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McMorrow LA, Czarnecki P, Reid AJ, Tos P. Current perspectives on peripheral nerve repair and management of the nerve gap. J Hand Surg Eur Vol 2024; 49:698-711. [PMID: 38603601 DOI: 10.1177/17531934241242002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace. Whether performing primary neurorrhaphy or managing multiple large nerve defects, the modern nerve surgeon has an extensive range of tools, techniques and choices available to them. Continuous innovation in surgical equipment and technique has enabled the maturation of autografting as a gold standard for reconstruction and welcomed the era of nerve transfer techniques all while bioengineers have continued to add to our armamentarium with implantable devices, such as conduits and acellular allografts. We provide the reader a concise and up-to-date summary of the techniques available to them, and the evidence base for their use when managing nerve transection including current use and applicability of nerve transfer procedures.
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Affiliation(s)
- Liam A McMorrow
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Adam J Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Pierluigi Tos
- Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
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Roca FG, Santos LG, Roig MM, Medina LM, Martínez-Ramos C, Pradas MM. Novel Tissue-Engineered Multimodular Hyaluronic Acid-Polylactic Acid Conduits for the Regeneration of Sciatic Nerve Defect. Biomedicines 2022; 10:biomedicines10050963. [PMID: 35625700 PMCID: PMC9138968 DOI: 10.3390/biomedicines10050963] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
The gold standard for the treatment of peripheral nerve injuries, the autograft, presents several drawbacks, and engineered constructs are currently suitable only for short gaps or small diameter nerves. Here, we study a novel tissue-engineered multimodular nerve guidance conduit for the treatment of large nerve damages based in a polylactic acid (PLA) microfibrillar structure inserted inside several co-linear hyaluronic acid (HA) conduits. The highly aligned PLA microfibers provide a topographical cue that guides axonal growth, and the HA conduits play the role of an epineurium and retain the pre-seeded auxiliary cells. The multimodular design increases the flexibility of the device. Its performance for the regeneration of a critical-size (15 mm) rabbit sciatic nerve defect was studied and, after six months, very good nerve regeneration was observed. The multimodular approach contributed to a better vascularization through the micrometrical gaps between HA conduits, and the pre-seeded Schwann cells increased axonal growth. Six months after surgery, a cross-sectional available area occupied by myelinated nerve fibers above 65% at the central and distal portions was obtained when the multimodular device with pre-seeded Schwann cells was employed. The results validate the multi-module approach for the regeneration of large nerve defects and open new possibilities for surgical solutions in this field.
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Affiliation(s)
- Fernando Gisbert Roca
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain; (F.G.R.); (L.G.S.); (C.M.-R.)
| | - Luis Gil Santos
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain; (F.G.R.); (L.G.S.); (C.M.-R.)
| | - Manuel Mata Roig
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain; (M.M.R.); (L.M.M.)
| | - Lara Milian Medina
- Department of Pathology, Faculty of Medicine and Dentistry, Universitat de València, 46010 Valencia, Spain; (M.M.R.); (L.M.M.)
| | - Cristina Martínez-Ramos
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain; (F.G.R.); (L.G.S.); (C.M.-R.)
- Unitat Predepartamental de Medicina, Universitat Jaume I, 12071 Castellón de la Plana, Spain
| | - Manuel Monleón Pradas
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, 46022 Valencia, Spain; (F.G.R.); (L.G.S.); (C.M.-R.)
- Biomedical Research Networking Center in Bioengineering Biomaterials and Nanomedicine (CIBER-BBN), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-963-877000
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Wolfe EM, Mathis SA, Ovadia SA, Panthaki ZJ. Comparison of Collagen and Human Amniotic Membrane Nerve Wraps and Conduits for Peripheral Nerve Repair in Preclinical Models: A Systematic Review of the Literature. J Reconstr Microsurg 2022; 39:245-253. [PMID: 35008116 DOI: 10.1055/s-0041-1732432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Collagen and human amniotic membrane (hAM) are Food and Drug Administration (FDA)-approved biomaterials that can be used as nerve wraps or conduits for repair of peripheral nerve injuries. Both biomaterials have been shown to reduce scarring and fibrosis of injured peripheral nerves. However, comparative advantages and disadvantages have not been definitively shown in the literature. The purpose of this systematic review is to comprehensively evaluate the literature regarding the roles of hAM and collagen nerve wraps and conduits on peripheral nerve regeneration in preclinical models. METHODS The MEDLINE database was queried using the PubMed search engine on July 7, 2019, with the following search strategy: ("amniotic membrane" OR "amnion") OR ("collagen conduit" OR "nerve wrap")] AND "nerve." All resulting articles were screened by two independent reviewers. Nerve type, lesion type/injury model, repair type, treatment, and outcomes were assessed. RESULTS Two hundred and fifty-eight articles were identified, and 44 studies remained after application of inclusion and exclusion criteria. Seventeen studies utilized hAM, whereas 27 studies utilized collagen wraps or conduits. Twenty-three (85%) of the collagen studies utilized conduits, and four (15%) utilized wraps. Six (35%) of the hAM studies utilized conduits and 11 (65%) utilized wraps. Two (9%) collagen studies involving a conduit and one (25%) involving a wrap demonstrated at least one significant improvement in outcomes compared with a control. While none of the hAM conduit studies showed significant improvements, eight (73%) of the studies investigating hAM wraps showed at least one significant improvement in outcomes. CONCLUSION The majority of studies reported positive outcomes, indicating that collagen and hAM nerve wraps and conduits both have the potential to enhance peripheral nerve regeneration. However, relatively few studies reported significant findings, except for studies evaluating hAM wraps. Preclinical models may help guide clinical practice regarding applications of these biomaterials in peripheral nerve repair.
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Affiliation(s)
- Erin M Wolfe
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Sydney A Mathis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Steven A Ovadia
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Zubin J Panthaki
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida
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Effect of Collagen Nerve Wrapping in a Rabbit Peripheral Neuropathy Model. Plast Reconstr Surg Glob Open 2021; 9:e3919. [PMID: 35028256 PMCID: PMC8751765 DOI: 10.1097/gox.0000000000003919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
Background: Collagen nerve wraps (CNWs) theoretically allow for improved nerve gliding and decreased perineural scarring, and create a secluded environment to allow for nerve myelination and axonal healing. The goal of this study was to investigate the effect of CNWs on nerve gliding as assessed by pull-out strength and nerve changes in a rabbit model of peripheral neuropathy. Methods: Ten New Zealand rabbits were included. Sham surgery (control) was performed on left hindlimbs. To simulate compressive neuropathy, right sciatic nerves were freed of the mesoneurium, and the epineurium was sutured to the wound bed. Five rabbits were euthanized at 6 weeks [scarred nerve (SN); n = 5]. Neurolysis with CNW was performed in the remaining rabbits at 6 weeks (CNW; n = 5), which were euthanized at 22 weeks. Outcomes included peak pull-out force and histopathological markers of nerve recovery (axonal and Schwann cell counts). Results: The CNW group demonstrated significantly higher pull-out forces compared with the CNW sham control group (median: 4.40N versus 0.37N, P = 0.043) and a trend toward greater peak pull-out forces compared with the SN group (median: 4.40N versus 2.01N, P = 0.076). The CNW group had a significantly higher median Schwann cell density compared with the CNW control group (CNW: 1.30 × 10−3 cells/μm2 versus CNW control: 7.781 × 10−4 cells/μm2, P = 0.0431) and SN group (CNW: 1.30 × 10−3 cells/μm2 versus SN: 7.31 × 10−4 cells/μm2, P = 0.009). No significant difference in axonal density was observed between groups. Conclusion: Our findings suggest using a CNW does not improve nerve gliding, but may instead play a role in recruiting and/or supporting Schwann cells and their proliferation.
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de Lima GG, Júnior ELDS, Aggio BB, Shee BS, Filho EMDM, Segundo FADS, Fournet MB, Devine DM, Magalhães WLE, de Sá MJC. Nanocellulose for peripheral nerve regeneration in rabbits using citric acid as crosslinker with chitosan and freeze/thawed PVA. Biomed Mater 2021; 16. [PMID: 34330112 DOI: 10.1088/1748-605x/ac199b] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/30/2021] [Indexed: 12/12/2022]
Abstract
This work investigates peripheral nerve regeneration using membranes consisting of pure chitosan (CHI), which was further blended with nanofibrillated cellulose, with citric acid as crosslinker, with posterior addition of polyvinyl alcohol, with subsequent freeze thawing. Nanocellulose improves the mechanical and thermal resistance, as well as flexibility of the film, which is ideal for the surgical procedure. The hydrogel presented a slow rate of swelling, which is adequate for cell and drug delivery. A series ofin vitrotests revealed to be non-toxic for neuronal Schwann cell from the peripheral nervous system of Rattus norvegicus, while there was a slight increase in toxicity if crosslink is performed-freeze-thaw. Thein vivoresults, using rabbits with a 5 mm gap nerve defect, revealed that even though pure CHI was able to regenerate the nerve, it did not present functional recovery with only the deep pain attribute being regenerated. When autologous implant was used jointly with the biomaterial membrane, as a covering agent, it revealed a functional recovery within 15 d when cellulose and the hydrogel were introduced, which was attributed to the film charge interaction that may help influence the neuronal axons growth into correct locations. Thus, indicating that this system presents ideal regeneration as nerve conduits.
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Affiliation(s)
- Gabriel G de Lima
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Emílio L de S Júnior
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Bruno B Aggio
- Departamento de Química, Universidade Federal do Paraná, Curitiba, Paraná, Brazil
| | - Bor Shin Shee
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Emanuel M de M Filho
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Francisco A de S Segundo
- Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
| | - Margaret B Fournet
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Declan M Devine
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Washington L E Magalhães
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Embrapa Florestas, Colombo, Brazil
| | - Marcelo J C de Sá
- Programa de Pós-Graduação em Engenharia e Ciência dos Materiais-PIPE, Universidade Federal do Paraná, Curitiba, PR, Brazil.,Programa de Pós-Graduação em Medicina Veterinária-PPGMV, Universidade Federal de Campina Grande, Campina Grande PB, Brazil
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Saffari S, Saffari TM, Moore AM, Shin AY. Peripheral Nerve Basic Science Research-What Is Important for Hand Surgeons to Know? J Hand Surg Am 2021; 46:608-618. [PMID: 33867203 DOI: 10.1016/j.jhsa.2021.02.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/19/2020] [Accepted: 02/16/2021] [Indexed: 02/02/2023]
Abstract
Peripheral nerve injury and regeneration continue to be extensively studied through basic science research using animal models. A translational gap remains between basic science research and clinical application. The importance of peripheral nerve regeneration in basic science research depends on the design of the study, the outcome measures, and the time of regeneration selected. The purpose of this article is to provide an overview of the importance of the design and outcome measures of peripheral nerve basic science research, for hand surgeons to understand for potential clinical translation.
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Affiliation(s)
- Sara Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic, Reconstructive, and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Tiam M Saffari
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN; Department of Plastic, Reconstructive, and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Amy M Moore
- Department of Plastic and Reconstructive Surgery, Ohio State University, Columbus, OH
| | - Alexander Y Shin
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
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Li Q, Li L, Yu M, Zheng M, Li Y, Yang J, Dai M, Zhong L, Sun L, Lu D. Elastomeric polyurethane porous film functionalized with gastrodin for peripheral nerve regeneration. J Biomed Mater Res A 2020; 108:1713-1725. [PMID: 32196902 DOI: 10.1002/jbm.a.36937] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Qing Li
- Science and Technology Achievement Incubation CenterKunming Medical University Kunming China
| | - Limei Li
- Science and Technology Achievement Incubation CenterKunming Medical University Kunming China
| | - Mali Yu
- Science and Technology Achievement Incubation CenterKunming Medical University Kunming China
| | - Meng Zheng
- Science and Technology Achievement Incubation CenterKunming Medical University Kunming China
| | - Yao Li
- Department of StomatologyThe First People's Hospital of Yunnan Provience Kunming China
| | - Jian Yang
- Department of Biomedical EngineeringMaterials Research Institute, The Huck Institutes of The Life Sciences, The Pennsylvania State University University Park Pennsylvania USA
| | - Min Dai
- Department of Second CardiologyThe Third People's Hospital of Kunming Kunming China
| | - Lianmei Zhong
- Department of NeurologyThe First Affiliated Hospital, Kunming Medical University Kunming China
| | - Lin Sun
- Department of CardiologyThe Second Affiliated Hospital, Kunming Medical University Kunming China
| | - Di Lu
- Science and Technology Achievement Incubation CenterKunming Medical University Kunming China
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Farinas AF, Pollins AC, Stephanides M, O’Neill D, Al-Kassis S, Esteve IVM, Colazo JM, Keller PR, Rankin T, Wormer BA, Kaoutzanis C, Dortch RD, Thayer WP. Diffusion tensor tractography to visualize axonal outgrowth and regeneration in a 4-cm reverse autograft sciatic nerve rabbit injury model. Neurol Res 2019; 41:257-264. [PMID: 30582740 PMCID: PMC6435384 DOI: 10.1080/01616412.2018.1554284] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/24/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Diffusion tensor tractography (DTT) has recently been shown to accurately detect nerve injury and regeneration. This study assesses whether 7-tesla (7T) DTT imaging is a viable modality to observe axonal outgrowth in a 4 cm rabbit sciatic nerve injury model fixed by a reverse autograft (RA) surgical technique. METHODS Transection injury of unilateral sciatic nerve (4 cm long) was performed in 25 rabbits and repaired using a RA surgical technique. Analysis of the nerve autograft was performed at 3, 6, and 11 weeks postoperatively and compared to normal contralateral sciatic nerve, used as control group. High-resolution DTT from ex vivo sciatic nerves were obtained using 3D diffusion-weighted spin-echo acquisitions at 7-T. Total axons and motor and sensory axons were counted at defined lengths along the graft. RESULTS At 11 weeks, histologically, the total axon count of the RA group was equivalent to the contralateral uninjured nerve control group. Similarly, by qualitative DTT visualization, the 11-week RA group showed increased fiber tracts compared to the 3 and 6 weeks counterparts. Upon immunohistochemical evaluation, 11-week motor axon counts did not significantly differ between RA and control; but significantly decreased sensory axon counts remained. Nerves explanted at 3 weeks and 6 weeks showed decreased motor and sensory axon counts. DISCUSSION 7-T DTT is an effective imaging modality that may be used qualitatively to visualize axonal outgrowth and regeneration. This has implications for the development of technology that non-invasively monitors peripheral nerve regeneration in a variety of clinical settings.
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Affiliation(s)
- Angel F. Farinas
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
| | - Alonda C. Pollins
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
| | | | - Dillon O’Neill
- University of Utah, Department of Orthopedics, Salt Lake
City, UT
| | - Salam Al-Kassis
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
| | - Isaac V. Manzanera Esteve
- Vanderbilt University Medical Center, Department Radiology
and Radiological Sciences, Nashville, TN
- Vanderbilt University Medical Center, Institute of Imaging
Science, Nashville, TN
| | | | | | - Timothy Rankin
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
| | - Blair A. Wormer
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
| | | | - Richard D. Dortch
- Vanderbilt University, Department of Biomedical
Engineering, Nashville, TN
- Vanderbilt University Medical Center, Department Radiology
and Radiological Sciences, Nashville, TN
- Vanderbilt University Medical Center, Institute of Imaging
Science, Nashville, TN
| | - Wesley P. Thayer
- Vanderbilt University Medical Center, Department of Plastic
Surgery, Nashville, TN
- Vanderbilt University, Department of Biomedical
Engineering, Nashville, TN
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