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Alare K, Salam T, Abioye E, Utah F, Balogun O, Adedokun P, Moradeyo A, Adeniran-Yusuf A, Soyinka E, Egbo C, Alao A. The outcomes of peripheral nerve surgeries in Africa: Narrative synthesis from existing literature. Clin Neurol Neurosurg 2024; 244:108419. [PMID: 38986367 DOI: 10.1016/j.clineuro.2024.108419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND In Africa, peripheral nerve pathologies are a major source of disability, and the results of surgical therapies differ greatly among countries. The goal of this narrative review is to compile the most recent data on peripheral nerve surgery results in Africa, pinpoint critical variables that affect surgical outcomes, and offer suggestions for enhancing patient care. METHODS A comprehensive literature review was conducted, focusing on studies published over the past four decades. The sources included peer-reviewed journals, hospital records, and reports from healthcare organizations. The review examined outcomes related to functional recovery, quality of life, and postoperative complications. RESULTS The outcomes of peripheral nerve surgeries in Africa are influenced by the availability of medical infrastructure, the level of surgeon expertise, and the timeliness of the intervention. Urban centers with better resources tend to report more favorable outcomes, whereas rural areas face significant challenges. Common barriers include limited access to advanced surgical tools, a shortage of specialized surgeons, and inadequate postoperative care and rehabilitation services. Despite these challenges, successful interventions have been reported, particularly in settings where targeted training programs and international collaborations are in place. CONCLUSION Enhancing surgeon training programs, building comprehensive postoperative care and rehabilitation facilities, and investing in healthcare infrastructure are critical to improving peripheral nerve surgery results in Africa. International and regional collaborations can be extremely helpful in advancing these initiatives by enabling the sharing of knowledge and granting access to cutting-edge methods. Patients with peripheral nerve injuries across the continent may experience improved functional recovery and overall quality of life if these criteria are met.
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Affiliation(s)
- Kehinde Alare
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
| | - Temiloluwa Salam
- Department of Medicine, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Elishama Abioye
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Francisca Utah
- Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Nigeria
| | - Opeyemi Balogun
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Precious Adedokun
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria
| | - Abdulrahmon Moradeyo
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | | | | | | | - Adedoyin Alao
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Huang LX, Sun T, Sun J, Wu ZM, Ling C, Zhang BY, Chen C, Wang H. Non-Coding RNA in Schwann Cell and Peripheral Nerve Injury: A Review. Adv Biol (Weinh) 2024:e2400357. [PMID: 39185790 DOI: 10.1002/adbi.202400357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/28/2024] [Indexed: 08/27/2024]
Abstract
Peripheral nerve injury (PNI) can result in severe disabilities, profoundly impacting patients' quality of life and potentially endangering their lives. Therefore, understanding the potential molecular mechanisms that facilitate the regeneration of damaged nerves is crucial. Evidence indicates that Schwann cells (SCs) play a pivotal role in repairing peripheral nerve injuries. Previous studies have shown that RNA, particularly non-coding RNA (ncRNA), plays a crucial role in nerve regeneration, including the proliferation and dedifferentiation of SCs. In this review, the individual roles of ncRNA in SCs and PNI are analyzed. This review not only enhances the understanding of ncRNA's role in nerve injury repair but also provides a significant theoretical foundation and inspiration for the development of new therapeutic strategies.
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Affiliation(s)
- Li-Xin Huang
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Tao Sun
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Jun Sun
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Zhi-Min Wu
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Cong Ling
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Bao-Yu Zhang
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Chuan Chen
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
| | - Hui Wang
- Department of Neurosurgery, The Third Affiliated Hospital, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China
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Kou Y, Yuan Y, Li Q, Xie W, Xu H, Han N. Neutrophil peptide 1 accelerates the clearance of degenerative axons during Wallerian degeneration by activating macrophages after peripheral nerve crush injury. Neural Regen Res 2024; 19:1822-1827. [PMID: 38103249 PMCID: PMC10960303 DOI: 10.4103/1673-5374.387978] [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: 10/31/2022] [Revised: 01/18/2023] [Accepted: 08/29/2023] [Indexed: 12/18/2023] Open
Abstract
JOURNAL/nrgr/04.03/01300535-202408000-00036/figure1/v/2023-12-16T180322Z/r/image-tiff Macrophages play an important role in peripheral nerve regeneration, but the specific mechanism of regeneration is still unclear. Our preliminary findings indicated that neutrophil peptide 1 is an innate immune peptide closely involved in peripheral nerve regeneration. However, the mechanism by which neutrophil peptide 1 enhances nerve regeneration remains unclear. This study was designed to investigate the relationship between neutrophil peptide 1 and macrophages in vivo and in vitro in peripheral nerve crush injury. The functions of RAW 264.7 cells were elucidated by Cell Counting Kit-8 assay, flow cytometry, migration assays, phagocytosis assays, immunohistochemistry and enzyme-linked immunosorbent assay. Axonal debris phagocytosis was observed using the CUBIC (Clear, Unobstructed Brain/Body Imaging Cocktails and Computational analysis) optical clearing technique during Wallerian degeneration. Macrophage inflammatory factor expression in different polarization states was detected using a protein chip. The results showed that neutrophil peptide 1 promoted the proliferation, migration and phagocytosis of macrophages, and CD206 expression on the surface of macrophages, indicating M2 polarization. The axonal debris clearance rate during Wallerian degeneration was enhanced after neutrophil peptide 1 intervention. Neutrophil peptide 1 also downregulated inflammatory factors interleukin-1α, -6, -12, and tumor necrosis factor-α in vivo and in vitro. Thus, the results suggest that neutrophil peptide 1 activates macrophages and accelerates Wallerian degeneration, which may be one mechanism by which neutrophil peptide 1 enhances peripheral nerve regeneration.
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Affiliation(s)
- Yuhui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
- National Center for Trauma Medicine, Beijing, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
| | - Yusong Yuan
- Department of Orthopedics, China-Japan Friendship Hospital, Beijing, China
| | - Qicheng Li
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
| | - Wenyong Xie
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
| | - Hailin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Beijing, China
- National Center for Trauma Medicine, Beijing, China
| | - Na Han
- National Center for Trauma Medicine, Beijing, China
- Key Laboratory of Trauma and Neural Regeneration (Peking University), Ministry of Education, Beijing, China
- Department of Central Laboratory and Institute of Clinical Molecular Biology, Peking University People's Hospital, Beijing, China
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Debenham MIB, Franz CK, Berger MJ. Neuromuscular consequences of spinal cord injury: New mechanistic insights and clinical considerations. Muscle Nerve 2024; 70:12-27. [PMID: 38477416 DOI: 10.1002/mus.28070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024]
Abstract
The spinal cord facilitates communication between the brain and the body, containing intrinsic systems that work with lower motor neurons (LMNs) to manage movement. Spinal cord injuries (SCIs) can lead to partial paralysis and dysfunctions in muscles below the injury. While traditionally this paralysis has been attributed to disruptions in the corticospinal tract, a growing body of work demonstrates LMN damage is a factor. Motor units, comprising the LMN and the muscle fibers with which they connect, are essential for voluntary movement. Our understanding of their changes post-SCI is still emerging, but the health of motor units is vital, especially when considering innovative SCI treatments like nerve transfer surgery. This review seeks to collate current literature on how SCI impact motor units and explore neuromuscular clinical implications and treatment avenues. SCI reduced motor unit number estimates, and surviving motor units had impaired signal transmission at the neuromuscular junction, force-generating capacity, and excitability, which have the potential to recover chronically, yet the underlaying mechanisms are unclear. Furthermore, electrodiagnostic evaluations can aid in assessing the health lower and upper motor neurons, identify suitable targets for nerve transfer surgeries, and detect patients with time sensitive injuries. Lastly, many electrodiagnostic abnormalities occur in both chronic and acute SCI, yet factors contributing to these abnormalities are unknown. Future studies are required to determine how motor units adapt following SCI and the clinical implications of these adaptations.
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Affiliation(s)
- Mathew I B Debenham
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colin K Franz
- Biologics Laboratory, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Zhang Y, Xu T, Xie J, Wu H, Hu W, Yuan X. MSC-derived mitochondria promote axonal regeneration via Atf3 gene up-regulation by ROS induced DNA double strand breaks at transcription initiation region. Cell Commun Signal 2024; 22:240. [PMID: 38664711 PMCID: PMC11046838 DOI: 10.1186/s12964-024-01617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The repair of peripheral nerve injury poses a clinical challenge, necessitating further investigation into novel therapeutic approaches. In recent years, bone marrow mesenchymal stromal cell (MSC)-derived mitochondrial transfer has emerged as a promising therapy for cellular injury, with reported applications in central nerve injury. However, its potential therapeutic effect on peripheral nerve injury remains unclear. METHODS We established a mouse sciatic nerve crush injury model. Mitochondria extracted from MSCs were intraneurally injected into the injured sciatic nerves. Axonal regeneration was observed through whole-mount nerve imaging. The dorsal root ganglions (DRGs) corresponding to the injured nerve were harvested to test the gene expression, reactive oxygen species (ROS) levels, as well as the degree and location of DNA double strand breaks (DSBs). RESULTS The in vivo experiments showed that the mitochondrial injection therapy effectively promoted axon regeneration in injured sciatic nerves. Four days after injection of fluorescently labeled mitochondria into the injured nerves, fluorescently labeled mitochondria were detected in the corresponding DRGs. RNA-seq and qPCR results showed that the mitochondrial injection therapy enhanced the expression of Atf3 and other regeneration-associated genes in DRG neurons. Knocking down of Atf3 in DRGs by siRNA could diminish the therapeutic effect of mitochondrial injection. Subsequent experiments showed that mitochondrial injection therapy could increase the levels of ROS and DSBs in injury-associated DRG neurons, with this increase being correlated with Atf3 expression. ChIP and Co-IP experiments revealed an elevation of DSB levels within the transcription initiation region of the Atf3 gene following mitochondrial injection therapy, while also demonstrating a spatial proximity between mitochondria-induced DSBs and CTCF binding sites. CONCLUSION These findings suggest that MSC-derived mitochondria injected into the injured nerves can be retrogradely transferred to DRG neuron somas via axoplasmic transport, and increase the DSBs at the transcription initiation regions of the Atf3 gene through ROS accumulation, which rapidly release the CTCF-mediated topological constraints on chromatin interactions. This process may enhance spatial interactions between the Atf3 promoter and enhancer, ultimately promoting Atf3 expression. The up-regulation of Atf3 induced by mitochondria further promotes the expression of downstream regeneration-associated genes and facilitates axon regeneration.
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Affiliation(s)
- Yingchi Zhang
- Department of Traumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China
| | - Tao Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China
| | - Jie Xie
- Department of Traumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China
| | - Hua Wu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China
| | - Weihua Hu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China.
| | - Xuefeng Yuan
- Department of Traumatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue 1095, Wuhan, Hubei, 430030, People's Republic of China.
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Yang F, Chen L, Wang H, Zhang J, Shen Y, Qiu Y, Qu Z, Li J, Xu W. Combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for treating limb hemiplegia after stroke. Br J Neurosurg 2024; 38:510-513. [PMID: 33843383 DOI: 10.1080/02688697.2021.1910764] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contralateral C7 to C7 cross nerve transfer has been proved to be safe and effective for patients with spastic arm paralysis due to stroke and traumatic brain injury. For the lower limb, contralateral L5 to S1 cross nerve transfer serves as a novel surgical approach. In many cases, patients with hemiplegia have both upper and lower limb dysfunction and hope to restore all limb functions within one operation. To cope with this demand, we performed combined contralateral C7 to C7 and L5 to S1 cross nerve transfer in two cases successfully. CASE DESCRIPTION Two patients were enrolled in this study. The first patient is a 36-year-old woman who had spasticity and hemiplegia in both upper and lower limbs on the left side after a right cerebral hemorrhage 14 years prior. The second patient is a 64-year-old man who suffered from permanent muscle weakness in his right limbs, especially the leg, after a left cerebral hemorrhage 7 years prior. Both patients underwent the combined nerve transfer to improve upper and lower limb motor functions simultaneously. During the 10-month follow-up after surgery, the limb functions of both patients improved significantly. CONCLUSIONS This study demonstrates the safety and benefits of combined contralateral C7 to C7 and L5 to S1 cross nerve transfer for hemiplegic patients after stroke. This novel combined surgical approach could provide an optimal choice for patients suffering from both upper and lower limb dysfunction, to reduce hospital stay while reducing financial burden.
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Affiliation(s)
- Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liwen Chen
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Haipeng Wang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Jionghao Zhang
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Yundong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Yanqun Qiu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Zhiwei Qu
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- Department of Orthopedics, Jing'an District Center Hospital, Shanghai, China
| | - Jie Li
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China
- Shanghai Clinical Medical Center for Limb Function Reconstruction, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, China, Shanghai
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Tang H, Li J, Wang H, Ren J, Ding H, Shang J, Wang M, Wei Z, Feng S. Human umbilical cord mesenchymal stem cell-derived exosomes loaded into a composite conduit promote functional recovery after peripheral nerve injury in rats. Neural Regen Res 2024; 19:900-907. [PMID: 37843227 PMCID: PMC10664107 DOI: 10.4103/1673-5374.380911] [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: 01/17/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 10/17/2023] Open
Abstract
Complete transverse injury of peripheral nerves is challenging to treat. Exosomes secreted by human umbilical cord mesenchymal stem cells are considered to play an important role in intercellular communication and regulate tissue regeneration. In previous studies, a collagen/hyaluronic acid sponge was shown to provide a suitable regeneration environment for Schwann cell proliferation and to promote axonal regeneration. This three-dimensional (3D) composite conduit contains a collagen/hyaluronic acid inner sponge enclosed in an electrospun hollow poly (lactic-co-glycolic acid) tube. However, whether there is a synergy between the 3D composite conduit and exosomes in the repair of peripheral nerve injury remains unknown. In this study, we tested a comprehensive strategy for repairing long-gap (10 mm) peripheral nerve injury that combined the 3D composite conduit with human umbilical cord mesenchymal stem cell-derived exosomes. Repair effectiveness was evaluated by sciatic functional index, sciatic nerve compound muscle action potential recording, recovery of muscle mass, measuring the cross-sectional area of the muscle fiber, Masson trichrome staining, and transmission electron microscopy of the regenerated nerve in rats. The results showed that transplantation of the 3D composite conduit loaded with human umbilical cord mesenchymal stem cell-derived exosomes promoted peripheral nerve regeneration and restoration of motor function, similar to autograft transplantation. More CD31-positive endothelial cells were observed in the regenerated nerve after transplantation of the loaded conduit than after transplantation of the conduit without exosomes, which may have contributed to the observed increase in axon regeneration and distal nerve reconnection. Therefore, the use of a 3D composite conduit loaded with human umbilical cord mesenchymal stem cell-derived exosomes represents a promising cell-free therapeutic option for the treatment of peripheral nerve injury.
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Affiliation(s)
- Haoshuai Tang
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Junjin Li
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongda Wang
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Ren
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Han Ding
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Shang
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Min Wang
- Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhijian Wei
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
- Department of Othopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Othopedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong Province, China
- Orthopedic Research Center of Shandong University & Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Shiqing Feng
- Department of Othopaedics, Tianjin Medical University General Hospital, Tianjin, China
- International Science and Technology Cooperation Base of Spinal Cord Injury, Tianjin Key Laboratory of Spine and Spinal Cord Injury, Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
- Department of Othopaedics, Qilu Hospital of Shandong University, Shandong University Centre for Othopedics, Advanced Medical Research Institute, Shandong University, Jinan, Shandong Province, China
- Orthopedic Research Center of Shandong University & Advanced Medical Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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Wang X, Hu S, Ouyang S, Pan X, Fu Y, Chen X, Wu S. TsMS combined with EA promotes functional recovery and axonal regeneration via mediating the miR-539-5p/Sema3A/PlexinA1 signalling axis in sciatic nerve-injured rats. Neurosci Lett 2024; 824:137691. [PMID: 38373630 DOI: 10.1016/j.neulet.2024.137691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
Enhancing axonal regeneration is one of the most important processes in treating nerve injuries. Both magnetic and electrical stimulation have the effect of promoting nerve axon regeneration. But few study has investigated the effects of trans-spinal magnetic stimulation (TsMS) combined with electroacupuncture (EA) on nerve regeneration in rats with sciatic nerve injury. In this study, we compared the improvement of neurological function in rats with sciatic nerve crush injuries after 4 weeks of different interventions (EA, TsMS, or TsMS combined with EA). We further explored the morphological and molecular biological alterations following sciatic nerve injury by HE, Masson, RT-PCR, western blotting, immunofluorescence staining and small RNA transcriptome sequencing. The results showed that TsMS combined with EA treatment significantly promoted axonal regeneration, increased the survival rate of neurons, and suppressed denervation atrophy of the gastrocnemius muscle. Subsequent experiments suggested that the combination treatment may play an active role by mediating the miR-539-5p/Sema3A/PlexinA1 signaling axis.
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Affiliation(s)
- Xianbin Wang
- Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Yunyan District, Guiyang, Guizhou, China; Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Shouxing Hu
- Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Shuai Ouyang
- Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Xiao Pan
- Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Yingxue Fu
- Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Xingyu Chen
- Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China
| | - Shuang Wu
- Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Yunyan District, Guiyang, Guizhou, China; Guizhou Medical University, 9 Beijing Street, Yunyan District, Guiyang, Guizhou, China.
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Gantiwala S, Hamidian Jahromi A, Konofaos P. A Historical Perspective on Brachial Plexus Palsy Management: From Ancient Civilizations to the Modern Era. J Craniofac Surg 2024; 35:33-38. [PMID: 37791800 DOI: 10.1097/scs.0000000000009669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/26/2023] [Indexed: 10/05/2023] Open
Abstract
Evidence of brachial plexus palsies and potential therapies have been identified by investigators across cultures and civilizations. It could be argued that there are early records of brachial plexus injuries in not only literary work but also paintings, sculptures, and ancient medical texts. The compiled ancient evidence in this review provides a historical framework of brachial plexus palsies and potential management techniques that have been utilized from ancient to modern time.
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Affiliation(s)
| | | | - Petros Konofaos
- Department of Plastic and Reconstructive Surgery, University of Texas Medical Branch (UTMB), Galveston, TX
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10
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Umansky D, Elzinga K, Midha R. Surgery for mononeuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:227-249. [PMID: 38697743 DOI: 10.1016/b978-0-323-90108-6.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Advancement in microsurgical techniques and innovative approaches including greater use of nerve and tendon transfers have resulted in better peripheral nerve injury (PNI) surgical outcomes. Clinical evaluation of the patient and their injury factors along with a shift toward earlier time frame for intervention remain key. A better understanding of the pathophysiology and biology involved in PNI and specifically mononeuropathies along with advances in ultrasound and magnetic resonance imaging allow us, nowadays, to provide our patients with a logical and sophisticated approach. While functional outcomes are constantly being refined through different surgical techniques, basic scientific concepts are being advanced and translated to clinical practice on a continuous basis. Finally, a combination of nerve transfers and technological advances in nerve/brain and machine interfaces are expanding the scope of nerve surgery to help patients with amputations, spinal cord, and brain lesions.
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Affiliation(s)
- Daniel Umansky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Kate Elzinga
- Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Chu TH, Alzahrani S, McConnachie A, Lasaleta N, Kalifa A, Pathiyil R, Midha R. Perineurial Window is Critical for Experimental Reverse End-to-Side Nerve Transfer. Neurosurgery 2023; 93:952-960. [PMID: 37018413 DOI: 10.1227/neu.0000000000002481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/08/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND The depth of connective tissue window in the side of a recipient nerve in reverse end-to-side transfers (RETS) remains controversial. OBJECTIVE To test whether the depth of connective tissue disruption influences the efficiency of donor axonal regeneration in the context of RETS. METHODS Sprague-Dawley rats (n = 24) were assigned to 1 of the 3 groups for obturator nerve to motor femoral nerve RETS: group 1, without epineurium opening; group 2, with epineurium only opening; and group 3, with epineurium and perineurium opening. Triple retrograde labeling was used to assess the number of motor neurons that had regenerated into the recipient motor femoral branch. Thy1-GFP rats (n = 8) were also used to visualize the regeneration pathways in the nerve transfer networks at 2- and 8-week time point using light sheet fluorescence microscopy. RESULTS The number of retrogradely labeled motor neurons that had regenerated distally toward the target muscle was significantly higher in group 3 than that in groups 1 and 2. Immunohistochemistry validated the degree of connective tissue disruption among the 3 groups, and optical tissue clearing methods demonstrated donor axons traveling outside the fascicles in groups 1 and 2 but mostly within the fascicles in group 3. CONCLUSION Creating a perineurial window in the side of recipient nerves provides the best chances of robust donor axonal regeneration across the RETS repair site. This finding aids nerve surgeons by confirming that a deep window should be undertaken when doing a RETS procedure.
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Affiliation(s)
- Tak-Ho Chu
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Saud Alzahrani
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Amanda McConnachie
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Nicolas Lasaleta
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Amira Kalifa
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Rajesh Pathiyil
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, University of Calgary, Calgary , Alberta , Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary , Alberta , Canada
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12
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Fasce I, Fiaschi P, Bianconi A, Sacco C, Staffa G, Capone C. Long-term functional recovery in C5-C6 avulsions treated with distal nerve transfers. Neurol Res 2023; 45:867-873. [PMID: 34193028 DOI: 10.1080/01616412.2021.1942410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND In patients suffering from traction lesions of the brachial plexus, complete C5 and/or C6 root avulsion patients with C7 root preservation are relatively uncommon occurrences, but represent excellent candidates for surgical treatment, with satisfactory results. Shoulder abduction and extra-rotation, elbow flexion and forearm supination are lost functions restorable with surgical treatment. METHODS This single-center, prospective observational study involved a series of 27 young adults with C5 and/or C6 root complete avulsion and C7 preservation, which underwent surgical repair with double or triple nerve transfer. RESULTS Patients recovered a useful elbow flexion. Electromyographic and clinical signs of biceps reinnervation were observed in each UN-MC nerve transfer. The abduction strength recovery was M5 in 10 patients, M4 in 14 patients and M3 in 3 patients. The external rotation strength recovery was M5 in 4 patients, M4 in 18 patients, M3 in 3 patients and M2 in 2 patients. The elbow flection strength was M5 in 5 patients, M4 in 15 patients and M3 in 7 patients. Elbow extension was preserved in all cases. CONCLUSIONS The concept of 'peripheral rewiring procedures' represents an advance in the repair of the peripheral nerve injuries. Triple nerve transfer can be nowadays considered a standard treatment for isolated C5-C6 avulsions. We report our experience with the second-biggest casuistry in the literature on patients treated with this technique. We consider our outcome concerning functional recovery to be satisfying and comparable to data reported in the literature.
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Affiliation(s)
- Irene Fasce
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Università di Genova, Genova, Italy
| | - Pietro Fiaschi
- Department of Neurosurgery, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Università di Genova, Genova, Italy
| | - Andrea Bianconi
- Department of Neurosurgery, Università Degli Studi dI Torino, Torino, Italy
| | - Carlo Sacco
- Department of Peripheral Nerve Surgery, Ospedale Civile Degli Infermi, Faenza, Italy
| | - Guido Staffa
- Department of Peripheral Nerve Surgery, Ospedale Civile Degli Infermi, Faenza, Italy
| | - Crescenzo Capone
- Department of Peripheral Nerve Surgery, Ospedale Civile Degli Infermi, Faenza, Italy
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13
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Nemati Mahand S, Jahanmardi R, Kruppke B, Khonakdar HA. Sciatic nerve injury regeneration in adult male rats using gelatin methacrylate (GelMA)/poly(2-ethy-2-oxazoline) (PEtOx) hydrogel containing 4-aminopyridine (4-AP). J Biomed Mater Res A 2023; 111:1243-1252. [PMID: 36808867 DOI: 10.1002/jbm.a.37514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 01/02/2023] [Accepted: 02/06/2023] [Indexed: 02/22/2023]
Abstract
One of the most important parts of the body is the peripheral nervous system, and any injuries in this system may result in potentially lethal consequences or severe side effects. The peripheral nervous system may not rehabilitate the harmed regions following disabling disorders, which reduce the quality of life of patients. Fortunately, in recent years, hydrogels have been proposed as exogenous alternatives to bridge damaged nerve stumps to create a useful microenvironment for advancing nerve recovery. However, hydrogel-based medicine in the therapy of peripheral nerve injury still needs a lot of improvement. In this study, GelMA/PEtOx hydrogel was used for the first time to deliver 4-Aminopyridine (4-AP) small molecules. 4-AP is a broad-spectrum potassium channel blocker, which has been demonstrated to increase neuromuscular function in patients with various demyelinating disorders. The prepared hydrogel showed a porosity of 92.2 ± 2.6% after 20 min, swelling ratio of 456.01 ± 2.0% after 180 min, weight loss of 81.7 ± 3.1% after 2 weeks, and good blood compatibility as well as sustainable drug release. MTT analysis was performed to assess the cell viability of the hydrogel and proved that the hydrogel is an appropriate substrate for the survival of cells. In vivo studies were performed for functional analysis and the sciatic functional index (SFI) as well as hot plate latency results showed that the use of GelMA/PEtOx+4-AP hydrogel enhances the regeneration compared to the GelMA/PEtOx hydrogel and the control group.
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Affiliation(s)
- Saba Nemati Mahand
- Department of Polymer Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Reza Jahanmardi
- Department of Polymer Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Benjamin Kruppke
- Max Bergmann Center of Biomaterials and Institute of Materials Science, Technische Universität Dresden, Dresden, Germany
| | - Hossein Ali Khonakdar
- Max Bergmann Center of Biomaterials and Institute of Materials Science, Technische Universität Dresden, Dresden, Germany
- Department of Polymer Processing, Iran Polymer and Petrochemical Institute, Tehran, Iran
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14
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Yu E, Chen Z, Huang Y, Wu Y, Wang Z, Wang F, Wu M, Xu K, Peng W. A grooved conduit combined with decellularized tissues for peripheral nerve regeneration. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:35. [PMID: 37477830 PMCID: PMC10361901 DOI: 10.1007/s10856-023-06737-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 07/01/2023] [Indexed: 07/22/2023]
Abstract
Peripheral nerve injury (PNI) is a common and severe clinical disease worldwide, which leads to a poor prognosis because of the complicated treatments and high morbidity. Autologous nerve grafting as the gold standard still cannot meet the needs of clinical nerve transplantation because of its low availability and limited size. The development of artificial nerve conduits was led to a novel direction for PNI treatment, while most of the currently developed artificial nerve conduits was lack biochemical cues to promote nerve regeneration. In this study, we designed a novel composite neural conduit by inserting decellularized the rat sciatic nerve or kidney in a poly (lactic-co-glycolic acid) (PLGA) grooved conduit. The nerve regeneration effect of all samples was analyzed using rat sciatic nerve defect model, where decellularized tissues and grooved PLGA conduit alone were used as controls. The degree of nerve regeneration was evaluated using the motor function, gastrocnemius recovery, and morphological and histological assessments suggested that the combination of a grooved conduit with decellularized tissues significantly promoted nerve regeneration compared with decellularized tissues and PLGA conduit alone. It is worth to note that the grooved conduits containing decellularized nerves have a promotive effect similar to that of autologous nerve grafting, suggesting that it could be an artificial nerve conduit used for clinical practice in the future.
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Affiliation(s)
- Enxing Yu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Zhiwu Chen
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Yuye Huang
- Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Yibing Wu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Zonghuan Wang
- Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Fangfang Wang
- Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China
| | - Miaoben Wu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Kailei Xu
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
- Center for Medical and Engineering Innovation, Central Laboratory, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
- Key Laboratory of Precision Medicine for Atherosclerotic Diseases of Zhejiang Province, Ningbo, Zhejiang, 315010, China.
| | - Wei Peng
- Department of Plastic and reconstructive surgery, The First Affiliated Hospital, Ningbo University School of Medicine, Ningbo, Zhejiang, 315010, China.
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15
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Pathiyil RK, Alzahrani S, Midha R. Reverse End-to-Side Transfer to Ulnar Motor Nerve: Evidence From Preclinical and Clinical Studies. Neurosurgery 2023; 92:667-679. [PMID: 36757319 DOI: 10.1227/neu.0000000000002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/26/2022] [Indexed: 02/10/2023] Open
Abstract
The disappointing outcomes of conventional nerve repair or grafting procedures for proximal ulnar nerve injuries have led the scientific community to search for better alternatives. The pronator quadratus branch of the anterior interosseous nerve has been transferred to the distal ulnar motor branch in a reverse end-to-side fashion with encouraging results. This transfer is now becoming commonly used as an adjunct to cubital tunnel decompression in patients with compressive ulnar neuropathy, underscoring the need for this knowledge transfer to the neurosurgical community. However, the mechanism of recovery after these transfers is not understood completely. We have reviewed the existing preclinical and clinical literature relevant to this transfer to summarize the current level of understanding of the underlying mechanisms, define the indications for performing this transfer in the clinic, and identify the complications and best practices with respect to the operative technique. We have also attempted to identify the major deficiencies in our current level of understanding of the recovery process to propose directions for future research.
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Affiliation(s)
- Rajesh Krishna Pathiyil
- Department of Clinical Neurosciences and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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16
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Alzahrani S, Brito da Silva H, Chu TH, Tariq Z, Umansky D, Elliott DA, Midha R. Successful retrograde regeneration using a sensory branch for motor nerve transfer. J Neurosurg 2023; 138:858-867. [PMID: 35907191 DOI: 10.3171/2022.6.jns22734] [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: 03/29/2022] [Accepted: 06/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to test whether regenerating motor axons from a donor nerve can travel in a retrograde fashion using sensory branches to successfully reinnervate a motor nerve end organ. METHODS This study has two parts. In part I, rats (n = 30) were assigned to one of five groups for obturator nerve (ON)-to-femoral nerve transfer: group 1, ON-to-saphenous nerve (SN) distal stump; group 2, ON-to-SN proximal stump without femoral nerve proper (FNP) injury; group 3, ON-to-SN proximal stump with FNP crush injury; group 4, ON-to-SN proximal stump with FNP transection injury; and group 5, gold standard transfer, ON-to-motor femoral nerve (MFN) branch. At 8 weeks, retrograde labeling was done from the distal MFN, and the spinal cords were examined to assess the degree of obturator motor axon regeneration across the five groups. In part II, only group 4 was examined (n = 8). Through use of immunostaining and optical tissue clearing methods, the nerve transfer networks were cleared and imaged using light-sheet fluorescence microscopy to visualize the regeneration pathways in 2D and 3D models at 2- and 8-week time points. RESULTS Proximal FNP transection (group 4) enabled a significantly higher number of retrogradely regenerated motor axons compared with control groups 1-3. Moreover, group 4 had modest, but nonsignificant, superiority of motor neuron counts compared with the positive control group, group 5. Optical tissue clearing demonstrated that the axons traveled in a retrograde fashion from the recipient sensory branch to the FNP mixed stump, then through complex turns, down to distal branches. Immunostaining confirmed the tissue clearing findings and suggested perineurium disruption as a means by which axons could traverse across fascicular boundaries. CONCLUSIONS Sensory branches can transmit regenerating axons from donor nerves back to main mixed recipient nerves, then distally toward target organs. The extent of retrograde regeneration is markedly influenced by the type and severity of injury sustained by the recipient nerve. Using a sensory branch as a bridge for retrogradely regenerating axons can open new potential horizons in nerve repair surgery for severely injured mixed nerves.
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Affiliation(s)
- Saud Alzahrani
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
| | - Harley Brito da Silva
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
| | - Tak-Ho Chu
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
| | - Zain Tariq
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
| | - Daniel Umansky
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
| | - David A Elliott
- 3Hotchkiss Brain Institute Advanced Microscopy Platform, University of Calgary, Alberta, Canada
| | - Rajiv Midha
- 1Department of Clinical Neurosciences, University of Calgary.,2Hotchkiss Brain Institute, University of Calgary
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17
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Brennan R, Carter J, Gonzalez G, Herrera FA. Primary Repair of Upper Extremity Peripheral Nerve Injuries: An NSQIP Analysis From 2010 to 2016. Hand (N Y) 2023; 18:154S-160S. [PMID: 34546145 PMCID: PMC9896278 DOI: 10.1177/15589447211044768] [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: 02/06/2023]
Abstract
BACKGROUND To identify the rate of 30-day complications after primary repair of upper extremity peripheral nerve injuries, associated diagnoses, and postoperative complication rate. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed from 2010 to 2016. Current Procedural Terminology codes consistent with primary nerve repair of the upper extremity were identified and included in the analysis. Patient demographics, comorbidities, type of procedure (elective/emergent), wound class, operative time, and 30-day complications were recorded. Patients with isolated upper extremity nerve injuries (isolated) were compared with those with peripheral nerve injuries in addition to bone, tendon, or soft tissue injuries (multiple). RESULTS In all, 785 patients were identified as having upper extremity nerve repairs (0.16%). Of them, 64% were men and 36% were women; the average patient age was 40 years. The most common indication for surgery was injury to the digits (54% of cases). Thirty-day adverse events occurred in 3% of all cases. Isolated nerve injury occurred in 43% of patients, whereas 57% had additional injuries. The multiple injury group had a significantly higher complication rate compared with the isolated group (1% vs 4.5%) (P = .007). Repair of tendon at forearm or wrist was the most common concurrent procedure performed. CONCLUSIONS Thirty-day complications among upper extremity peripheral nerve injuries are low, accounting for 3% of cases. Return to the operating room accounted for nearly half of all complications. Patients in the multiple injury group accounted for more than half of these and had a significantly higher complication rate compared with patients with isolated nerve injuries.
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Affiliation(s)
- Ryan Brennan
- University of Kansas School of
Medicine, Kansas City, USA
| | - Jordan Carter
- Texas Tech University Health Sciences
Center, El Paso, USA
| | | | - Fernando A. Herrera
- Medical University of South Carolina,
Charleston, USA
- Ralph H. Johnson VA Medical Center,
Charleston, SC, USA
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18
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Naum R, Gwathmey KG. Autoimmune polyneuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 195:587-608. [PMID: 37562888 DOI: 10.1016/b978-0-323-98818-6.00004-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The autoimmune peripheral neuropathies with prominent motor manifestations are a diverse collection of unusual peripheral neuropathies that are appreciated in vast clinical settings. This chapter highlights the most common immune-mediated, motor predominant neuropathies excluding acute, and chronic inflammatory demyelinating polyradiculoneuropathy (AIDP and CIDP, respectively). Other acquired demyelinating neuropathies such as distal CIDP and multifocal motor neuropathy will be covered. Additionally, the radiculoplexus neuropathies, resulting from microvasculitis-induced injury to nerve roots, plexuses, and nerves, including diabetic and nondiabetic lumbosacral radiculoplexus neuropathy and neuralgic amyotrophy (i.e., Parsonage-Turner syndrome), will be included. Finally, the motor predominant peripheral neuropathies encountered in association with rheumatological disease, particularly Sjögren's syndrome and rheumatoid arthritis, are covered. Early recognition of these distinct motor predominant autoimmune neuropathies and initiation of immunomodulatory and immunosuppressant treatment likely result in improved outcomes.
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Affiliation(s)
- Ryan Naum
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States
| | - Kelly Graham Gwathmey
- Neuromuscular Division, Department of Neurology, Virginia Commonwealth University, Richmond, VA, United States.
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19
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Abstract
ABSTRACT Magnetic resonance neurography of the brachial plexus (BP) is challenging owing to its complex anatomy and technical obstacles around this anatomic region. Magnetic resonance techniques to improve image quality center around increasing nerve-to-background contrast ratio and mitigating imaging artifacts. General considerations include unilateral imaging of the BP at 3.0 T, appropriate selection and placement of surface coils, and optimization of pulse sequences. Technical considerations to improve nerve conspicuity include fat, vascular, and respiratory artifact suppression techniques; metal artifact reduction techniques; and 3-dimensional sequences. Specific optimization of these techniques for BP magnetic resonance neurography greatly improves image quality and diagnostic confidence to help guide nonoperative and operative management.
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20
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Mayer J, Krug C, Saller M, Feuchtinger A, Giunta R, Volkmer E, Holzbach T. Hypoxic pre-conditioned adipose-derived stem/progenitor cells embedded in fibrin conduits promote peripheral nerve regeneration in a sciatic nerve graft model. Neural Regen Res 2023; 18:652-656. [DOI: 10.4103/1673-5374.346464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Saadeh YS, Chopra Z, Olsen E, Smith BW, Kashlan ON, Yang LJS, Park P. Optimal timing of referral for nerve transfer surgery for postoperative C5 palsy. J Neurosurg Spine 2022; 37:563-568. [PMID: 35426819 DOI: 10.3171/2022.3.spine2222] [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: 01/07/2022] [Accepted: 03/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical nerve 5 palsy can occur following surgery for cervical spine pathology. The prognosis of C5 palsy is generally favorable, and most patients recover useful function. However, some patients do not recover useful strength. Nerve transfers are a potential effective treatment of postoperative severe C5 palsy. This study aimed to further delineate the natural history of recovery from postoperative C5 palsy, determine whether lack of recovery at specific time points predicts poor recovery prognosis, and thereby determine a reasonable time point for referral to a complex peripheral nerve specialist. METHODS The authors conducted a retrospective review of 72 patients who underwent surgery for cervical spondylosis and stenosis complicated by C5 palsy. Medical Research Council (MRC) motor strength grades were recorded preoperatively; immediately postoperatively; at discharge; and at 2 weeks, 3 months, 6 months, and 12 months postoperatively. Univariate and multivariate logistic regression models were used to identify demographic and clinical risk factors associated with recovery of useful strength after severe C5 palsy. RESULTS The mean patient age was 62.5 years, and 36.1% of patients were female. Thirty patients (41.7%) experienced severe C5 palsy with less than antigravity strength (MRC grade 2 or less) at discharge. Twenty-one (70%) of these patients recovered useful strength (MRC grade 3 or greater) at 12 months postoperatively, and 9 patients (30%) did not recover useful strength at 12 months. Of those patients with persistent severe C5 palsy at 3 months postoperatively, 50% recovered useful strength at 12 months. Of those patients with persistent severe C5 palsy at 6 months postoperatively, 25% recovered useful strength at 12 months. No patient with MRC grade 0 or 1 strength at 6 months postoperatively recovered useful strength. A history of diabetes was associated with the occurrence of severe C5 palsy. On multivariate analysis, female sex was associated with recovery of useful strength. CONCLUSIONS Most patients with severe C5 palsy recover useful strength in their C5 myotome within 12 months of onset. However, at 3 months postoperatively, patients with persistent severe C5 palsy had only a 50% chance of recovering useful strength by 12 months. Lack of recovery of useful strength at 3 months postoperatively is a reasonable time point for referral to a complex peripheral nerve center to establish care and to determine candidacy for nerve transfer surgery if severe C5 palsy persists.
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Affiliation(s)
| | - Zoey Chopra
- 1Department of Neurosurgery and
- 2School of Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Eric Olsen
- 1Department of Neurosurgery and
- 2School of Medicine, University of Michigan, Ann Arbor, Michigan; and
| | - Brandon W Smith
- 3Department of Neurosurgery, Duke University, Durham, North Carolina
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22
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Chu XL, Song XZ, Li Q, Li YR, He F, Gu XS, Ming D. Basic mechanisms of peripheral nerve injury and treatment via electrical stimulation. Neural Regen Res 2022; 17:2185-2193. [PMID: 35259827 PMCID: PMC9083151 DOI: 10.4103/1673-5374.335823] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Previous studies on the mechanisms of peripheral nerve injury (PNI) have mainly focused on the pathophysiological changes within a single injury site. However, recent studies have indicated that within the central nervous system, PNI can lead to changes in both injury sites and target organs at the cellular and molecular levels. Therefore, the basic mechanisms of PNI have not been comprehensively understood. Although electrical stimulation was found to promote axonal regeneration and functional rehabilitation after PNI, as well as to alleviate neuropathic pain, the specific mechanisms of successful PNI treatment are unclear. We summarize and discuss the basic mechanisms of PNI and of treatment via electrical stimulation. After PNI, activity in the central nervous system (spinal cord) is altered, which can limit regeneration of the damaged nerve. For example, cell apoptosis and synaptic stripping in the anterior horn of the spinal cord can reduce the speed of nerve regeneration. The pathological changes in the posterior horn of the spinal cord can modulate sensory abnormalities after PNI. This can be observed in cases of ectopic discharge of the dorsal root ganglion leading to increased pain signal transmission. The injured site of the peripheral nerve is also an important factor affecting post-PNI repair. After PNI, the proximal end of the injured site sends out axial buds to innervate both the skin and muscle at the injury site. A slow speed of axon regeneration leads to low nerve regeneration. Therefore, it can take a long time for the proximal nerve to reinnervate the skin and muscle at the injured site. From the perspective of target organs, long-term denervation can cause atrophy of the corresponding skeletal muscle, which leads to abnormal sensory perception and hyperalgesia, and finally, the loss of target organ function. The mechanisms underlying the use of electrical stimulation to treat PNI include the inhibition of synaptic stripping, addressing the excessive excitability of the dorsal root ganglion, alleviating neuropathic pain, improving neurological function, and accelerating nerve regeneration. Electrical stimulation of target organs can reduce the atrophy of denervated skeletal muscle and promote the recovery of sensory function. Findings from the included studies confirm that after PNI, a series of physiological and pathological changes occur in the spinal cord, injury site, and target organs, leading to dysfunction. Electrical stimulation may address the pathophysiological changes mentioned above, thus promoting nerve regeneration and ameliorating dysfunction.
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Affiliation(s)
- Xiao-Lei Chu
- Academy of Medical Engineering and Translational Medicine, Tianjin University; Department of Rehabilitation, Tianjin Hospital, Tianjin, China
| | - Xi-Zi Song
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Qi Li
- Academy of Medical Engineering and Translational Medicine, Tianjin University; Department of Rehabilitation, Tianjin Hospital, Tianjin, China
| | - Yu-Ru Li
- College of Exercise & Health Sciences, Tianjin University of Sport, Tianjin, China
| | - Feng He
- College of Precision Instruments & Optoelectronics Engineering, Tianjin University, Tianjin, China
| | - Xiao-Song Gu
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine; College of Precision Instruments & Optoelectronics Engineering, Tianjin University, Tianjin, China
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23
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Neuropathic Pain Relief after Surgical Neurolysis in Patients with Traumatic Brachial Plexus Injuries: A Preliminary Report. Pain Res Manag 2022; 2022:5660462. [PMID: 35958676 PMCID: PMC9363225 DOI: 10.1155/2022/5660462] [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: 03/23/2022] [Revised: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 11/24/2022]
Abstract
Objective To evaluate the usefulness of surgical neurolysis for neuropathic pain relief in patients with posttraumatic brachial plexus injury (BPI). Methods A prospective, longitudinal, nonrandomized, self-controlled before and after study was performed to evaluate the pain changes according to their intensity using the Visual Analogue Scale (VAS), and the sensory recovery after surgery using the British Medical Research Council (BMRC) scale for sensory recovery. To establish significant changes, a paired T-test was performed, and in order to determine the magnitude of these changes, an effect size was measured. α = 0.05. Results Ten patients were included with an average follow-up of 61.9 ± 53.62 months. The main mechanism of injury was vehicular trauma (70%). A significant decrease in pain after the surgical intervention was observed resulting from an average preoperative state according to VAS of 8.4 ± 1.58, to a postoperative state of 3.4 ± 3.27 (59.52%, p = 0.005, Δ = 1.572), added to a mean sensory improvement (25%) from 2.8 ± 1.62 to 3.5 ± 0.97 after surgery according to BMRC, without statistically significant changes (p=0.062), showing a moderate effect size (Δ = 0.413). Almost all patients showed improvement in the continuous and paroxysmal pattern of pain. No postoperative complications were observed. Discussion. These results suggest that in cases of BPI that originates from a compressive syndrome secondary to the posttraumatic fibrosis that surrounds the nerve structures causing strangulation and inducing hypernociception, the use of surgical neurolysis is an appropriate alternative for patients with medically refractory neuropathic pain.
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Plasticity of the Central Nervous System Involving Peripheral Nerve Transfer. Neural Plast 2022; 2022:5345269. [PMID: 35342394 PMCID: PMC8956439 DOI: 10.1155/2022/5345269] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/09/2022] [Accepted: 02/28/2022] [Indexed: 11/22/2022] Open
Abstract
Peripheral nerve injury can lead to partial or complete loss of limb function, and nerve transfer is an effective surgical salvage for patients with these injuries. The inability of deprived cortical regions representing damaged nerves to overcome corresponding maladaptive plasticity after the reinnervation of muscle fibers and sensory receptors is thought to be correlated with lasting and unfavorable functional recovery. However, the concept of central nervous system plasticity is rarely elucidated in classical textbooks involving peripheral nerve injury, let alone peripheral nerve transfer. This article is aimed at providing a comprehensive understanding of central nervous system plasticity involving peripheral nerve injury by reviewing studies mainly in human or nonhuman primate and by highlighting the functional and structural modifications in the central nervous system after peripheral nerve transfer. Hopefully, it will help surgeons perform successful nerve transfer under the guidance of modern concepts in neuroplasticity.
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Brito da Silva H, Midha R. Editorial. Distal end-to-side motor transfer to augment ulnar nerve entrapment surgery at elbow. J Neurosurg 2022; 136:840-842. [PMID: 34479208 DOI: 10.3171/2021.2.jns21291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Harley Brito da Silva
- 1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Rajiv Midha
- 1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Siemionow M, Strojny MM, Kozlowska K, Brodowska S, Grau-Kazmierczak W, Cwykiel J. Application of Human Epineural Conduit Supported with Human Mesenchymal Stem Cells as a Novel Therapy for Enhancement of Nerve Gap Regeneration. Stem Cell Rev Rep 2021; 18:642-659. [PMID: 34787795 PMCID: PMC8930890 DOI: 10.1007/s12015-021-10301-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2021] [Indexed: 12/18/2022]
Abstract
Various therapeutic methods have been suggested to enhance nerve regeneration. In this study, we propose a novel approach for enhancement of nerve gap regeneration by applying human epineural conduit (hEC) supported with human mesenchymal stem cells (hMSC), as an alternative to autograft repair. Restoration of 20 mm sciatic nerve defect with hEC created from human sciatic nerve supported with hMSC was tested in 4 experimental groups (n = 6 each) in the athymic nude rat model (Crl:NIH-Foxn1rnu): 1 - No repair control, 2 - Autograft control, 3 - Matched diameter hEC filled with 1 mL saline, 4 - Matched diameter hEC supported with 3 × 106 hMSC. Assessments included: functional tests: toe-spread and pinprick, regeneration assessment by immunofluorescence staining: HLA-1, HLA-DR, NGF, GFAP, Laminin B, S-100, VEGF, vWF and PKH26 labeling; histomorphometric analysis of myelin thickness, axonal density, fiber diameter and myelinated nerve fibers percentage; Gastrocnemius Muscle Index (GMI) and muscle fiber area ratio. Best sensory and motor function recovery, as well as GMI and muscle fiber area ratio, were observed in the autograft group, and were comparable to the hEC with hMSC group (p = 0.038). Significant improvements of myelin thickness (p = 0.003), fiber diameter (p = 0.0296), and percentage of myelinated fibers (p < 0.0001) were detected in hEC group supported with hMSC compared to hEC with saline controls. At 12-weeks after nerve gap repair, hEC combined with hMSC revealed increased expression of neurotrophic and proangiogenic factors, which corresponded with improvement of function comparable with the autograft control. Application of our novel hEC supported with hMSC provides a potential alternative to the autograft nerve repair.
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Affiliation(s)
- Maria Siemionow
- Poznan University of Medical Sciences, Poznan, Poland. .,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA.
| | - Marcin Michal Strojny
- Poznan University of Medical Sciences, Poznan, Poland.,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Katarzyna Kozlowska
- Poznan University of Medical Sciences, Poznan, Poland.,Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | - Sonia Brodowska
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Joanna Cwykiel
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, IL, USA
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27
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Garg SP, Hassan AM, Patel AA, Perez MM, Stoehr JR, Ketheeswaran S, Chappell AG, Galiano RD, Ko JH. Outcomes of Tibial Nerve Repair and Transfer: A Structured Evidence-Based Systematic Review and Meta-Analysis. J Foot Ankle Surg 2021; 60:1280-1289. [PMID: 34366221 DOI: 10.1053/j.jfas.2021.07.001] [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: 03/05/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 02/03/2023]
Abstract
Although nerve transfer and repair are well-established for treatment of nerve injury in the upper extremity, there are no established parameters for when or which treatment modalities to utilize for tibial nerve injuries. The objective of our study is to conduct a systematic review of the effectiveness of end-to-end repair, neurolysis, nerve grafting, and nerve transfer in improving motor function after tibial nerve injury. PubMed, Cochrane, Medline, and Embase libraries were queried according to the PRISMA guidelines for articles that present functional outcomes after tibial nerve injury in humans treated with nerve transfer or repair. The final selection included Nineteen studies with 677 patients treated with neurolysis (373), grafting (178), end-to-end repair (90), and nerve transfer (30), from 1985 to 2018. The mean age of all patients was 27.0 ± 10.8 years, with a mean preoperative interval of 7.4 ± 10.5 months, and follow-up period of 82.9 ± 25.4 months. The mean graft repair length for nerve transfer and grafting patients was 10.0 ± 5.8 cm, and the most common donor nerve was the sural nerve. The most common mechanism of injury was gunshot wound, and the mean MRC of all patients was 3.7 ± 0.6. Good outcomes were defined as MRC ≥ 3. End-to-end repair treatment had the greatest number of good outcomes, followed by neurolysis. Patients with preoperative intervals less than 7 months were more likely to have good outcomes than those greater than 7 months. Patients with sport injuries had the highest percentage of good outcomes in contrast to patients with transections and who were in MVAs. We found no statistically significant difference in good outcomes between the use of sural and peroneal donor nerve grafts, nor between age, graft length, and MRC score.
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Affiliation(s)
- Stuti P Garg
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Abbas M Hassan
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anooj A Patel
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Megan M Perez
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jenna R Stoehr
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Ava G Chappell
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert D Galiano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jason H Ko
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
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Castanov V, Berger MJ, Ritsma B, Trier J, Hendry JM. Optimizing the timing of peripheral nerve transfers for functional re-animation in cervical spinal cord injury: a conceptual framework. J Neurotrauma 2021; 38:3365-3375. [PMID: 34715742 DOI: 10.1089/neu.2021.0247] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Loss of upper extremity function following spinal cord injury (SCI) can have devastating consequences on quality of life. Peripheral nerve transfer surgery aims to restore motor control of upper extremities following cervical SCI and is poised to revolutionize surgical management in this population. The surgery involves dividing an expendable donor nerve above the level of the spinal lesion and coapting it to a recipient nerve arising from the lesional or infralesional segment of the injured cord. In order to maximize outcomes in this complex patient population, refinements in surgical technique need to be integrated with principles of spinal cord medicine and basic science. Deciding on the ideal timing of nerve transfer surgery is one aspect of care that is critical to maximizing recovery and has received very little attention to date in the literature. This complex topic is reviewed, with a focus on expectations for spontaneous recovery within upper motor neuron components of the injury, balanced against the need for expeditious reinnervation for lower motor neuron elements of the injury. The discussion also considers the case of a patient with C6 motor complete SCI where myotomes without electrodiagnostic evidence of denervation spontaneously improved by 6 months post-injury, thereby adjusting the surgical plan. The relevant concepts are integrated into a clinical algorithm with recommendations that consider maximal opportunity for spontaneous clinical improvement post-injury while avoiding excessive delays that may adversely affect patient outcomes.
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Affiliation(s)
- Valera Castanov
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada;
| | - Michael James Berger
- The University of British Columbia, 8166, Division of Physical Medicine and Rehabilitation, Vancouver, British Columbia, Canada.,The University of British Columbia, 8166, International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada;
| | - Benjamin Ritsma
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - Jessica Trier
- Queen's University, 4257, Department of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada.,Providence Care Hospital, 4256, Kingston, Ontario, Canada;
| | - J Michael Hendry
- Queen's University, 4257, School of Medicine, Kingston, Ontario, Canada.,Queen's University, 4257, Division of Plastic Surgery, Department of Surgery, Kingston, Ontario, Canada.,Kingston Health Sciences Centre, 71459, Kingston, Ontario, Canada;
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Yao Y, Wen Y, Li Y, Zhu J, Tian T, Zhang Q, Xiao D, Gao Y, Lin Y, Wei W, Cai X. Tetrahedral framework nucleic acids facilitate neurorestoration of facial nerves by activating the NGF/PI3K/AKT pathway. NANOSCALE 2021; 13:15598-15610. [PMID: 34529749 DOI: 10.1039/d1nr04619e] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The facial nerve is a crucial nerve in the maxillofacial region and is vulnerable to damage. As a consequence of the complications during nerve restoration, existing remedies have certain limitations, thus the treatment of facial nerve injury is always a perplexing task for people. Regulation of Schwann cells is always the breakpoint of neurorestoration since Schwann cells count a great deal in injured nerve repair. In this study, we presented proof that tetrahedral framework nucleic acids (tFNAs), a kind of nucleic acid nanomaterial, were capable of regulating the neurorestorative pathway NGF/PI3 K/AKT, resulting in the activation of a series of cell behaviors related to injured nerve restoration such as proliferation and migration. In vivo experiments also proved that tFNAs enhanced the expressions of axon and myelin marker proteins, impelled histological recovery, promoted the efficient restoration of nerve conduction and muscle movement. Additionally, tFNAs possessed excellent biocompatibility and superior endocytosis ability. Thus, there is good potential for tFNAs to be applied in the therapy of facial nerve injury or even peripheral nerve injury.
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Affiliation(s)
- Yangxue Yao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Yuting Wen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Yanjing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Jianwei Zhu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, P. R. China
| | - Taoran Tian
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Qi Zhang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Dexuan Xiao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Yang Gao
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
| | - Yunfeng Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China. .,College of Biomedical Engineering, Sichuan University, Chengdu 610041, P. R. China
| | - Wei Wei
- Department of Emergency, West China Hospital, Sichuan University, 610041, Chengdu, China.
| | - Xiaoxiao Cai
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, P. R. China.
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30
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Martins RS, Siqueira MG, Heise CO, Foroni L, Neto HS, Teixeira MJ. The nerve to the levator scapulae muscle as donor in brachial plexus surgery: an anatomical study and case series. J Neurosurg 2021; 135:1223-1230. [PMID: 33513572 DOI: 10.3171/2020.8.jns201216] [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: 04/10/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nerve transfers are commonly used in treating complete injuries of the brachial plexus, but donor nerves are limited and preferentially directed toward the recovery of elbow flexion and shoulder abduction. The aims of this study were to characterize the anatomical parameters for identifying the nerve to the levator scapulae muscle (LSN) in brachial plexus surgery, to evaluate the feasibility of transferring this branch to the suprascapular nerve (SSN) or lateral pectoral nerve (LPN), and to present the results from a surgical series. METHODS Supra- and infraclavicular exposure of the brachial plexus was performed on 20 fresh human cadavers in order to measure different anatomical parameters for identification of the LSN. Next, an anatomical and histomorphometric evaluation of the feasibility of transferring this branch to the SSN and LPN was made. Lastly, the effectiveness of the LSN-LPN transfer was evaluated among 10 patients by quantifying their arm adduction strength. RESULTS The LSN was identified in 95% of the cadaveric specimens. A direct coaptation of the LSN and SSN was possible in 45% of the specimens (n = 9) but not between the LSN and LPN in any of the specimens. Comparison of axonal counts among the three nerves did not show any significant difference. Good results from reinnervation of the major pectoral muscle (Medical Research Council grade ≥ 3) were observed in 70% (n = 7) of the patients who had undergone LSN to LPN transfer. CONCLUSIONS The LSN is consistently identified through a supraclavicular approach to the brachial plexus, and its transfer to supply the functions of the SSN and LPN is anatomically viable. Good results from an LSN-LPN transfer are observed in most patients, even if long nerve grafts need to be used.
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31
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Chen K, Ding L, Shui H, Liang Y, Zhang X, Wang T, Li L, Liu S, Wu H. MiR-615 Agomir Encapsulated in Pluronic F-127 Alleviates Neuron Damage and Facilitates Function Recovery After Brachial Plexus Avulsion. J Mol Neurosci 2021; 72:136-148. [PMID: 34569008 PMCID: PMC8755699 DOI: 10.1007/s12031-021-01916-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
Brachial plexus avulsion (BPA) is a devastating traumatic peripheral nerve injury complicated with paralysis of the upper extremity. We previously reported that leucine-rich repeat and immunoglobulin-like domain-containing NOGO receptor-interacting protein 1 (LINGO-1) has a potent role in inhibiting neuron survival and axonal regeneration after the central nervous system (CNS) damage and miR-615 is a potential microRNA (miRNA) negatively regulated LINGO-1. However, the effect of miR-615 in BPA remains to be elucidated. Accumulating evidence indicates that pluronic F-127 (PF-127) hydrogel could serve as a promising vehicle for miRNA encapsulation. Thus, to further explore the potential role of hydrogel-miR-615 in BPA-reimplantation, the present study established the BPA rat model and injected miR-615 agomir encapsulated by PF-127 hydrogel into the reimplantation site using a microsyringe. In this study, results indicated that hydrogel-miR-615 agomir effectively alleviated motoneuron loss by LINGO-1 inhibition, promoted musculocutaneous nerve regeneration and myelination, reduced astrocytes activation, promoted angiogenesis and attenuated peripheral amyotrophy, leading to improved motor functional rehabilitation of the upper extremity. In conclusion, our findings demonstrate that miR-615-loaded PF-127 hydrogel may represent a novel therapeutic strategy for BPA treatment.
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Affiliation(s)
- Kangzhen Chen
- Department of Anesthesiology, Guangzhou Huadu Affiliated Hospital of Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, 510800, China
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China
| | - Lu Ding
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China
- Scientific Research Center, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518107, China
| | - Hua Shui
- Department of Anesthesiology, Guangzhou Huadu Affiliated Hospital of Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, 510800, China
| | - Yinru Liang
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China
| | - Xiaomin Zhang
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China
| | - Tao Wang
- Department of Surgery, The Third Hospital of Guangdong Medical University (Longjiang Hospital of Shunde District), Foshan, 528318, China
| | - Linke Li
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China
| | - Shuxian Liu
- Department of Anesthesiology, Guangzhou Huadu Affiliated Hospital of Guangdong Medical University (Guangzhou Huadu District Maternal and Child Health Care Hospital), Guangzhou, 510800, China.
| | - Hongfu Wu
- Key Laboratory of Stem Cell and Regenerative Tissue Engineering, Guangdong Medical University, Dongguan, 523808, China.
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Masmejean EH. Nerve surgery and palliative surgery: From conceptual revolutions to technological progress. HAND SURGERY & REHABILITATION 2021; 41S:S2-S4. [PMID: 34482012 DOI: 10.1016/j.hansur.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 10/20/2022]
Affiliation(s)
- Emmanuel H Masmejean
- University of Paris, 12, rue de l'École de Médecine, 75006 Paris, France; Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 20, rue Leblanc, 75015 Paris, France; Clinique Blomet, Research Unit, 136, rue Blomet, 75015 Paris, France.
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Abstract
Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks.The true incidence is unknown, and many cases are diagnosed as neurapraxia with the expectation of a full and timely recovery without the need for intervention. The incorrect assignation of a neurapraxia diagnosis may delay treatment for a higher grade of injury and in addition fails to recognize that a diagnosis of neurapraxia should be made with caution and a commitment to regular clinical review. Untreated, a neurapraxia can deteriorate and result in axonopathy. The failure to promptly diagnose such a nerve injury and instigate treatment may result in further deterioration and expose the clinician to medicolegal challenge.The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. Cite this article: EFORT Open Rev 2021;6:607-617. DOI: 10.1302/2058-5241.6.200123.
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Affiliation(s)
- Timothy Bage
- The Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Dominic M Power
- The Peripheral Nerve Injury Service, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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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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35
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Armas-Salazar A, García-Jerónimo AI, Villegas-López FA, Navarro-Olvera JL, Carrillo-Ruiz JD. Clinical outcomes report in different brachial plexus injury surgeries: a systematic review. Neurosurg Rev 2021; 45:411-419. [PMID: 34142268 DOI: 10.1007/s10143-021-01574-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/30/2021] [Accepted: 05/26/2021] [Indexed: 01/20/2023]
Abstract
Brachial plexus injury is a lesion that results in loss of function of the arm, and there are multiple ways of surgically approaching its treatment. Controlled trials that compare all surgical repair strategies and their clinical outcomes have not been performed. A systematic review was conducted to identify all articles that reported clinical outcomes in different surgeries (nerve transfer, nerve graft, neurolysis, end-to-end, multiple interventions, and others). Advanced search in PubMed was performed using the Mesh terms "brachial plexus injury" as the main topic and "surgery" as a subtopic, obtaining a total of 2153 articles. The clinical data for eligibility extraction was focused on collecting motor, sensory, pain, and functional recovery. A statistical analysis was performed to find the superior surgical techniques in terms of motor recovery, through the assessment of heterogeneity between groups, and of relationships between surgery and motor recovery. The frequency and the manner in which clinical outcomes are recording were described. The differences that correspond to the demographics and procedural factors were not statistically significant among groups (p > 0.05). Neurolysis showed the highest proportion of motor recovery (85.18%), with significant results between preoperative and post-operative motor assessment (p = 0.028). The proportion of motor recovery in each group according to the surgical approach differed significantly (X2 = 82.495, p = 0.0001). The motor outcome was the most reported clinical outcome (97.56%), whereas the other clinical outcomes were reported in less than 15% of the included articles. Unexpectedly, neurolysis, a technique displaced by new surgical alternatives such as nerve transfer/graft, demonstrated the highest proportion of motor recovery. Clinical outcomes such as pain, sensory, and functional recovery were infrequently reported. These results introduce the need to re-evaluate neurolysis through comparative clinical trials, as well as to standardize the way in which clinical outcomes are reported.
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Affiliation(s)
- A Armas-Salazar
- Mexican Faculty of Medicine, La Salle University, Mexico City, Mexico
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - A I García-Jerónimo
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - F A Villegas-López
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - J L Navarro-Olvera
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México
| | - J D Carrillo-Ruiz
- Functional & Stereotactic Neurosurgery & Radiosurgery Service, General Hospital of Mexico, Doctor Balmis 148 Doctores, México City, 06720, México.
- Research Direction of General Hospital of Mexico, Mexico City, Mexico.
- Faculty of Health Sciences Direction, of Anahuac University Mexico, Mexico City, Mexico.
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Abstract
PURPOSE OF REVIEW This review focuses on the current insights and developments in neuralgic amyotrophy (NA), an auto-immune multifocal peripheral nervous system disorder that leaves many patients permanently impaired if not recognized and treated properly. RECENT FINDINGS NA is not as rare as previously thought. The phenotype is broad, and recent nerve imaging developments suggest that NA is the most common cause of acute anterior or posterior interosseous nerve palsy. Phrenic nerve involvement occurs in 8% of all NA patients, often with debilitating consequences. Acute phase treatment of NA with steroids or i.v. immunoglobulin may benefit patients. Long-term consequences are the rule, and persisting symptoms are mainly caused by a combination of decreased endurance in the affected nerves and an altered posture and movement pattern, not by the axonal damage itself. Patients benefit from specific rehabilitation treatment. For nerves that do not recover, surgery may be an option. SUMMARY NA is not uncommon, and has a long-term impact on patients' well-being. Early immunomodulating treatment, and identifying phrenic neuropathy or complete nerve paralysis is important for optimal recovery. For persistent symptoms a specific treatment strategy aiming at regaining an energy balance and well-coordinated scapular movement are paramount.
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[Peripheral nerve reconstruction - diagnostics as a basis for decision-making: report of the Consensus Workshop at the 35th Meeting of the DAM]. HANDCHIR MIKROCHIR P 2021; 53:168-174. [PMID: 33860493 DOI: 10.1055/a-1307-3963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
In the early stage of nerve lesions, the clinical differentiation between neurapraxia, axonotmesis and neurotmesis often presents a big challenge. Especially in the early stage, however, it is crucial to correctly classify the type of damage because this is what essentially determines the therapeutic concept, in particular the surgical approach and, therefore, the prognosis. A precise diagnosis not only requires detailed clinical assessment and medical history taking, but also the use of additional electrophysiological (functional) and/or imaging examinations. Electrophysiological diagnostic tests may provide information ion localization, severity, course, type of damage and incipient or past reinnervation. Preoperative functional diagnostic measures should include neurography, needle electromyography (EMG) and, if needed, evoked potentials (EP), while imaging procedures should include neural sonography and magnetic resonance imaging (MRI). As a complimentary procedure, EMG may also be performed during surgery.
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Lower Extremity Combat Sustained Peripheral Nerve Injury in US Military Personnel. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3447. [PMID: 33747687 PMCID: PMC7963502 DOI: 10.1097/gox.0000000000003447] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
Background: Since the civil war, combat sustained peripheral nerve injuries (CSPNI) have been documented during wartime. Warfare has evolved and current combat involves a greater severity of blast injuries secondary to increased use of improvised explosive devices. The purpose of this study was to describe CSPNI and report outcomes after evaluation and treatment. We hypothesize that a shorter time to evaluation will improve outcomes. Methods: A database including all active duty service members who sustained a CSPNI and were treated by the PNC between 2004 and 2009 was used. Service member demographic information, injury mechanism, CSPNI description, and Medical Research Council (MRC) final motor and sensory outcomes were queried from this database. Results: One hundred and four military service members sustained 144 PNIs. The average age was 26.7 years, and nearly all were men (98.1%). There was no correlation between Sunderland classification and age, specific PNI, injury type, or time to evaluation. Higher Sunderland classifications were found to be correlated with worse final motor (r = 0.51, P < 0.001) and final sensory (r = 0.41, P < 0.001) scores. Final motor and sensory scores were not associated with specific nerve injury, mechanism of injury, initial EMG, or surgical procedure. Shorter time to initial assessment was associated with improved final motor and sensory scores, but was not found to be statistically significant. Conclusions: As the complexity of CSPNIs progress as combat weaponry evolves, a firm understanding of treatment factors is important. Our study demonstrates in recent conflict that military service members’ initial injury severity is a key factor in expected outcome.
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Krzesniak NE, Sarnowska A, Figiel-Dabrowska A, Osiak K, Domanska-Janik K, Noszczyk BH. Secondary release of the peripheral nerve with autologous fat derivates benefits for functional and sensory recovery. Neural Regen Res 2021; 16:856-864. [PMID: 33229720 PMCID: PMC8178762 DOI: 10.4103/1673-5374.297081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The reconstruction of nerve continuity after traumatic nerve injury is the gold standard in hand surgery. Immediate, tension-free, end-to-end nerve suture ensures the best prognosis. The recovery is mostly promising; however, in a few cases, insufficient outcomes in motor or sensory function are observed. Intra- and extra-fascicular scarring accompanies the nerve regeneration process and limits final outcomes. Secondary nerve release in those cases is recommended. Unfortunately, scarring recurrence cannot be eliminated after secondary revision and neurolysis. The supportive influences of mesenchymal stem cells in the process of nerve regeneration were observed in many preclinical studies. However, a limited number of studies in humans have analyzed the clinical usage of mesenchymal stem cells in peripheral nerve reconstruction and revisions. The objective of this study was to evaluate the effects of undifferentiated adipose-derived stromal/stem cell injection during a last-chance surgery (neurolysis, nerve release) on a previously reconstructed nerve. Three patients (one female, two males; mean age 59 ± 4.5 years at the time of injury), who experienced failure of reconstructions of median and ulnar nerves, were included in this study. During the revision surgery, nerve fascicles were released, and adipose-derived stromal/stem cells were administered through microinjections along the fascicles and around the adjacent tissues after external neurolysis. During 36 months of follow-up, patients noticed gradual signs of sensory and in consequence functional recovery. No adverse effects were observed. Simultaneous nerve release with adipose-derived stromal/stem cells support is a promising method in patients who need secondary nerve release after nerve reconstruction. This method can constitute an alternative procedure in patients experiencing recovery failure and allow improvement in cases of limited nerve regeneration. The study protocol was approved by the Institutional Review Board (IRB) at the Centre of Postgraduate Medical Education (No. 62/PB/2016) on September 14, 2016.
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Affiliation(s)
- Natalia E Krzesniak
- Department of Plastic and Reconstructive Surgery, Center of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | - Anna Sarnowska
- Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | | | - Katarzyna Osiak
- Department of Plastic and Reconstructive Surgery, Center of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
| | | | - Bartłomiej H Noszczyk
- Department of Plastic and Reconstructive Surgery, Center of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland
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Gordon T. Peripheral Nerve Regeneration and Muscle Reinnervation. Int J Mol Sci 2020; 21:ijms21228652. [PMID: 33212795 PMCID: PMC7697710 DOI: 10.3390/ijms21228652] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/24/2022] Open
Abstract
Injured peripheral nerves but not central nerves have the capacity to regenerate and reinnervate their target organs. After the two most severe peripheral nerve injuries of six types, crush and transection injuries, nerve fibers distal to the injury site undergo Wallerian degeneration. The denervated Schwann cells (SCs) proliferate, elongate and line the endoneurial tubes to guide and support regenerating axons. The axons emerge from the stump of the viable nerve attached to the neuronal soma. The SCs downregulate myelin-associated genes and concurrently, upregulate growth-associated genes that include neurotrophic factors as do the injured neurons. However, the gene expression is transient and progressively fails to support axon regeneration within the SC-containing endoneurial tubes. Moreover, despite some preference of regenerating motor and sensory axons to “find” their appropriate pathways, the axons fail to enter their original endoneurial tubes and to reinnervate original target organs, obstacles to functional recovery that confront nerve surgeons. Several surgical manipulations in clinical use, including nerve and tendon transfers, the potential for brief low-frequency electrical stimulation proximal to nerve repair, and local FK506 application to accelerate axon outgrowth, are encouraging as is the continuing research to elucidate the molecular basis of nerve regeneration.
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Affiliation(s)
- Tessa Gordon
- Department of Surgery, University of Toronto, Division of Plastic Reconstructive Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
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Hanno Millesi: Pioneer of Plastic Surgery and Nerve Surgery (1927-2017). Ann Plast Surg 2020; 85:588-591. [PMID: 33165114 DOI: 10.1097/sap.0000000000002600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recently, plastic surgery lost one of its most prominent surgeons-Dr. Hanno Millesi. His contributions to the field continue to impact the practice of medicine and surgery. As such, it is appropriate to reflect upon his career and recognize his accomplishments in peripheral nerve surgery, hand surgery, and Dupuytren disease.
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Molotkovets VY, Medvediev VV, Korsak AV, Chaikovsky YB, Marynsky GS, Tsymbaliuk VI. Restoration of the Integrity of a Transected Peripheral Nerve with the Use of an Electric Welding Technology. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Martin E, Dullaart MJ, Verhoef C, Coert JH. A systematic review of functional outcomes after nerve reconstruction in extremity soft tissue sarcomas: A need for general implementation in the armamentarium. J Plast Reconstr Aesthet Surg 2020; 73:621-632. [PMID: 32088187 DOI: 10.1016/j.bjps.2019.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Resection of nerves in extremity soft tissue sarcomas (STS) can lead to large functional deficits. Nerve reconstructions are rarely performed and little is known on their outcomes and indications for their use, even though they are essential in restoring sensation in limb salvage procedures. This study investigated current knowledge on functional outcomes and considerations to be taken before performing such reconstructions after sarcoma resection. A systematic search was performed in July 2018 in PubMed and Embase databases according to PRISMA guidelines. Search terms related to "soft tissue sarcoma" and "nerve reconstruction" were used. Studies evaluating functional outcomes after nerve grafting or nerve transfers in extremity STS were included. Qualitative synthesis was performed on all studies. Nineteen studies were included after full-text screening, describing 26 patients. The majority of patients had a nerve reconstruction in the upper extremity (65%). Perioperative radiotherapy was administered in 67% and perioperative chemotherapy in 29% of patients. Nerve grafting was most commonly performed (n = 23) and nerve transfers were performed in six patients. A wide variety of outcome measures were used. Most patients recovered at least some motor function and sensation, but success rates were higher after upper than lower extremity defects. Multimodal treatment did not preclude successful reconstructions. Nerve reconstructions in extremity STS allow the restoration of sensation in limb salvation, even motor nerve function can be restored with satisfactory function. The use of multimodal therapy does not seem to interfere with success. Nerve reconstructions should therefore be considered in STS patients.
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Affiliation(s)
- Enrico Martin
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
| | - Max J Dullaart
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands
| | - Cornelis Verhoef
- Department of Surgical Oncology, Erasmus Medical Center Cancer Institute, Molewaterplein 40, Rotterdam, the Netherlands
| | - J Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, the Netherlands.
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Customized Scaffold Design Based on Natural Peripheral Nerve Fascicle Characteristics for Biofabrication in Tissue Regeneration. BIOMED RESEARCH INTERNATIONAL 2020; 2019:3845780. [PMID: 31915690 PMCID: PMC6935460 DOI: 10.1155/2019/3845780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/21/2019] [Accepted: 08/31/2019] [Indexed: 12/21/2022]
Abstract
Objective The use of a biofabrication nerve scaffold, which mimics the nerve microstructure, as an alternative for autologous nerve transplantation is a promising strategy for treating peripheral nerve defects. This study aimed to design a customized biofabrication scaffold model with the characteristics of human peripheral nerve fascicles. Methods We used Micro-MRI technique to obtain different nerve fascicles. A full-length 28 cm tibial nerve specimen was obtained and was divided into 14 two-centimetre nerve segments. 3D models of the nerve fascicles were obtained by three-dimensional reconstruction after image segmentation. The central line of the nerve fascicles was fitted, and the aggregation of nerve fascicles was analysed quantitatively. The nerve scaffold was designed by simulating the clinical nerve defect and extracting information from the acquired nerve fascicle data; the scaffold design was displayed by 3D printing to verify the accuracy of the model. Result The microstructure of the sciatic nerve, tibial nerve, and common peroneal nerve in the nerve fascicles could be obtained by three-dimensional reconstruction. The number of cross fusions of tibial nerve fascicles from proximal end to distal end decreased gradually. By designing the nerve graft in accordance with the microstructure of the nerve fascicles, the 3D printed model demonstrated that the two ends of the nerve defect can be well matched. Conclusion The microstructure of the nerve fascicles is complicated and changeable, and the spatial position of each nerve fascicle and the long segment of the nerve fascicle aggregation show great changes at different levels. Under the premise of the stability of the existing imaging techniques, a large number of scanning nerve samples can be used to set up a three-dimensional database of the peripheral nerve fascicle microstructure, integrating the gross imaging information, and provide a template for the design of the downstream nerve graft model.
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