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Xu G, Zou X, Dong Y, Alhaskawi A, Zhou H, Ezzi SHA, Kota VG, Abdulla MHAH, Alenikova O, Abdalbary SA, Lu H. Advancements in autologous peripheral nerve transplantation care: a review of strategies and practices to facilitate recovery. Front Neurol 2024; 15:1330224. [PMID: 38523615 PMCID: PMC10959128 DOI: 10.3389/fneur.2024.1330224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Autologous peripheral nerve transplantation, a pioneering technique in nerve injury treatment, has demonstrated remarkable progress. We examine recent nursing strategies and methodologies tailored to various anatomical sites, highlighting their role in postoperative recovery enhancement. Encompassing brachial plexus, upper limb, and lower limb nerve transplantation care, this discussion underscores the importance of personalized rehabilitation plans, interdisciplinary collaboration, and innovative approaches like nerve electrical stimulation and nerve growth factor therapy. Moreover, the exploration extends to effective complication management and prevention strategies, encompassing infection control and pain management. Ultimately, the review concludes by emphasizing the advances achieved in autologous peripheral nerve transplantation care, showcasing the potential to optimize postoperative recovery through tailored and advanced practices.
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Affiliation(s)
- Guoying Xu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
| | - Xiaodi Zou
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- Faculty of Medicine, School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | | | | | | | - Olga Alenikova
- Department of Neurology, Republican Research and Clinical Center of Neurology and Neurosurgery, Minsk, Belarus
| | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Operating Theater, Shaoxing City Keqiao District Hospital of Traditional Chinese Medicine, Shaoxing, Zhejiang, China
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Sisubalan N, Shalini R, Ramya S, Sivamaruthi BS, Chaiyasut C. Recent advances in nanomaterials for neural applications: opportunities and challenges. Nanomedicine (Lond) 2023; 18:1979-1994. [PMID: 38078433 DOI: 10.2217/nnm-2023-0261] [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] [Indexed: 12/19/2023] Open
Abstract
Nanomedicines are promising for delivering drugs to the central nervous system, though their precision is still being improved. Fortifying nanoparticles with vital molecules can interact with the blood-brain barrier, enabling access to brain tissue. This study summarizes recent advances in nanomedicine to treat neurological complications. The integration of nanotechnology into cell biology aids in the study of brain cells' interactions. Magnetic microhydrogels have exhibited superior neuron activation compared with superparamagnetic iron oxide nanoparticles and hold promise for neuropsychiatric disorders. Nanomaterials have shown notable results, such as tackling neurodegenerative diseases by hindering harmful protein buildup and regulating cellular processes. However, further studies of the safety and effectiveness of nanoparticles in managing neurological diseases and disorders are still required.
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Affiliation(s)
- Natarajan Sisubalan
- Office of Research Administration, Chiang Mai University, Chiang Mai, 50200, Thailand
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Ramadoss Shalini
- Department of Botany, Bishop Heber College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620017, India
| | - Sakthivel Ramya
- Department of Botany, Bishop Heber College (Autonomous), Affiliated to Bharathidasan University, Tiruchirappalli, Tamil Nadu, 620017, India
| | - Bhagavathi Sundaram Sivamaruthi
- Office of Research Administration, Chiang Mai University, Chiang Mai, 50200, Thailand
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Chaiyavat Chaiyasut
- Innovation Center for Holistic Health, Nutraceuticals, and Cosmeceuticals, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
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Conduit-assisted Allograft Neurorrhaphy for the Treatment of Intractable Lower Extremity Pain Due to Neuromas-in-continuity. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3867. [PMID: 34745789 PMCID: PMC8563064 DOI: 10.1097/gox.0000000000003867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 08/16/2021] [Indexed: 11/26/2022]
Abstract
We present a novel technique for the management of intractable lower extremity pain, due to neuromas-in-continuity of two peripheral nerves, through combined neurectomies proximal to the zone of initial injury and subsequent bridging utilizing an allograft-coupled conduit construct.
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Ward KL, Rodriguez-Collazo ER. Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower Extremity: A Systematic Approach. Clin Podiatr Med Surg 2021; 38:73-82. [PMID: 33220745 DOI: 10.1016/j.cpm.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To date, more than 150 surgical techniques have been described for the treatment of intractable nerve pain. However, owing to their technical complexity, as well as the lack of comparative studies in the literature, there is currently no consensus on the appropriate management of this often debilitating condition. Therefore, we present our surgical algorithm, based on Seddon's classification to differentiate the degree of nerve injury, and subsequent treatment course for the management of lower extremity neurogenic pain.
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Affiliation(s)
- Kaitlyn L Ward
- Complex Deformity Correction & Microsurgical Limb Reconstruction.
| | - Edgardo R Rodriguez-Collazo
- AMITA St. Joseph Hospital, St. Joseph Hospital-Manor Building, Attn: Podiatric Fellowship Office Room #425, 2913 Commonwealth Avenue, Chicago, IL 60657, USA; Podiatric Medicine and Surgery Reconstructive Rearfoot/Ankle Surgery, Complex Deformity Correction & Microsurgical Limb Reconstruction
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Oexeman S, Arroyo CI, Rodriguez-Collazo ER, Segura RP. Redefining the Topography of the Tibial Nerve: Updated Treatment Guide for Tibial Nerve Entrapments: An Addendum to Surgical Treatment Protocol for Peripheral Nerve Dysfunction of the Lower Extremity: A Systematic Approach. Clin Podiatr Med Surg 2021; 38:e7-e23. [PMID: 35101242 DOI: 10.1016/j.cpm.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dysfunction of the tibial nerve can progress to painful and potentially disabling conditions. There are multiple sites of entrapment along the course of the tibial nerve. Detailed knowledge of the anatomy and anatomic variations is critical for a surgeon to be able to properly diagnose and treat patients with tibial nerve injuries. Repair of tibial nerve injuries involves a thorough history, physical examination, diagnostic studies, and microsurgical techniques. This article discusses sites of tibial nerve entrapment and use of a surgical algorithm that provides a systematic approach that has been successful within the literature in treating chronic tibial neuritic pain.
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Affiliation(s)
- Stephanie Oexeman
- AMITA Health - St. Joseph Hospital, Podiatric Fellow Office, Suite 425, 2913 North Commonwealth Avenue, Chicago, IL 60657, USA.
| | - Carlos I Arroyo
- Department of Surgery, Pavia Hospital, San Juan, PR, USA; Department of Surgery, Centro Medico Episcopal San Lucas, Ponce, PR, USA; Instituto de Podiatria y Pie Diabetico de Puerto Rico, 1494 Avenue Franklin Delano Roosevelt, San Juan, PR 00920, USA
| | - Edgardo R Rodriguez-Collazo
- Department of Surgery, Amita Saint Joseph Hospital, Laboure Outpatient Clinic, 2913 North Commonwealth Avenue, Chicago, IL 60657, USA
| | - Roberto P Segura
- Chicago Peripheral Nerve Center, Chicago, IL, USA; Laboure Outpatient Clinic, 2913 North Commonwealth Avenue, Chicago, IL 60657, USA
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Advances in nanotechnology and nanomaterials based strategies for neural tissue engineering. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101617] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Manning C, Cook S, Rand R, Mills J, Thomas A, Galloway K. Communications between the superficial and deep fibular nerves in the foot: An anatomical and electrophysiological study. Clin Anat 2020; 34:544-549. [PMID: 32196762 DOI: 10.1002/ca.23592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The deep fibular sensory nerve can be recorded to evaluate for peripheral nerve injury; however, it can be challenging in some individuals. Anatomic variation could account for some of this difficulty. Cadaver dissection and electrophysiological testing were used to characterize deep and superficial fibular sensory nerve supply to the foot. MATERIALS AND METHODS Nineteen feet from 15 (8 males and 7 females) cadavers were dissected to identify the deep fibular nerves (DFNs) and superficial fibular nerves (SFNs). Sensation to the first dorsal web space was tested electrophysiologically in 101 participants (31 males and 70 females) with an age range of 18-47 years with stimulation over both DFNs and SFNs. RESULTS Eleven of the 19 (58%) cadaver limbs had a communication between SFNs and DFNs in the dorsum of the foot. A reliable sensory response was recorded in the first dorsal web space in 88% of the limbs tested. Deep fibular stimulation alone produced a response in 34% of the limbs, while superficial fibular stimulation alone produced a response in 10% of the limbs. A separate response with stimulation of both the DFNs and SFNs was recorded in 44% of the limbs. CONCLUSIONS A functional superficial to deep fibular sensory communication is present in a significant portion of the population. Those with the communication may not have the isolated sensory loss that would be expected in the first dorsal web space in conditions impacting the DFNs.
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Affiliation(s)
- Colleen Manning
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
| | - Samantha Cook
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
| | - Royale Rand
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
| | - Jessie Mills
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
| | - Ashley Thomas
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
| | - Kathleen Galloway
- College of Health Sciences, Belmont University, Nashville, Tennessee, USA
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Treatment of Neuroma-induced Chronic Pain and Management of Nerve Defects with Processed Nerve Allografts. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2467. [PMID: 32537284 PMCID: PMC7288900 DOI: 10.1097/gox.0000000000002467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/02/2019] [Indexed: 01/19/2023]
Abstract
Symptomatic neuromas can cause significant chronic pain and negatively impact quality of life. Symptoms often persist despite narcotics and nonoperative interventions, which are largely ineffective. With the opioid crisis, treatments for chronic pain that limit narcotics are needed. Traditional surgical options may result in neuroma recurrence. Autograft reconstruction often results in donor-site morbidity. Processed nerve allografts facilitate axonal growth, nerve regeneration, and eliminate donor-site morbidity. Methods A literature review was performed to identify studies in which chronic neuroma pain was treated with excision and processed nerve allograft reconstruction. PubMed was queried, and data from the studies were grouped into treatment effective and ineffective groups. Statistical analyses were performed on these groups, and further subgroup analysis was performed on overall change of preoperative and postoperative pain scores using a paired t test. Results Seven studies fulfilled inclusion criteria yielding 42 patients. Greater than 90% of patients had improvement of pain postoperatively. The preoperative and postoperative pain scores could be determined for 40 patients. The mean preoperative score was 7.9, and the mean postoperative score was 3.54. These results were statistically significant using a paired t test with a P value of <0.001. Conclusions Chronic pain resulting from symptomatic neuromas can be treated with neuroma excision and nerve stump reconstruction with processed nerve allograft. This obviates autograft-associated donor-site morbidity and provides a platform to potentially restore sensation to the involved nerve whenever a distal nerve end is available. Addressing the root cause is an important paradigm shift for treating symptomatic neuromas.
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Thatte MR, Hiremath A, Goklani MS, Patel NR, Takwale AB. Peripheral Nerve Injury to the Lower Limb: Repair and Secondary Reconstruction. Indian J Plast Surg 2019; 52:93-99. [PMID: 31456617 PMCID: PMC6664834 DOI: 10.1055/s-0039-1687921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This article is based on literature review of relevant articles as well as the authors’ own experiences in treating peripheral nerve injuries of the lower limb. The article deals with causative factors of lower limb nerve injuries, various grading systems of the injuries, approaches to such injuries, and techniques to repair lower limb nerve injuries. It also enumerates several reasons to explain the poorer prognosis of peroneal nerve injuries and the possible distal nerve transfers in lower limb albeit with poorer outcomes.
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Affiliation(s)
- Mukund R Thatte
- Department of Plastic Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Amita Hiremath
- Department of Plastic Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Mayur S Goklani
- Department of Plastic Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Neehar R Patel
- Department of Plastic Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Anupam B Takwale
- Department of Plastic Surgery, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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Miller TJ, Rodriguez-Collazo E, Frania SJ, Thione A. Regenerative Surgery & Intra-Operative Protocols Utilizing Bone Marrow Aspirate Concentrate in Microsurgical & Limb Reconstruction. ACTA ACUST UNITED AC 2019. [DOI: 10.29337/ijops.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Tuturov AO. The role of peripheral nerve surgery in a tissue reinnervation. Chin Neurosurg J 2019; 5:5. [PMID: 32922905 PMCID: PMC7398204 DOI: 10.1186/s41016-019-0151-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
In modern neuroscience, the most relevant is the study of the problem of reinnervation of tissues after severe injuries. Complete restoration of lost physiological functions is still impossible with lesions of peripheral nerves with the formation of extensive diastasis between their proximal and distal sites. In this case, the standard neurorrhaphy cannot be carried out because of the eruption of the filaments during tension and convergence of the ends. To solve this problem, a technique was developed for autotransplantation of the nerve sections, which is still the gold standard for the reconstruction of extensive nerve defects. However, the presence of significant shortcomings led to the development of the doctrine of the direction of regeneration with the help of conduits. Currently, the use of nerve channels is the most promising technology for peripheral nerve repair after trauma. The most actively developing now is the direction of reinnervation, such as neurotization. Neurotization, in some way, combined all the methods of restoring nerves. The overall goal of all these methods-the restoration of extensive nerve defects-allows them to be combined into a new industry: reinnervating neurosurgery.
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Affiliation(s)
- Alexander O. Tuturov
- Department of Physiology, Samara State Medical University, Samara, Russian Federation
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