoting factors possibly contribute to this result.
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Affiliation(s)
- Güzin Yeşim Ozgenel
- Departments of Plastic and Reconstructive Surgery, and Pathology, Uludağ University Medical School, Bursa, Turkey.
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Krarup C, Archibald SJ, Madison RD. Factors that influence peripheral nerve regeneration: an electrophysiological study of the monkey median nerve. Ann Neurol 2002; 51:69-81. [PMID: 11782986 DOI: 10.1002/ana.10054] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Regeneration in the peripheral nervous system is often incomplete though it is uncertain which factors, such as the type and extent of the injury or the method or timing of repair, determine the degree of functional recovery. Serial electrophysiological techniques were used to follow recovery from median nerve lesions (n = 46) in nonhuman primates over 3 to 4 years, a time span comparable with such lesions in humans. Nerve gap distances of 5, 20, or 50mm were repaired with nerve grafts or collagen-based nerve guide tubes, and three electrophysiological outcome measures were followed: (1) compound muscle action potentials in the abductor pollicis brevis muscle, (2) the number and size of motor units in reinnervated muscle, and (3) compound sensory action potentials from digital nerve. A statistical model was used to assess the influence of three variables (repair type, nerve gap distance, and time to earliest muscle reinnervation) on the final recovery of the outcome measures. Nerve gap distance and the repair type, individually and concertedly, strongly influenced the time to earliest muscle reinnervation, and only time to reinnervation was significant when all three variables were included as outcome predictors. Thus, nerve gap distance and repair type exert their influence through time to muscle reinnervation. These findings emphasize that factors that control early axonal outgrowth influence the final level of recovery attained years later. They also highlight that a time window exists within which axons must grow through the distal nerve stump in order for recovery after nerve lesions to be optimal. Future work should focus on interventions that may accelerate the growth of axons from the lesion site into the distal nerve stump.
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Affiliation(s)
- Christian Krarup
- Department of Clinical Neurophysiology, National University Hospital (Rigshospitalet), Copenhagen, Denmark.
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19
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Abstract
The presence of bioabsorbable materials in orthopaedics has grown significantly over the past two decades with applications in fracture fixation, bone replacement, cartilage repair, meniscal repair, fixation of ligaments, and drug delivery. Numerous biocompatible, biodegradable polymers are now available for both experimental and clinical use. Not surprisingly, there have been a wealth of studies investigating the biomechanical properties, biocompatibility, degradation characteristics, osteoconductivity, potential toxicity, and histologic effects of various materials. Promising results have been reported in the areas of fracture fixation, ligament repair, and drug delivery. In this article we review the pre-clinical in vivo testing of bioabsorbable devices with particular emphasis on implants used for these applications.
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Affiliation(s)
- Y H An
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston 29425, USA.
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20
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Vasconcelos BC, Gay-Escoda C. Facial nerve repair with expanded polytetrafluoroethylene and collagen conduits: an experimental study in the rabbit. J Oral Maxillofac Surg 2000; 58:1257-62. [PMID: 11078137 DOI: 10.1053/joms.2000.16626] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE This study evaluated autogenous nerve grafts and expanded polytetrafluoroethylene (e-PTFE) and collagen tubes as conduits for the repair of continuity defects in the facial nerve of rabbits. MATERIALS AND METHODS The buccal division of 24 facial nerves was isolated, transected, and separated 10 mm. The gap between the 2 nerve ends was then repaired with an autologous nerve graft or an e-PTFE or collagen conduit. Fifteen days and 1, 2, and 4 months after the procedure, the animals were subjected to electrophysiologic tests, killed, and the nerves were removed for histologic examination. RESULTS At 15 days postsurgery, no regeneration was observed through the e-PTFE and collagen tubes or across the autologous nerve grafts at the midpoint of the specimens. However, regeneration across the chambers and autologous nerve grafts was seen in the following 4 months, although the number of axons regenerated was small. CONCLUSIONS The results of the study indicate that e-PTFE and collagen tubing may be effective in the repair of continuity defects in peripheral nerves. However, further research will be necessary for generalization of this procedure.
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Abstract
Peripheral nerve injuries are common, and there is no easily available formula for successful treatment. Incomplete injuries are most frequent. Seddon classified nerve injuries into three categories: neurapraxia, axonotmesis, and neurotmesis. After complete axonal transection, the neuron undergoes a number of degenerative processes, followed by attempts at regeneration. A distal growth cone seeks out connections with the degenerated distal fiber. The current surgical standard is epineurial repair with nylon suture. To span gaps that primary repair cannot bridge without excessive tension, nerve-cable interfascicular auto-grafts are employed. Unfortunately, results of nerve repair to date have been no better than fair, with only 50% of patients regaining useful function. There is much ongoing research regarding pharmacologic agents, immune system modulators, enhancing factors, and entubulation chambers. Clinically applicable developments from these investigations will continue to improve the results of treatment of nerve injuries.
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Affiliation(s)
- S K Lee
- United States Air Force, Section of Orthopaedic Surgery, Walson Air Force Hospital, Fort Dix, NJ, USA
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22
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Zhang F, Cheng C, Chin BT, Ho PR, Weibel TJ, Lineaweaver WC, Buncke HJ. Results of termino-lateral neurorrhaphy to original and adjacent nerves. Microsurgery 2000; 18:276-81. [PMID: 9779642 DOI: 10.1002/(sici)1098-2752(1998)18:4<276::aid-micr12>3.0.co;2-v] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this comprehensive investigation, we studied three different neurorrhaphy models in an attempt to elucidate the potential of termino-lateral nerve repair to original and adjacent nerves. In experimental group 1, the peroneal nerve was sectioned and then attached to the posterior tibial nerve in a termino-lateral fashion. In experiment group 2, the motor nerves to the gastrocnemius muscle were sectioned and then attached to the posterior tibial nerve in a termino-lateral fashion. In experimental group 3, the obturator nerve (L2-4) was sectioned and attached to the sciatic nerve (L4-6) in a termino-lateral fashion. For the control in each group, the same type of nerve used in each respective group was transected without repair. Experimental groups 1 and 2 showed viable axons in the peroneal nerve distal to the neurorrhaphy site. Experimental group 3 showed no viable axons at these sites. No regeneration was observed in the transected nerve without repair in all three control groups. This study suggests that termino-lateral neurorrhaphy is a viable means of repairing damaged nerves if the distal segment of the sectioned nerve is reattached to its original trunk distal to its original branch point. However, the results from experimental group 3 demonstrate that termino-lateral neurorrhaphy cannot be used to repair nerves when the donor and recipient nerves originate from different spinal cord levels.
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Affiliation(s)
- F Zhang
- Microsurgical Replantation and Transplantation Service, Davies Medical Center, San Francisco, CA 94114, USA
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23
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Santos X, Rodrigo J, Hontanilla B, Bilbao G. Local administration of neurotrophic growth factor in subcutaneous silicon chambers enhances the regeneration of the sensory component of the rat sciatic nerve. Microsurgery 1999; 19:275-80. [PMID: 10469442 DOI: 10.1002/(sici)1098-2752(1999)19:6<275::aid-micr4>3.0.co;2-f] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
An experimental model for local administration of neurotrophic growth factor (NGF) in peripheral nerve lesions is tested. The model consists of a subcutaneous reservoir connected to the sciatic nerve neurorrhaphy. The right sciatic nerves were exposed, severed, and repaired at a level 1.5 cm proximal to their trifurcation. Then, a dome-shaped silicone reservoir connected to the proximal end of a silicone tube was placed subcutaneously in the dorsum of the experimental animal. The distal end of the connecting tube was located in the nerve neurorrhaphy. Two experimental groups were made: Group A (n = 90) received daily doses of a solution containing NGF-7S during the first 4 weeks after surgery and a single weekly dose thereafter. Within this group, three subgroups of 30 rats each were made: A-4 sacrificed 4 weeks after surgery, A-8 sacrificed after 8 weeks, and A-12 after 12 weeks. Group B (n = 90) received the same vehicle solution without NGF under the same schedule and volume as in Group A. Three subgroups were also made as in Group A depending on the survival period. In order to locate the neurons in the dorsal root ganglia, the retrograde tracer horseradish peroxidase was administered at the proximal stump of the sciatic nerve (tibialis branch), which was severed 1 cm distal to the sciatic trifurcation. In respect of the nonoperated side, the percentage between the number of dorsal root ganglia neurons in the NGF-treated group was significantly higher than in the control group (P < 0.001). These results demonstrate that percutaneous administration of multiple doses of NGF in this model enhances sensory nerve regeneration after sciatic lesions evaluated by horseradish peroxidase labeling of dorsal root ganglia neurons.
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Affiliation(s)
- X Santos
- Unidad de Cirugía Experimental, Hospital Universitario del Aire, Madrid, Spain.
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24
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Tountas CP, Bergman RA, Lewis TW, Stone HE, Pyrek JD, Mendenhall HV. A comparison of peripheral nerve repair using an absorbable tubulization device and conventional suture in primates. JOURNAL OF APPLIED BIOMATERIALS : AN OFFICIAL JOURNAL OF THE SOCIETY FOR BIOMATERIALS 1999; 4:261-8. [PMID: 10171979 DOI: 10.1002/jab.770040308] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Median nerve regeneration was studied in 30 adult primates after repair by microsurgical suture or tubulization with a nonwoven, bioabsorbable, polyglycolic acid device. The two methods were compared electrophysiologically and histologically 6 and 12 months after repair. The electrophysiology included recording of electrically evoked compound action potentials and subsequent determination of threshold, conduction velocity, amplitude, and area above the baseline for each component. Measurements were obtained before nerve transection and at the time of biopsy by stimulating both proximal and distal to the transection site. Analysis of all electrophysiological parameters revealed no statistically significant differences (p less than 0.05) between the two repair techniques. Histopathology included examination of cross sections proximal and distal to the repair sites and longitudinal sections through the coaptation site. End organs (Meissner's and Pacinian corpuscles and muscle) were sectioned to determine the degree of reinnervation. No significant differences between the repair techniques were observed by histological analysis of these sections. These evaluations indicated that the tubulization repair technique produced results comparable to that of the suture technique.
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25
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Terris DJ, Cheng ET, Utley DS, Tarn DM, Ho PR, Verity AN. Functional recovery following nerve injury and repair by silicon tubulization: comparison of laminin-fibronectin, dialyzed plasma, collagen gel, and phosphate buffered solution. Auris Nasus Larynx 1999; 26:117-22. [PMID: 10214888 DOI: 10.1016/s0385-8146(98)00067-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This study was designed to investigate the potential for enhancement of peripheral nerve regeneration by the manipulation of the neural microenvironment with laminin-fibronectin solution (LF), dialyzed plasma (DP), collagen gel (CG), or phosphate buffered saline (PBS) in a silicon tubulization repair model. METHOD A rat sciatic nerve model of injury and repair was used to study the effects of exogenous matrix precursors (contained in LF or DP), CG or PBS on nerve regeneration. A total of 50 Sprague-Dawley rats underwent left sciatic nerve transection and repair by silicon tubulization. The silicon tubules were either left empty (E), or filled with solutions of LF, DP, CG, or PBS. Nerve function was assessed preoperatively and then postoperatively, every 10 days for 90 days using sciatic functional indexes (SFI). On postoperative day 90, the sciatic nerves were harvested for histologic analysis and the posterior compartment muscles of each animal were harvested and weighed. Molecular analysis for two proteins associated with neural regeneration was performed on the nerve segments. RESULTS All five animal groups demonstrated equivalent functional recovery. Comparison of the rate of recovery and mean maximal recovery between each group revealed no statistically significant differences, with P-values ranging from 0.30 to 0.95. Posterior compartment muscle masses were similar in all groups except for LF, whose animals had muscle masses 8-9% lower than CG, PBS, or E (P < 0.05). CONCLUSION Alteration of the regenerating neural microenvironment with exogenous matrix precursors (LF, DP), CG or PBS failed to improve sciatic functional recovery after nerve transection and silicon tubulization in this model. From this study, we conclude that LF, DP, CG, and PBS do not enhance the rate or degree of recovery of peripheral nerve function across a narrow gap when nerves are repaired by silicon tubulization.
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Affiliation(s)
- D J Terris
- Stanford University Medical Center, Division of Otolaryngology/Head and Neck Surgery, CA 94305-5328, USA.
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26
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Lenihan DV, Carter AJ, Gilchrist T, Healy DM, Miller IA, Myles LM, Glasby MA. Biodegradable controlled release glass in the repair of peripheral nerve injuries. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1998; 23:588-93. [PMID: 9821599 DOI: 10.1016/s0266-7681(98)80007-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The experiments in this paper were concerned with the recovery of function and ease of application of an entubulation technique using a biodegradable, controlled release glass tube (CRG) for the repair of a transected peripheral nerve. The peroneal nerves of 15 New Zealand White rabbits were repaired with either a CRG tube filled with freeze-thawed muscle, or a conventional freeze thawed muscle graft (FTMG). These were compared with controls in which a CRG was used to enclose the cut ends of a nerve separated by a 1 cm gap. Electrophysiological and morphometric assessment was carried out 6 months after repair. No statistical difference was found in any test between the FTMG and the CRG tube filled with freeze thawed muscle. The CRG tube and 1 cm gap produced inferior levels of recovery of function when compared with the other two repair groups.
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Affiliation(s)
- D V Lenihan
- Department of Clinical Neuroscience, University of Edinburgh, Ayr, UK
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27
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Gilchrist T, Glasby MA, Healy DM, Kelly G, Lenihan DV, McDowall KL, Miller IA, Myles LM. In vitro nerve repair--in vivo. The reconstruction of peripheral nerves by entubulation with biodegradeable glass tubes--a preliminary report. BRITISH JOURNAL OF PLASTIC SURGERY 1998; 51:231-7. [PMID: 9664883 DOI: 10.1054/bjps.1997.0243] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Biodegradeable "controlled release" inorganic polymer glass tubes can be manufactured to fit the dimensions of any nerve and their rate of solubility can be adjusted to encompass the time taken for nerve regeneration. They have been used in a number of biological applications. The facial nerve was repaired in a group of five sheep by entubulation with biodegradeable glass tubes. The sheep were assessed 10 months after repair and compared with a similar sized group of normal sheep. It was found that while there was a reduction in the peak velocity of conduction in the repaired nerves and in the range of conduction velocities, the minimum conduction velocity was within normal limits. There was a diminution in all of the measured variables of nerve morphometry but in no case did this reach statistical significance. These findings are consistent with the view that regeneration of the nerves had taken place to a degree at least as effective as that seen in nerves of a similar size repaired by conventional means.
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Affiliation(s)
- T Gilchrist
- Department of Clinical Neurosciences, University of Edinburgh, Western General Hospital, Scotland, UK
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28
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Heath CA, Rutkowski GE. The development of bioartificial nerve grafts for peripheral-nerve regeneration. Trends Biotechnol 1998; 16:163-8. [PMID: 9586239 DOI: 10.1016/s0167-7799(97)01165-7] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article describes recent, significant scientific advances leading to the development of the bioartificial nerve graft. Schwann cells, which play an active role in the repair and function of peripheral nerves, are used to seed a synthetic, often resorbable conduit, which is then used to bridge and repair nerve gaps caused by injury or disease. By enhancing the rate and extent of regeneration, the bioartificial nerve graft holds great promise for improving recovery in the peripheral (and central) nervous system.
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Affiliation(s)
- C A Heath
- Department of Chemical Engineering, Iowa State University, Ames, LA 50011-2230, USA
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29
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Meyer RS, Abrams RA, Botte MJ, Davey JP, Bodine-Fowler SC. Functional recovery following neurorrhaphy of the rat sciatic nerve by epineurial repair compared with tubulization. J Orthop Res 1997; 15:664-9. [PMID: 9420594 DOI: 10.1002/jor.1100150506] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Recovery of motor function is often poor following transection injuries to peripheral nerves. The purpose of this study was to measure and compare functional recovery of the sciatic nerve in the rat following transection and neurorrhaphy with the use of a nerve guide tube and with traditional end-to-end epineurial repair. Muscle recovery was also evaluated following a crush injury, a model of an axonotmetic lesion. Recovery was assessed at 8, 16, and 32 weeks after injury by measuring the isometric contractile properties of the soleus muscle and at 8 and 16 weeks by measuring the conduction properties of the sciatic nerve. The mean conduction velocity of the sciatic nerve in the crush group and both transection groups was significantly slower than that of controls at both 8 and 16 weeks. Following a transection injury, the soleus became a significantly faster muscle as measured by time to peak twitch tension. By 32 weeks, the maximum isometric tension of the soleus muscle recovered to 90% that of the control group following a crush injury and to less than 70% following a transection injury and repair. Recovery was better in the epineurial repair group than in the tube repair group at 8 weeks, but no difference was found between the groups at 16 or 32 weeks. These results demonstrate that nerve guide tubes are a potential alternative to epineurial repair. The poor motor recovery following repair of transection injuries may be related to poor specificity of reinnervation.
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Affiliation(s)
- R S Meyer
- Department of Orthopaedic Surgery, University of California, San Diego 92103, USA
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30
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Nicoli Aldini N, Perego G, Cella GD, Maltarello MC, Fini M, Rocca M, Giardino R. Effectiveness of a bioabsorbable conduit in the repair of peripheral nerves. Biomaterials 1996; 17:959-62. [PMID: 8736729 DOI: 10.1016/0142-9612(96)84669-2] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A new conduit made with a bioabsorbable copolymer, poly (L-lactide-co-6-caprolactone), was evaluated in an animal model as a guide for nerve regeneration. The conduit had an inner diameter of 1.3 mm and a wall thickness of 175 microns. Segments of length 1.2 cm were interposed between the proximal and distal stumps of transected ischiatic nerves in Wistar rats, bridging a nerve gap of 1 cm. All of the procedure was performed under general anaesthesia using microsurgical techniques. Controls were performed at 1, 3 and 6 months and it was demonstrated that the conduit was still undamaged after 30 d. Progressive signs of degradation appeared at 90 and 180 d. Nerve regeneration in the lumen was effective as confirmed by histological and electron microscopical investigations. These preliminary results emphasize the interesting properties of the conduit with regard to the achievement of a neural prosthesis.
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Affiliation(s)
- N Nicoli Aldini
- Servizio di Chirurgia Sperimentale, Istituto di Ricerca Codivilla Putti I.O.R., Bologna, Italy
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31
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Abstract
The restoration of effective and meaningful axonal function following peripheral nerve injury continues to be a considerable clinical challenge. The use of conduits to bridge the gap between severed ends is a contemporary experimental maneuver that isolates the microenvironment of regenerating axons. Entubulation has allowed analysis and manipulation of putative influences upon nerve regeneration. A review is provided of the research efforts that have explored the neurobiological and mechanical factors that guide nerve regeneration within conduits. Levels of specificity, from tissue specific growth to end-organ specific growth, are outlined within the framework of the theories of Neurotropism, Contact Guidance and Neurotrophism. Included are investigations utilizing different conduit materials and the few clinical applications of these conduits. A number of chamber manipulations, extra-cellular matrix substrates and growth factors and their molecular receptors have been implicated in enhanced regeneration specificity. This information has been extended to the conduit model. The interposition of healthy nerve segments into conduits is proposed as a means of extending the length of successful nerve regeneration.
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Affiliation(s)
- V B Doolabh
- Division of Plastic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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32
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Abstract
A considerable amount of research is being undertaken regarding the possibility of bridging loss of nerve substance with different guiding tubes, in order to improve functional outcome, reduce the surgical time, and reduce damage at donor nerve sites. A review of the literature and personal research allows us to state that: for short gaps, biological tubes (autologous veins) may give good results and also allow chemotactic attraction with selective arrangements of motor and sensory axons. Gaps longer than 1 cm do not allow tropism and are associated with failure to support axonal regrowth. Artificial biodegradable conduits still show results that are controversial; they may give good results provided that the material of which they are made is perfectly tolerated. Empty tubes, longer than 8-10 mm, besides being deprived of the chemotactic attraction, may collapse or be partially reabsorbed and replaced by scar. Probably in the near future biological or biodegradable tubes, containing laminin-like substances or muscle scaffold, will allow us to bridge increasingly large defects in nerves.
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Affiliation(s)
- G A Brunelli
- Department of Orthopaedics, Brescia University, Medical School, Italy
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33
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Hentz VR, Rosen JM, Xiao SJ, McGill KC, Abraham G. The nerve gap dilemma: a comparison of nerves repaired end to end under tension with nerve grafts in a primate model. J Hand Surg Am 1993; 18:417-25. [PMID: 8515008 DOI: 10.1016/0363-5023(93)90084-g] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The objective of this study was to compare, in a clinically relevant primate model, axon regeneration after epineurial repair under tension (15 mm gap) with interfascicular nerve grafts with the use of either standard microsuture techniques or a new interfascicular nerve graft technique termed fascicular tubulization that uses a hypoantigenic collagen membrane formed into a tube to approximate nerve ends. Electrophysiologic analysis demonstrated that the percentage of proximal axons that conducted across the repair site was greater in those nerves repaired under tension with epineurially placed sutures than in either of the tensionless repairs involving interfascicular graft techniques. The mean diameters of the regenerated axons repaired under tension with epineurial sutures were greater than those of the nerves repaired with interfascicular grafts, although the difference was not statistically significant. Interfascicular nerve grafting with tubulization using the current collagen tube resulted in regeneration equal to the sutured interfascicular nerve grafts. For modest defects (perhaps up to 3 to 4 cm in the adult), it seems advantageous to accept the modest tension associated with an epineurial repair rather than to use an autograft (or artificial graft) to achieve a tension-free repair.
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Affiliation(s)
- V R Hentz
- Stanford University Medical Center, Calif
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34
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Dellon AL, Crawley WA. Nerve Reconstruction with Alloplastic Material in the Head and Neck Region. Oral Maxillofac Surg Clin North Am 1992. [DOI: 10.1016/s1042-3699(20)30607-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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