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Irisarri C. History of peripheral nerve injuries. J Hand Surg Eur Vol 2024; 49:812-823. [PMID: 37728740 DOI: 10.1177/17531934231198455] [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: 09/21/2023]
Abstract
This article reviews the history of peripheral nerve (PN) injuries and successive advances in their management by notable pioneers, an interesting topic that I chose for my Doctoral Thesis in 1990 in Madrid. Mentioning all their names and contributions is an obligatory tribute, and I offer my sincere apologies for inevitably leaving a few out. For half a century I have witnessed microsurgery advances, and also experienced frequent failures in my practice with the use of new techniques; a testimony that we are very far from achieving the 'Holy Grail' of complete PN recovery for these injuries. Our experience is often like a pendulum, from nihilism to optimism and vice versa. Many factors influence the results of PN repair. Fortunately, microsurgery has been a breakthrough but, too often, emergency surgery is carried out by surgeons without enough tools and experience, both very important factors in this field.
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Broeren BO, Hundepool CA, Kumas AH, Duraku LS, Walbeehm ET, Hooijmans CR, Power DM, Zuidam JM, De Jong T. The effectiveness of acellular nerve allografts compared to autografts in animal models: A systematic review and meta-analysis. PLoS One 2024; 19:e0279324. [PMID: 38295088 PMCID: PMC10829984 DOI: 10.1371/journal.pone.0279324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/07/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Treatment of nerve injuries proves to be a worldwide clinical challenge. Acellular nerve allografts are suggested to be a promising alternative for bridging a nerve gap to the current gold standard, an autologous nerve graft. OBJECTIVE To systematically review the efficacy of the acellular nerve allograft, its difference from the gold standard (the nerve autograft) and to discuss its possible indications. MATERIAL AND METHODS PubMed, Embase and Web of Science were systematically searched until the 4th of January 2022. Original peer reviewed paper that presented 1) distinctive data; 2) a clear comparison between not immunologically processed acellular allografts and autologous nerve transfers; 3) was performed in laboratory animals of all species and sex. Meta analyses and subgroup analyses (for graft length and species) were conducted for muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count diameter, tetanic contraction and amplitude using a Random effects model. Subgroup analyses were conducted on graft length and species. RESULTS Fifty articles were included in this review and all were included in the meta-analyses. An acellular allograft resulted in a significantly lower muscle weight, sciatic function index, ankle angle, nerve conduction velocity, axon count and smaller diameter, tetanic contraction compared to an autologous nerve graft. No difference was found in amplitude between acellular allografts and autologous nerve transfers. Post hoc subgroup analyses of graft length showed a significant reduced muscle weight in long grafts versus small and medium length grafts. All included studies showed a large variance in methodological design. CONCLUSION Our review shows that the included studies, investigating the use of acellular allografts, showed a large variance in methodological design and are as a consequence difficult to compare. Nevertheless, our results indicate that treating a nerve gap with an allograft results in an inferior nerve recovery compared to an autograft in seven out of eight outcomes assessed in experimental animals. In addition, based on our preliminary post hoc subgroup analyses we suggest that when an allograft is being used an allograft in short and medium (0-1cm, > 1-2cm) nerve gaps is preferred over an allograft in long (> 2cm) nerve gaps.
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Affiliation(s)
- Berend O. Broeren
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Caroline A. Hundepool
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Ali H. Kumas
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Liron S. Duraku
- Department of Plastic, Reconstructive & Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erik T. Walbeehm
- Department of Plastic, Reconstructive & Hand Surgery, Haga Hospital and Xpert Clinic, Den Haag, The Netherlands
| | - Carlijn R. Hooijmans
- Department for Health Evidence Unit SYRCLE, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Anesthesiology, Pain and Palliative Care (Meta Research Team), Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Dominic M. Power
- Department of Hand & Peripheral Nerve Surgery, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J. Michiel Zuidam
- Department of Plastic & Reconstructive Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Tim De Jong
- Department of Plastic & Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Peters BR, Wood MD, Hunter DA, Mackinnon SE. Acellular Nerve Allografts in Major Peripheral Nerve Repairs: An Analysis of Cases Presenting With Limited Recovery. Hand (N Y) 2023; 18:236-243. [PMID: 33880944 PMCID: PMC10035101 DOI: 10.1177/15589447211003175] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acellular nerve allografts have been used successfully and with increasing frequency to reconstruct nerve injuries. As their use has been expanded to treat longer gap, larger diameter nerve injuries, some failed cases have been reported. We present the histomorphometry of 5 such cases illustrating these limitations and review the current literature of acellular nerve allografts. METHODS Between 2014 and 2019, 5 patients with iatrogenic nerve injuries to the median or ulnar nerve reconstructed with an AxoGen AVANCE nerve allograft at an outside hospital were treated in our center with allograft excision and alternative reconstruction. These patients had no clinical or electrophysiological evidence of recovery, and allograft specimens at the time of surgery were sent for histomorphological examination. RESULTS Three patients with a median and 2 with ulnar nerve injury were included. Histology demonstrated myelinated axons present in all proximal native nerve specimens. In 2 cases, axons failed to regenerate into the allograft and in 3 cases, axonal regeneration diminished or terminated within the allograft. CONCLUSIONS The reported cases demonstrate the importance of evaluating the length and the function of nerves undergoing acellular nerve allograft repair. In long length, large-diameter nerves, the use of acellular nerve allografts should be carefully considered.
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Affiliation(s)
- Blair R. Peters
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health & Science Univeristy, Portland, OR, USA
| | - Matthew D. Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel A. Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Sanchez Rezza A, Kulahci Y, Gorantla VS, Zor F, Drzeniek NM. Implantable Biomaterials for Peripheral Nerve Regeneration–Technology Trends and Translational Tribulations. Front Bioeng Biotechnol 2022; 10:863969. [PMID: 35573254 PMCID: PMC9092979 DOI: 10.3389/fbioe.2022.863969] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
The use of autografted nerve in surgical repair of peripheral nerve injuries (PNI) is severely limited due to donor site morbidity and restricted tissue availability. As an alternative, synthetic nerve guidance channels (NGCs) are available on the market for surgical nerve repair, but they fail to promote nerve regeneration across larger critical gap nerve injuries. Therefore, such injuries remain unaddressed, result in poor healing outcomes and are a limiting factor in limb reconstruction and transplantation. On the other hand, a myriad of advanced biomaterial strategies to address critical nerve injuries are proposed in preclinical literature but only few of those have found their way into clinical practice. The design of synthetic nerve grafts should follow rational criteria and make use of a combination of bioinstructive cues to actively promote nerve regeneration. To identify the most promising NGC designs for translation into applicable products, thorough mode of action studies, standardized readouts and validation in large animals are needed. We identify design criteria for NGC fabrication according to the current state of research, give a broad overview of bioactive and functionalized biomaterials and highlight emerging composite implant strategies using therapeutic cells, soluble factors, structural features and intrinsically conductive substrates. Finally, we discuss translational progress in bioartificial conduits for nerve repair from the surgeon’s perspective and give an outlook toward future challenges in the field.
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Affiliation(s)
- Angela Sanchez Rezza
- Charité— Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
| | - Yalcin Kulahci
- Wake Forest School of Medicine, Department of Surgery, Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, United States
| | - Vijay S. Gorantla
- Wake Forest School of Medicine, Department of Surgery, Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, United States
| | - Fatih Zor
- Wake Forest School of Medicine, Department of Surgery, Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC, United States
- *Correspondence: Fatih Zor, ; Norman M. Drzeniek,
| | - Norman M. Drzeniek
- Charité— Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt–Universität zu Berlin, Institute of Medical Immunology, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
- Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin-Brandenburg School for Regenerative Therapies (BSRT), Berlin, Germany
- *Correspondence: Fatih Zor, ; Norman M. Drzeniek,
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5
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The Evolution of Two Ideas. Plast Reconstr Surg 2021; 147:1019-1024. [PMID: 33776046 DOI: 10.1097/prs.0000000000007799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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Balakrishnan A, Belfiore L, Chu TH, Fleming T, Midha R, Biernaskie J, Schuurmans C. Insights Into the Role and Potential of Schwann Cells for Peripheral Nerve Repair From Studies of Development and Injury. Front Mol Neurosci 2021; 13:608442. [PMID: 33568974 PMCID: PMC7868393 DOI: 10.3389/fnmol.2020.608442] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022] Open
Abstract
Peripheral nerve injuries arising from trauma or disease can lead to sensory and motor deficits and neuropathic pain. Despite the purported ability of the peripheral nerve to self-repair, lifelong disability is common. New molecular and cellular insights have begun to reveal why the peripheral nerve has limited repair capacity. The peripheral nerve is primarily comprised of axons and Schwann cells, the supporting glial cells that produce myelin to facilitate the rapid conduction of electrical impulses. Schwann cells are required for successful nerve regeneration; they partially “de-differentiate” in response to injury, re-initiating the expression of developmental genes that support nerve repair. However, Schwann cell dysfunction, which occurs in chronic nerve injury, disease, and aging, limits their capacity to support endogenous repair, worsening patient outcomes. Cell replacement-based therapeutic approaches using exogenous Schwann cells could be curative, but not all Schwann cells have a “repair” phenotype, defined as the ability to promote axonal growth, maintain a proliferative phenotype, and remyelinate axons. Two cell replacement strategies are being championed for peripheral nerve repair: prospective isolation of “repair” Schwann cells for autologous cell transplants, which is hampered by supply challenges, and directed differentiation of pluripotent stem cells or lineage conversion of accessible somatic cells to induced Schwann cells, with the potential of “unlimited” supply. All approaches require a solid understanding of the molecular mechanisms guiding Schwann cell development and the repair phenotype, which we review herein. Together these studies provide essential context for current efforts to design glial cell-based therapies for peripheral nerve regeneration.
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Affiliation(s)
- Anjali Balakrishnan
- Biological Sciences Platform, Sunnybrook Research Institute (SRI), Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Lauren Belfiore
- Biological Sciences Platform, Sunnybrook Research Institute (SRI), Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Tak-Ho Chu
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Taylor Fleming
- Biological Sciences Platform, Sunnybrook Research Institute (SRI), Toronto, ON, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeff Biernaskie
- Department of Comparative Biology and Experimental Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carol Schuurmans
- Biological Sciences Platform, Sunnybrook Research Institute (SRI), Toronto, ON, Canada.,Department of Biochemistry, University of Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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7
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Nakamura Y, Takanari K, Ebisawa K, Kanbe M, Nakamura R, Kamei Y. Repair of temporal branch of the facial nerve with novel polyglycolic acid-collagen tube: a case report of two cases. NAGOYA JOURNAL OF MEDICAL SCIENCE 2020; 82:123-128. [PMID: 32273640 PMCID: PMC7103875 DOI: 10.18999/nagjms.82.1.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Autologous nerve transplantation has been the gold standard in the treatment of facial nerve injury, however it has not been achieved satisfactory result and needs donor sacrifice. A polyglycolic acid collagen conduit (Nerbridge, Toyobo Co., Japan) has the potential to compare to or exceed autologous nerve grafts in promoting nerve regeneration. Here we report two cases of traumatic temporal facial nerve injury repairs with Nerbridge. The severed temporal branch of the facial nerve was repaired with Nerbridge conduits in two patients. Recovery of movement was assessed by clinical photography and needle electromyography. The frontal muscle started moving five months postoperatively in both cases. Electromyography at twelve months showed polymorphic electric discharge, suggesting connection of the injured nerve to the frontal muscle. In the final results, each patient had good eyebrow elevation distance and moderate forward gaze recovery in comparison to their healthy sides. Considering that facial nerves are reported to recover incompletely even in autologous nerve graft repair cases, our two cases showed reasonable recovery comparable to nerve autografting. The Nerbridge conduit is a promising alternative to standard treatments for facial nerve recovery.
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Affiliation(s)
- Yutaka Nakamura
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keisuke Takanari
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Katsumi Ebisawa
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Miki Kanbe
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Nakamura
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuzuru Kamei
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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8
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Kaya H, Sabah D, Keçeci B, Küçük L, Erbaş O, Oltulu F, Yiğittürk G, Taskiran D. Comparison of the Effects of Extracorporeal Irradiation and Liquid Nitrogen on Nerve Recovery in a Rat Model. J INVEST SURG 2020; 34:773-783. [DOI: 10.1080/08941939.2019.1691686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Hüseyin Kaya
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Dündar Sabah
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burçin Keçeci
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Levent Küçük
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Oytun Erbaş
- Department of Physiology, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey
| | - Fatih Oltulu
- Department of Histology and Embryology, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gürkan Yiğittürk
- Department of Histology and Embryology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Dilek Taskiran
- Department of Physiology, Faculty of Medicine, Ege University, Izmir, Turkey
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9
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Pan D, Mackinnon SE, Wood MD. Advances in the repair of segmental nerve injuries and trends in reconstruction. Muscle Nerve 2020; 61:726-739. [PMID: 31883129 DOI: 10.1002/mus.26797] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system.
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Affiliation(s)
- Deng Pan
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew D Wood
- Division of Plastic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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10
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An Anatomical Feasibility Study Using a Great Auricular Nerve Graft for Ipsilateral Inferior Alveolar Nerve Repair. J Craniofac Surg 2020; 30:2625-2627. [PMID: 31274821 DOI: 10.1097/scs.0000000000005739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The great auricular nerve (GAN) has been used for trigeminal and facial nerve repair and the inferior alveolar nerve (IAN) are often sacrificed during segmental mandibulectomy. To our knowledge, only 1 case report has discussed IAN repair using GAN after segmental mandibulectomy. The goal of this study is to clarify the feasibility of using GAN for IAN repair. Eleven sides from 6 fresh frozen Caucasian cadavers were used for this study. The mean age at the time of death was 82.3 years. A submandibular skin incision was made 2 finger breadths below and parallel to the inferior border of the mandible. The GAN was identified and then the mental foramen was found via extraoral dissection. The buccal cortical bone was removed 5 mm posterior to the mental foramen to the wisdom tooth area. Next, the anteroposterior length of the window was measured. The diameter of the IAN at the first molar tooth area was measured. Finally, the GAN was cut with maximum available length to compare to the length of the window in the mandible. The anteroposterior length of the window and diameter of the IAN ranged from 23.1 to 31.2 mm and 1.2 to 2.1 mm, respectively. The length of the available GAN was longer than the ipsilateral bony window of the mandible on all sides. This study might encourage surgeons to consider a new way to treat patients who undergo segmental resection of the mandible with surgical neck dissection with injury to their IAN.
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11
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Wang Y, Zhang Y, Li X, Zhang Q. The progress of biomaterials in peripheral nerve repair and regeneration. JOURNAL OF NEURORESTORATOLOGY 2020. [DOI: 10.26599/jnr.2020.9040022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Repair and regeneration of the injured peripheral nerve (PN) is a challenging issue in clinics. Although the regeneration outcome of large PN defects is currently unsatisfactory, recently, the study of PN repair has considerably progressed. In particular, biomaterials for repairing PNs, such as nerve guidance conduits and nerve repair membranes, have been well developed. Herein, we summarize the anatomy of the PN, the pathophysiological features of the nerve injury, and the repair process post injury. Then, we highlight the progress in the development of natural and synthetic biomaterials and summarize the applications, advantages, and disadvantages of these materials. These materials can be used as nerve repair membranes and nerve conduits in the field of PN repair. Finally, we discuss the challenges encountered and development strategies for PN repair in the future.
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12
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Binnetoglu A, Demir B, Akakin D, Kervancioglu Demirci E, Batman C. Bacterial cellulose tubes as a nerve conduit for repairing complete facial nerve transection in a rat model. Eur Arch Otorhinolaryngol 2019; 277:277-283. [PMID: 31595316 DOI: 10.1007/s00405-019-05637-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/05/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE Functionality of the facial nerve is cosmetically important. While many techniques have been investigated, early and effective treatment for traumatic facial nerve paralysis remains challenging. Here, we aim to examine bacterial cellulose (BC) as a new tubularization material for improving facial nerve regeneration. METHODS Our study was performed on 40 female Sprague Dawley rats. Rats were randomly divided into four groups, with 10 rats per group. In all rats, the main trunk of the facial nerve was completely cut 8 mm before the branching point. For repairing the facial nerve, in group 1, the nerve was left to recover spontaneously (control group); in group 2, it was repaired by primary suturing (8.0 Ethilon sutures, Ethicon); in group 3, BC tubes alone were used to aid nerve repair; and in group 4, both BC tubes and primary sutures (8.0 Ethilon sutures) were used. After 10 weeks, the facial nerve regeneration was evaluated by the whisker movement test and electrophysiologically (nerve stimulation threshold and compound muscle action potential). Nerve regeneration was assessed by calculating the number of myelinated nerve fibers, and by microscopically evaluating the amount of regeneration and fibrosis. RESULTS No significant difference was observed among the groups in terms of whisker movement and electrophysiological parameters (P > 0.05). We found that the numbers of regenerating myelinated fibers were significantly increased (P < 0.05) when BC tubes were used as a nerve conduit. CONCLUSIONS BC can be easily shaped into a hollow tube that guides nerve axons, resulting in better nerve regeneration after transection.
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Affiliation(s)
- Adem Binnetoglu
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, 02135, USA.
| | - Berat Demir
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
| | - Dilek Akakin
- Department of Histology and Embryology, Marmara University Medical Faculty, Istanbul, Turkey
| | - Elif Kervancioglu Demirci
- Department of Histology and Embryology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Caglar Batman
- Department of Otorhinolaryngology-Head and Neck Surgery, Pendik Training and Research Hospital, Marmara University Medical Faculty, Istanbul, Turkey
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Uehara M, Wei Min W, Satoh M, Shimizu F. Fascicular turnover flap in the reconstruction of facial nerve defects: an experimental study in rats. J Plast Surg Hand Surg 2019; 53:155-160. [DOI: 10.1080/2000656x.2018.1562458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Miyuki Uehara
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Wu Wei Min
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Moriaki Satoh
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
| | - Fumiaki Shimizu
- Department of Plastic Surgery, Oita University Hospital, Oita, Japan
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14
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Bhandari P. Management of peripheral nerve injury. J Clin Orthop Trauma 2019; 10:862-866. [PMID: 31528058 PMCID: PMC6739245 DOI: 10.1016/j.jcot.2019.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023] Open
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15
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Duffy P, McMahon S, Wang X, Keaveney S, O'Cearbhaill ED, Quintana I, Rodríguez FJ, Wang W. Synthetic bioresorbable poly-α-hydroxyesters as peripheral nerve guidance conduits; a review of material properties, design strategies and their efficacy to date. Biomater Sci 2019; 7:4912-4943. [DOI: 10.1039/c9bm00246d] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Implantable tubular devices known as nerve guidance conduits (NGCs) have drawn considerable interest as an alternative to autografting in the repair of peripheral nerve injuries.
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Affiliation(s)
- Patrick Duffy
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
| | - Seán McMahon
- Ashland Specialties Ireland Ltd
- Synergy Centre
- Dublin
- Ireland
| | - Xi Wang
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
| | - Shane Keaveney
- School of Mechanical & Materials Engineering
- UCD Centre for Biomedical Engineering
- UCD Conway Institute of Biomolecular and Biomedical Research
- University College Dublin
- Dublin
| | - Eoin D. O'Cearbhaill
- School of Mechanical & Materials Engineering
- UCD Centre for Biomedical Engineering
- UCD Conway Institute of Biomolecular and Biomedical Research
- University College Dublin
- Dublin
| | - Iban Quintana
- IK4-Tekniker
- Surface Engineering and Materials Science Unit
- Eibar
- Spain
| | | | - Wenxin Wang
- The Charles Institute of Dermatology
- School of Medicine
- University College Dublin
- Dublin
- Ireland
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16
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Sahar MSU, Barton M, Tansley GD. Bridging larger gaps in peripheral nerves using neural prosthetics and physical therapeutic agents. Neural Regen Res 2019; 14:1109-1115. [PMID: 30804232 PMCID: PMC6425823 DOI: 10.4103/1673-5374.251186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Peripheral nerve injuries are relatively common and can be caused by a variety of traumatic events such as motor vehicle accidents. They can lead to long-term disability, pain, and financial burden, and contribute to poor quality of life. In this review, we systematically analyze the contemporary literature on peripheral nerve gap management using nerve prostheses in conjunction with physical therapeutic agents. The use of nerve prostheses to assist nerve regeneration across large gaps (> 30 mm) has revolutionized neural surgery. The materials used for nerve prostheses have been greatly refined, making them suitable for repairing large nerve gaps. However, research on peripheral nerve gap management using nerve prostheses reports inconsistent functional outcomes, especially when prostheses are integrated with physical therapeutic agents, and thus warrants careful investigation. This review explores the effectiveness of nerve prostheses for bridging large nerve gaps and then addresses their use in combination with physical therapeutic agents.
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Affiliation(s)
| | - Matthew Barton
- Clem Jones Centre for Neurobiology and Stem Cell Therapies, Griffith University, Gold Coast, Queensland, Australia
| | - Geoffrey Douglas Tansley
- School of Engineering and Built Environment, Griffith University, Gold Coast, Queensland, Australia
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17
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A clinical multi‐center registry study on digital nerve repair using a biodegradable nerve conduit of PGA with external and internal collagen scaffolding. Microsurgery 2018; 39:395-399. [DOI: 10.1002/micr.30417] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 01/23/2023]
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18
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Dixon AR, Jariwala SH, Bilis Z, Loverde JR, Pasquina PF, Alvarez LM. Bridging the gap in peripheral nerve repair with 3D printed and bioprinted conduits. Biomaterials 2018; 186:44-63. [DOI: 10.1016/j.biomaterials.2018.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 01/14/2023]
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19
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Evaluation of two collagen conduits and autograft in rabbit sciatic nerve regeneration with quantitative magnetic resonance DTI, electrophysiology, and histology. Eur Radiol Exp 2018; 2:19. [PMID: 30148252 PMCID: PMC6091702 DOI: 10.1186/s41747-018-0049-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Background We compared different surgical techniques for nerve regeneration in a rabbit sciatic nerve gap model using magnetic resonance diffusion tensor imaging (DTI), electrophysiology, limb function, and histology. Methods A total of 24 male New Zealand white rabbits were randomized into three groups: autograft (n = 8), hollow conduit (n = 8), and collagen-filled conduit (n = 8). A 10-mm segment of the rabbit proximal sciatic nerve was cut, and autograft or collagen conduit was used to bridge the gap. DTI on a 3-T system was performed preoperatively and 13 weeks after surgery using the contralateral, nonoperated nerve as a control. Results Overall, autograft performed better compared with both conduit groups. Differences in axonal diameter were significant (autograft > hollow conduit > collagen-filled conduit) at 13 weeks (autograft vs. hollow conduit, p = 0.001, and hollow conduit vs. collagen-filled conduit, p < 0.001). Significant group differences were found for axial diffusivity but not for any of the other DTI metrics (autograft > hollow conduit > collagen-filled conduit) (autograft vs. hollow conduit, p = 0.001 and hollow conduit vs. collagen-filled conduit, p = 0.021). As compared with hollow conduit (autograft > collagen-filled conduit > hollow conduit), collagen-filled conduit animals demonstrated a nonsignificant increased maximum tetanic force. Conclusions Autograft-treated rabbits demonstrated improved sciatic nerve regeneration compared with collagen-filled and hollow conduits as assessed by histologic, functional, and DTI parameters at 13 weeks.
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Wieringa PA, Gonçalves de Pinho AR, Micera S, Wezel RJA, Moroni L. Biomimetic Architectures for Peripheral Nerve Repair: A Review of Biofabrication Strategies. Adv Healthc Mater 2018; 7:e1701164. [PMID: 29349931 DOI: 10.1002/adhm.201701164] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/13/2017] [Indexed: 12/19/2022]
Abstract
Biofabrication techniques have endeavored to improve the regeneration of the peripheral nervous system (PNS), but nothing has surpassed the performance of current clinical practices. However, these current approaches have intrinsic limitations that compromise patient care. The "gold standard" autograft provides the best outcomes but requires suitable donor material, while implantable hollow nerve guide conduits (NGCs) can only repair small nerve defects. This review places emphasis on approaches that create structural cues within a hollow NGC lumen in order to match or exceed the regenerative performance of the autograft. An overview of the PNS and nerve regeneration is provided. This is followed by an assessment of reported devices, divided into three major categories: isotropic hydrogel fillers, acting as unstructured interluminal support for regenerating nerves; fibrous interluminal fillers, presenting neurites with topographical guidance within the lumen; and patterned interluminal scaffolds, providing 3D support for nerve growth via structures that mimic native PNS tissue. Also presented is a critical framework to evaluate the impact of reported outcomes. While a universal and versatile nerve repair strategy remains elusive, outlined here is a roadmap of past, present, and emerging fabrication techniques to inform and motivate new developments in the field of peripheral nerve regeneration.
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Affiliation(s)
- Paul A. Wieringa
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
| | - Ana Rita Gonçalves de Pinho
- Tissue Regeneration DepartmentMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Silvestro Micera
- BioRobotics InstituteScuola Superiore Sant'Anna Viale Rinaldo Piaggio 34 Pontedera 56025 Italy
- Translational Neural Engineering LaboratoryEcole Polytechnique Federale de Lausanne Ch. des Mines 9 Geneva CH‐1202 Switzerland
| | - Richard J. A. Wezel
- BiophysicsDonders Institute for BrainCognition and BehaviourRadboud University Kapittelweg 29 Nijmegen 6525 EN The Netherlands
- Biomedical Signals and SystemsMIRA InstituteUniversity of Twente Drienerlolaan 5 Enschede 7522 NB The Netherlands
| | - Lorenzo Moroni
- Department of Complex Tissue RegenerationMERLN Institute for Technology‐Inspired Regenerative MedicineMaastricht University Universiteitssingel 40 Maastricht 6229 ER The Netherlands
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Shionoya Y, Sunada K, Shigeno K, Nakada A, Honda M, Nakamura T. Can nerve regeneration on an artificial nerve conduit be enhanced by ethanol-induced cervical sympathetic ganglion block? PLoS One 2017; 12:e0189297. [PMID: 29220373 PMCID: PMC5722367 DOI: 10.1371/journal.pone.0189297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/22/2017] [Indexed: 11/27/2022] Open
Abstract
This study aimed to determine whether nerve regeneration by means of an artificial nerve conduit is promoted by ethanol-induced cervical sympathetic ganglion block (CSGB) in a canine model. This study involved two experiments—in part I, the authors examined the effect of CSGB by ethanol injection on long-term blood flow to the orofacial region; part II involved evaluation of the effect of CSGB by ethanol injection on inferior alveolar nerve (IAN) repair using polyglycolic acid-collagen tubes. In part I, seven Beagles were administered left CSGB by injection of 99.5% ethanol under direct visualization by means of thoracotomy, and changes in oral mucosal blood flow in the mental region and nasal skin temperature were evaluated. The increase in blood flow on the left side lasted for 7 weeks, while the increase in average skin temperature lasted 10 weeks on the left side and 3 weeks on the right. In part II, fourteen Beagles were each implanted with a polyglycolic acid-collagen tube across a 10-mm gap in the left IAN. A week after surgery, seven of these dogs were administered CSGB by injection of ethanol. Electrophysiological findings at 3 months after surgery revealed significantly higher sensory nerve conduction velocity and recovery index (ratio of left and right IAN peak amplitudes) after nerve regeneration in the reconstruction+CSGB group than in the reconstruction-only group. Myelinated axons in the reconstruction+CSGB group were greater in diameter than those in the reconstruction-only group. Administration of CSGB with ethanol resulted in improved nerve regeneration in some IAN defects. However, CSGB has several physiological effects, one of which could possibly be the long-term increase in adjacent blood flow.
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Affiliation(s)
- Yoshiki Shionoya
- Department of Dental Anesthesia, Nippon Dental University Hospital at Tokyo, Japan
- * E-mail:
| | - Katsuhisa Sunada
- Department of Dental Anesthesiology, Nippon Dental University School of Life Dentistry at Tokyo, Tokyo, Japan
| | - Keiji Shigeno
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Akira Nakada
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Michitaka Honda
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
| | - Tatsuo Nakamura
- Department of Bioartificial Organs, Institute for Frontier Medical Science, Kyoto University, Kyoto, Japan
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Zhao Y, Zhang Q, Zhao L, Gan L, Yi L, Zhao Y, Xue J, Luo L, Du Q, Geng R, Sun Z, Benkirane-Jessel N, Chen P, Li Y, Chen Y. Enhanced Peripheral Nerve Regeneration by a High Surface Area to Volume Ratio of Nerve Conduits Fabricated from Hydroxyethyl Cellulose/Soy Protein Composite Sponges. ACS OMEGA 2017; 2:7471-7481. [PMID: 30023554 PMCID: PMC6044839 DOI: 10.1021/acsomega.7b01003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 10/19/2017] [Indexed: 05/05/2023]
Abstract
Multichannel nerve guide conduits (MCNGCs) have been widely studied and exhibited outstanding nerve repair function. However, the effect of the geometric structure of MCNGCs on the nerve repair function was still not clear. Herein, we postulated that MCNGCs with different inner surface area-to-volume ratios (ISA/V) of the channels inside the nerve guide conduits (NGCs) would show different nerve repair functions. Therefore, in current work, we constructed a series of hydroxyethyl cellulose/soy protein sponge-based nerve conduit (HSSN) with low, medium, and high ISA/V from hydroxyethyl cellulose (HEC)/soy protein isolate (SPI) composite sponges, which were abbreviated as HSSN-L, HSSN-M and HSSN-H, respectively. These NGCs were applied to bridge and repair a 10 mm long sciatic nerve defect in a rat model. Finally, the influence of ISA/V on nerve repair function was evaluated by electrophysiological assessment, histological investigation, and in vivo biodegradability testing. The results of electrophysiological assessment and histological investigation showed that the regenerative nerve tissues bridged with HSSN-H and HSSN-M had higher compound muscle action potential amplitude ratio, higher percentage of positive NF200 and S100 staining, larger axon diameter, lower G-ratio, and greater myelination thickness. Furthermore, the regenerative nerve tissues bridged with HSSN-H also showed higher density of regenerated myelinated nerve fibers and more number of myelin sheath layers. On the whole, the repair efficiency of the peripheral nerve in HSSN-H and HSSN-M groups might be better than that in HSSN-L. These results indicated that higher ISA/V based on HEC/SPI composite sponge may result in greater nerve repair functions. The conclusion provided a probable guiding principle for the structural designs of NGCs in the future.
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Affiliation(s)
- Yanteng Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- Department
of Transfusion, The First Affiliated Hospital
of Zhengzhou University, Zhengzhou 450052, China
| | - Qiang Zhang
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Lei Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Li Gan
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- Department
of Cell Biology, School of Medicine, Wuhan
University of Science and Technology, Wuhan 430065, China
| | - Li Yi
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yanan Zhao
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Jingling Xue
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Lihua Luo
- Laboratory
of Stem Cells and Tissue Engineering, School & Hospital of Stomatology, Wenzhou Medical University, Wenzhou 325027, China
| | - Qiaoyue Du
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Rongxin Geng
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Zhihong Sun
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Nadia Benkirane-Jessel
- INSERM
(French National Institute of Health and Medical Research), Osteoarticular
and Dental Regenerative Nanomedicine Laboratory, UMR 1109, Faculté
de Médecine, Strasbourg F-67000, France
- Université
de Strasbourg, Faculté de Chirurgie Dentaire, 1 place de l’Hôpital, Strasbourg F-67000, France
| | - Pu Chen
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Yinping Li
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- E-mail: (Y.L.)
| | - Yun Chen
- Department
of Biomedical Engineering, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
- E-mail: (Y.C.)
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Mashhoudi Barez M, Tajziehchi M, Heidari MH, Bushehri A, Moayer F, Mansouri N, Safavi Naini N, Movafagh A. Stimulation Effect of Low Level Laser Therapy on Sciatic Nerve Regeneration in Rat. J Lasers Med Sci 2017; 8:S32-S37. [PMID: 29071033 PMCID: PMC5642176 DOI: 10.15171/jlms.2017.s7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Recent studies showed that low-level laser therapy (LLLT) accelerates the regeneration process of injured peripheral nerve tissue. The objective of this study was investigate the effect of LLLT (780 nm) on regeneration of injured right sciatic nerve of male Wistar rat. Methods: In this research work, the effect of LLLT (780 nm) on the regeneration process and reconstruction of injured peripheral right side sciatic nerve was investigated. Twelve adult male Wistar rats underwent surgery in aseptic conditions under general anesthesia to induce a lesion to their right side sciatic nerve according to standard protocol. Before suturing the location, only the experimental group was treated by laser. The damaged nerve was directly irradiated with (2 J, 100 mW, 40 seconds). The irradiation procedure was terminated in 21 days with little improvement (4 J, 200 mW, 40 seconds) across the skin surface of experimental group. Rats were selected randomly from each group to be sacrificed on different periods and histopathological examination was carried out on the extracted nerves. Results: Significant acceleration of revascularization and angiogenesis of the injury site was observed in the experimental group. Furthermore, a reduction of hemorrhages and increase in blood supply was observed. Also, Wallerian degeneration decreased while higher axonal density compared to the control rats was observed. Moreover, the cross-section analysis of the injured area on the 14th and 21st days as post-surgery showed that the nerve sheath diameter in the lesion area of the experimental group was reduced. While the ratio between thicknesses increased in the control group. Conclusion: The results of the current study suggest that laser phototherapy at 780 nm exactly could accelerate the regeneration process of injured peripheral nerves tissue.
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Affiliation(s)
- Mohammadreza Mashhoudi Barez
- Cell and Molecular Biology Research Center, Department of Anatomy and Biology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Tajziehchi
- Cell and Molecular Biology Research Center, Department of Anatomy and Biology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Hassan Heidari
- Cell and Molecular Biology Research Center, Department of Anatomy and Biology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atta Bushehri
- Genetics Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fariborz Moayer
- Department of Pathobiology, College of Veterinary Medicine, Karaj Branch, Islamic Azad University, Alborz, Iran
| | | | - Niloufar Safavi Naini
- Department of Medical Genetics, School of Medicine, Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abolfazl Movafagh
- Department of Medical Genetics, School of Medicine, Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rbia N, Shin AY. The Role of Nerve Graft Substitutes in Motor and Mixed Motor/Sensory Peripheral Nerve Injuries. J Hand Surg Am 2017; 42:367-377. [PMID: 28473159 DOI: 10.1016/j.jhsa.2017.02.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
Alternatives to nerve autograft have been invented and approved for clinical use. The reported outcomes of these alternatives in mixed motor nerve repair in humans are scarce and marked by wide variabilities. The purpose of our Current Concepts review is to provide an evidence-based overview of the effectiveness of nerve conduits and allografts in motor and mixed sensory/motor nerve reconstruction. Nerve graft substitutes have good outcomes in mixed/motor nerves in gaps less than 6 mm and internal diameters between 3 and 7 mm. There is insufficient evidence for their use in larger-gap and -diameter nerves; the evidence remains that major segmental motor or mixed nerve injury is optimally treated with a cabled nerve autograft.
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Affiliation(s)
- Nadia Rbia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
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25
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Gersey ZC, Burks SS, Anderson KD, Dididze M, Khan A, Dietrich WD, Levi AD. First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up. Neurosurg Focus 2017; 42:E2. [PMID: 28245668 DOI: 10.3171/2016.12.focus16474] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.
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Affiliation(s)
- Zachary C Gersey
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - S Shelby Burks
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Kim D Anderson
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Marine Dididze
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Aisha Khan
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - W Dalton Dietrich
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
| | - Allan D Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida
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Millesi H. Peripheral Nerve Surgery Today: Turning Point or Continuous Development? JOURNAL OF HAND SURGERY 2017; 15:281-7. [PMID: 2230491 DOI: 10.1016/0266-7681_90_90004-n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- H Millesi
- First Surgical Clinic, University of Vienna Medical School, Austria
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27
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Ducic I, Safa B, DeVinney E. Refinements of nerve repair with connector-assisted coaptation. Microsurgery 2016; 37:256-263. [DOI: 10.1002/micr.30151] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 12/03/2016] [Accepted: 12/16/2016] [Indexed: 01/12/2023]
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28
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Approaches to Peripheral Nerve Repair: Generations of Biomaterial Conduits Yielding to Replacing Autologous Nerve Grafts in Craniomaxillofacial Surgery. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3856262. [PMID: 27556032 PMCID: PMC4983313 DOI: 10.1155/2016/3856262] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/29/2016] [Indexed: 01/09/2023]
Abstract
Peripheral nerve injury is a common clinical entity, which may arise due to traumatic, tumorous, or even iatrogenic injury in craniomaxillofacial surgery. Despite advances in biomaterials and techniques over the past several decades, reconstruction of nerve gaps remains a challenge. Autografts are the gold standard for nerve reconstruction. Using autografts, there is donor site morbidity, subsequent sensory deficit, and potential for neuroma development and infection. Moreover, the need for a second surgical site and limited availability of donor nerves remain a challenge. Thus, increasing efforts have been directed to develop artificial nerve guidance conduits (ANCs) as new methods to replace autografts in the future. Various synthetic conduit materials have been tested in vitro and in vivo, and several first- and second-generation conduits are FDA approved and available for purchase, while third-generation conduits still remain in experimental stages. This paper reviews the current treatment options, summarizes the published literature, and assesses future prospects for the repair of peripheral nerve injury in craniomaxillofacial surgery with a particular focus on facial nerve regeneration.
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29
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Dezhznz Yin, Xiao Hong Wang, Yongnian Yan, Renji Zhang. Preliminary Studies on Peripheral Nerve Regeneration using a New Polyurethane Conduit. J BIOACT COMPAT POL 2016. [DOI: 10.1177/0883911506076063] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There is currently interest in the use of tube-shaped nerve guides to induce regeneration of severed peripheral nerve axons, to assist nerve growth in the correct directions and to provide protection for the regenerating nerves. In the present paper, preliminary studies on the degradation and biocompatibility of a new elastomeric polyurethane (PU), based on polycaprolactone, polyethylene glycol and 1,6-hexamethyl diisocyanate. The PU elastomer was evaluated in vivo for the repair of a 12-mm femoral nerve gap in rabbits. Histological and scanning electron microscope observations were carried out at three days and then 4, 8, 10 and 12 weeks postoperation. Electrophysiological recording was performed six months postoperation. Myelinated axon regeneration was observed from four weeks after implantation. Polymer degradation was observed over the duration of the study. The results suggest that PU channels can be used for the regeneration of peripheral nerves and are suitable for tissue engineering.
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Affiliation(s)
- Dezhznz Yin
- Key Laboratory for Advanced Materials Processing Technology, Ministry of Education & Center of Bio-manufacturing Engineering, Department of Mechanical Engineering and Institute of Life Science and Medicine, Tsinghua University, Beijing 100084, People's Republic of China
| | - Xiao Hong Wang
- Key Laboratory for Advanced Materials Processing Technology, Ministry of Education & Center of Bio-manufacturing Engineering, Department of Mechanical Engineering and Institute of Life Science and Medicine, Tsinghua University, Beijing 100084, People's Republic of China
| | - Yongnian Yan
- Key Laboratory for Advanced Materials Processing Technology, Ministry of Education & Center of Bio-manufacturing Engineering, Department of Mechanical Engineering and Institute of Life Science and Medicine, Tsinghua University, Beijing 100084, People's Republic of China
| | - Renji Zhang
- Key Laboratory for Advanced Materials Processing Technology, Ministry of Education & Center of Bio-manufacturing Engineering, Department of Mechanical Engineering and Institute of Life Science and Medicine, Tsinghua University, Beijing 100084, People's Republic of China
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Man AJ, Kujawski G, Burns TS, Miller EN, Fierro FA, Leach JK, Bannerman P. Neurogenic potential of engineered mesenchymal stem cells overexpressing VEGF. Cell Mol Bioeng 2016; 9:96-106. [PMID: 27087859 PMCID: PMC4830493 DOI: 10.1007/s12195-015-0425-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 12/08/2015] [Indexed: 02/04/2023] Open
Abstract
Numerous signaling molecules are altered following nerve injury, serving as a blueprint for drug delivery approaches that promote nerve repair. However, challenges with achieving the appropriate temporal duration of recombinant protein delivery have limited the therapeutic success of this approach. Genetic engineering of mesenchymal stem cells (MSCs) to enhance the secretion of proangiogenic molecules such as vascular endothelial growth factor (VEGF) may provide an alternative. We hypothesized that the administration of VEGF-expressing human MSCs would stimulate neurite outgrowth and proliferation of cell-types involved in neural repair. When cultured with dorsal root ganglion (DRG) explants in vitro, control and VEGF-expressing MSCs (VEGF-MSCs) increased neurite extension and proliferation of Schwann cells (SCs) and endothelial cells, while VEGF-MSCs stimulated significantly greater proliferation of endothelial cells. When embedded within a 3D fibrin matrix, VEGF-MSCs maintained overexpression and expressed detectable levels over 21 days. After transplantation into a murine sciatic nerve injury model, VEGF-MSCs maintained high VEGF levels for 2 weeks. This study provides new insight into the role of VEGF on peripheral nerve injury and the viability of transplanted genetically engineered MSCs. The study aims to provide a framework for future studies with the ultimate goal of developing an improved therapy for nerve repair.
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Affiliation(s)
- Alan J. Man
- Institute for Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Gregory Kujawski
- Institute for Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817
| | - Travis S. Burns
- Institute for Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817
| | - Elaine N. Miller
- Institute for Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817
| | - Fernando A. Fierro
- Institute of Regenerative Cures, University of California, Davis, Sacramento, CA 95817
| | - J. Kent Leach
- Department of Biomedical Engineering, University of California, Davis, Davis, CA 95616
| | - Peter Bannerman
- Institute for Pediatric Regenerative Medicine, Shriners Hospital for Children Northern California, Sacramento, CA 95817
- Department of Cell Biology, UC Davis School of Medicine, UC Davis Medical Center, Sacramento, CA 95817
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Zhao Q, Li ZY, Zhang ZP, Mo ZY, Chen SJ, Xiang SY, Zhang QS, Xue M. Polylactic-co-glycolic acid microspheres containing three neurotrophic factors promote sciatic nerve repair after injury. Neural Regen Res 2015; 10:1491-7. [PMID: 26604912 PMCID: PMC4625517 DOI: 10.4103/1673-5374.165522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A variety of neurotrophic factors have been shown to repair the damaged peripheral nerve. However, in clinical practice, nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor are all peptides or proteins that may be rapidly deactivated at the focal injury site; their local effective concentration time following a single medication cannot meet the required time for spinal axons to regenerate and cross the glial scar. In this study, we produced polymer sustained-release microspheres based on the polylactic-co-glycolic acid copolymer; the microspheres at 300-μm diameter contained nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor. Six microspheres were longitudinally implanted into the sciatic nerve at the anastomosis site, serving as the experimental group; while the sciatic nerve in the control group was subjected to the end-to-end anastomosis using 10/0 suture thread. At 6 weeks after implantation, the lower limb activity, weight of triceps surae muscle, sciatic nerve conduction velocity and the maximum amplitude were obviously better in the experimental group than in the control group. Compared with the control group, more regenerating nerve fibers were observed and distributed in a dense and ordered manner with thicker myelin sheaths in the experimental group. More angiogenesis was also visible. Experimental findings indicate that polylactic-co-glycolic acid composite microspheres containing nerve growth factor, neurotrophin-3 and brain-derived neurotrophic factor can promote the restoration of sciatic nerve in rats after injury.
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Affiliation(s)
- Qun Zhao
- Health Management Center, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhi-Yue Li
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Ze-Peng Zhang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Zhou-Yun Mo
- Department of Orthopedics, Yiyang Municipal Central Hospital, Yiyang, Hunan Province, China
| | - Shi-Jie Chen
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Si-Yu Xiang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Qing-Shan Zhang
- Department of Orthopedics, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Min Xue
- Department of Gynecology, Third Xiangya Hospital of Central South University, Changsha, Hunan Province, China
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Levi AD, Burks SS, Anderson KD, Dididze M, Khan A, Dietrich WD. The Use of Autologous Schwann Cells to Supplement Sciatic Nerve Repair With a Large Gap: First in Human Experience. Cell Transplant 2015; 25:1395-403. [PMID: 26610173 DOI: 10.3727/096368915x690198] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Insufficient donor nerve graft material in peripheral nerve surgery remains an obstacle for successful long-distance regeneration. Schwann cells (SCs) can be isolated from adult mammalian peripheral nerve biopsies and can be grown in culture and retain their capacity to enhance peripheral nerve regeneration within tubular repair strategies in multiple animal models. Human Schwann cells (hSCs) can be isolated, expanded in number, and retain their ability to promote regeneration and myelinate axons, but have never been tested in a clinical case of peripheral nerve injury. A sural nerve biopsy and peripheral nerve tissue from the traumatized sciatic nerve stumps was obtained after Food and Drug Administration (FDA) and Institutional Review Board (IRB) approval as well as patient consent. The SCs were isolated after enzymatic digestion of the nerve and expanded with the use of heregulin β1 (0.1 µg/ml) and forskolin (15 mM). After two passages the Schwann cell isolates were combined with sural nerve grafts to repair a large sciatic nerve defect (7.5 cm) after a traumatic nerve injury. The sural nerve and the traumatized sciatic nerve ends both served as an excellent source of purified (90% and 97%, respectively) hSCs. Using ultrasound and magnetic resonance imaging (MRI) we were able to determine continuity of the nerve graft repair and the absence of tumor formation. The patient had evidence of proximal sensory recovery and definitive motor recovery distal to the repair in the distribution of the tibial and common peroneal nerve. The patient did experience an improvement in her pain scores over time. The goals of this approach were to determine the safety and clinical feasibility of implementing a new cellular repair strategy. In summary, this approach represents a novel strategy in the treatment of peripheral nerve injury and represents the first reported use of autologous cultured SCs after human peripheral nerve injury.
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Affiliation(s)
- Allan D Levi
- Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
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Suzuki H, Araki K, Matsui T, Tomifuji M, Yamashita T, Kobayashi Y, Shiotani A. Value of a novel PGA-collagen tube on recurrent laryngeal nerve regeneration in a rat model. Laryngoscope 2015; 126:E233-9. [PMID: 26525485 DOI: 10.1002/lary.25750] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/13/2015] [Accepted: 09/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nerbridge (Toyobo Co., Ltd., Osaka, Japan) is a novel polyglycolic acid (PGA) tube that is filled with collagen fibers and that facilitates nerve fiber expansion and blood vessel growth. It is biocompatible and commercially available, with governmental approval for practical use in Japan. We hypothesized that the PGA-collagen tube would promote regeneration of the recurrent laryngeal nerve (RLN). This hypothesis was examined in a rat axotomy model of the RLN. STUDY DESIGN Prospective animal study. METHODS The axotomy model was established by transection of the left RLN in adult Sprague-Dawley rats. The cut ends of the nerve were bridged using Nerbridge (Toyobo Co., Ltd.) with a 1-mm gap (tube-treatment group) or direct sutures (sutured-control group). Left vocal fold mobility, nerve conduction velocity, morphology, and histology were assessed after 15 weeks. RESULTS Fifteen weeks after treatment, nerve fiber connections were observed macroscopically in both groups, and more clear myelinated fibers and better prevention of laryngeal muscle atrophy were observed in the tube-treatment group compared with the sutured-control group. However, vocal fold movement recovery was not observed in either group, and the conduction velocity of the RLN did not differ between the two groups. CONCLUSIONS Better nerve regeneration was observed in the tube-treatment group. The combination therapy with molecular or gene therapy might be an effective strategy to improve vocal fold movement. The PGA-collagen tube has the potential to promote regeneration of the RLN and to be a scaffold for drug administration in these combination therapies. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:E233-E239, 2016.
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Affiliation(s)
- Hiroshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Koji Araki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshiyasu Matsui
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasushi Kobayashi
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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Mechanical properties of a bioabsorbable nerve guide tube for long nerve defects. ACTA ACUST UNITED AC 2015; 34:186-92. [DOI: 10.1016/j.main.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 11/21/2022]
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Roam JL, Yan Y, Nguyen PK, Kinstlinger IS, Leuchter MK, Hunter DA, Wood MD, Elbert DL. A modular, plasmin-sensitive, clickable poly(ethylene glycol)-heparin-laminin microsphere system for establishing growth factor gradients in nerve guidance conduits. Biomaterials 2015; 72:112-24. [PMID: 26352518 DOI: 10.1016/j.biomaterials.2015.08.054] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/25/2015] [Accepted: 08/28/2015] [Indexed: 12/16/2022]
Abstract
Peripheral nerve regeneration is a complex problem that, despite many advancements and innovations, still has sub-optimal outcomes. Compared to biologically derived acellular nerve grafts and autografts, completely synthetic nerve guidance conduits (NGC), which allow for precise engineering of their properties, are promising but still far from optimal. We have developed an almost entirely synthetic NGC that allows control of soluble growth factor delivery kinetics, cell-initiated degradability and cell attachment. We have focused on the spatial patterning of glial-cell derived human neurotrophic factor (GDNF), which promotes motor axon extension. The base scaffolds consisted of heparin-containing poly(ethylene glycol) (PEG) microspheres. The modular microsphere format greatly simplifies the formation of concentration gradients of reversibly bound GDNF. To facilitate axon extension, we engineered the microspheres with tunable plasmin degradability. 'Click' cross-linking chemistries were also added to allow scaffold formation without risk of covalently coupling the growth factor to the scaffold. Cell adhesion was promoted by covalently bound laminin. GDNF that was released from these microspheres was confirmed to retain its activity. Graded scaffolds were formed inside silicone conduits using 3D-printed holders. The fully formed NGC's contained plasmin-degradable PEG/heparin scaffolds that developed linear gradients in reversibly bound GDNF. The NGC's were implanted into rats with severed sciatic nerves to confirm in vivo degradability and lack of a major foreign body response. The NGC's also promoted robust axonal regeneration into the conduit.
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Affiliation(s)
- Jacob L Roam
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Ying Yan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Peter K Nguyen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Ian S Kinstlinger
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Michael K Leuchter
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Daniel A Hunter
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Matthew D Wood
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Campus Box 8238, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Donald L Elbert
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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Costa MP, Teixeira NH, Longo MVL, Gemperli R, Costa HJZR. Combined polyglycolic acid tube and autografting versus autografting or polyglycolic acid tube alone. A comparative study of peripheral nerve regeneration in rats. Acta Cir Bras 2015; 30:46-53. [PMID: 25627270 DOI: 10.1590/s0102-86502015001000006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/18/2014] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To compare sciatic nerve regeneration in rats using three different techniques of repair. METHODS Fifteen isogonics rats were divided into three groups according to the method used to repair a 5-mm long defect created in the sciatic nerve: autogenous graft (Group A), polyglycolic acid tube (PGAt) (Group B), and of the association of PGAt with the graft (Group C). Histological analysis, regenerated myelinated axon number count and functional analysis were used to compare after six weeks. RESULTS There was no difference in fiber diameter and degree of myelinization presented by Groups A, B and C. Group B presented the lowest number of regenerated axons. The groups did not display any significant functional difference after walking track analysis (p<0.05). CONCLUSION No differences between the three groups in terms of functional recovery, although there were histological differences among them.
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Affiliation(s)
| | | | | | - Rolf Gemperli
- Department of Plastic Surgery, Faculty of Medicine, USP, Sao Paulo, SP, Brazil
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Sahin C, Karagoz H, Kulahci Y, Sever C, Akakin D, Kolbasi B, Ulkur E, Peker F. Minced nerve tissue in vein grafts used as conduits in rat tibial nerves. Ann Plast Surg 2015; 73:540-6. [PMID: 24691343 DOI: 10.1097/sap.0000000000000060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Peripheral nerve injuries are encountered frequently in clinical practice. In nerve repair, an end-to-end suture is the preferable choice of treatment. However, where primary closure is not possible, the defect is to be repaired with a nerve graft. METHODS A total of 21 female Wistar rats weighing 230 to 290 g were used in the study. They were classified into the following 3 groups: (I) nerve graft, (II) vein graft, and (III) minced nerve graft. In group I, after exposure of the tibial nerve, a 1-cm-long nerve gap was created on the tibial nerve, and the defect was repaired epineurally by using the autogenous nerve. In group II, the 1-cm tibial nerve defect was repaired by using an autogenous vein graft. In group III, a 1-cm nerve graft was divided to 3 equal parts, with one of the nerve parts being minced with microscissors and placed in the vein graft lumen. Thereafter, a 1-cm tibial nerve defect was repaired by the vein graft filled with minced nerve tissue. The tibial function indices (TFIs) were calculated for functional assessment using the Bain-Mackinnon-Hunter formula. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated fibers were counted in all groups. RESULTS The TFIs of group II were found to be the lowest among all the groups after the sixth week, whereas the TFI of group I was found to be better than the other groups after the sixth week. There was no difference in TFIs between group I and group III. On the basis of the number of myelinated fibers, there was no statistically significant difference between group I and group III, whereas the difference was significant (P<0.05) between groups I/III and group II. Presence of peripheral nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was near normal in the nerve graft group in electron microscopic evaluation. However, there were more degenerated axons with disturbed contours and vacuolizations in the vein graft group compared to the minced nerve graft group. CONCLUSIONS We can conclude that using minced nerve tissue in vein grafts as a conduit increases the regeneration of nerves (almost like the nerve graft group) and it may not be caused by donor-site morbidity. It can be used in the repair of nerve defects instead of autogenous nerve grafts after further experimental evidence and clinical trials.
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Affiliation(s)
- Cihan Sahin
- From the *Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul; †Department of Hand and Upper Extremity Surgery, Gulhane Military Medical Academy, Ankara; ‡Department of Histology and Embryology, Marmara University, Medical School; and §F&P Plastic Reconstructive and Aesthetic Surgery Center, Istanbul, Turkey
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3D multi-channel bi-functionalized silk electrospun conduits for peripheral nerve regeneration. J Mech Behav Biomed Mater 2015; 41:43-55. [DOI: 10.1016/j.jmbbm.2014.09.029] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 12/21/2022]
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Dinis TM, Elia R, Vidal G, Auffret A, Kaplan DL, Egles C. Method to form a fiber/growth factor dual-gradient along electrospun silk for nerve regeneration. ACS APPLIED MATERIALS & INTERFACES 2014; 6:16817-16826. [PMID: 25203247 DOI: 10.1021/am504159j] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Concentration gradients of guidance molecules influence cell behavior and growth in biological tissues and are therefore of interest for the design of biomedical scaffolds for regenerative medicine. We developed an electrospining method to generate a dual-gradient of bioactive molecules and fiber density along electrospun nanofibers without any post spinning treatment. Functionalization with fluorescent molecules demonstrated the efficiency of the method to generate a discontinuous concentration gradient along the aligned fibers. As a proof of concept for tissue engineering, the silk nanofibers were functionalized with increasing concentrations of nerve growth factor (NGF) and the biological activity was assessed and quantified with rat dorsal root ganglion (DRG) neurons cultures. Protein assays showed the absence of passive release of NGF from the functionalized fibers. The results demonstrated that the NGF concentration gradient led to an oriented and increased growth of DRG neurons (417.6 ± 55.7 μm) compared to a single uniform NGF concentration (264.5 ± 37.6 μm). The easy-to-use electrospinning technique combined with the multiple molecules that can be used for fiber functionalization makes this technique versatile for a broad range of applications from biosensors to regenerative medicine.
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Affiliation(s)
- Tony M Dinis
- CNRS UMR 7338: BioMécanique et BioIngénierie Centre de recherche, Université de Technologie de Compiègne , BP 20529 Rue Personne de Roberval, 60205 Compiègne, France
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Abstract
Autologous nerve grafts are the current criterion standard for repair of peripheral nerve injuries when the transected nerve ends are not amenable to primary end-to-end tensionless neurorrhaphy. However, donor-site morbidities such as neuroma formation and permanent loss of function have led to tremendous interest in developing an alternative to this technique. Artificial nerve conduits have therefore emerged as an alternative to autologous nerve grafting for the repair of short peripheral nerve defects of less than 30 mm; however, they do not yet surpass autologous nerve grafts clinically. A thorough understanding of the complex biological reactions that take place during peripheral nerve regeneration will allow researchers to develop a nerve conduit with physical and biological properties similar to those of an autologous nerve graft that supports regeneration over long nerve gaps and in large-diameter nerves. In this article, the authors assess the currently available nerve conduits, summarize research in the field of developing these conduits, and establish areas within this field in which further research would prove most beneficial.
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Abstract
Nerve conduits and acellular nerve allograft offer efficient and convenient tools for overcoming unexpected gaps during nerve repair. Both techniques offer guidance for migrating Schwann cells and axonal regeneration though utilizing very different scaffolds. The substantially greater amount of animal and clinical data published on nerve conduits is marked by wide discrepancies in results that may be partly explained by a still poorly defined critical repair gap and diameter size. The available information on acellular allografts appears more consistently positive though this tool is also hampered by a longer but also limited critical length. This article reviews the current relative literature and examines pertinent parameters for application of both acellular allograft and nerve conduits in overcoming short nerve gaps.
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Gu X, Ding F, Williams DF. Neural tissue engineering options for peripheral nerve regeneration. Biomaterials 2014; 35:6143-56. [PMID: 24818883 DOI: 10.1016/j.biomaterials.2014.04.064] [Citation(s) in RCA: 387] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/16/2014] [Indexed: 12/19/2022]
Abstract
Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system.
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Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China.
| | - Fei Ding
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China
| | - David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC, USA.
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Hundepool CA, Nijhuis THJ, Mohseny B, Selles RW, Hovius SER. The effect of stem cells in bridging peripheral nerve defects: a meta-analysis. J Neurosurg 2014; 121:195-209. [PMID: 24816327 DOI: 10.3171/2014.4.jns131260] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED OBJECT.: For decades the gold standard for reconstructing a large peripheral nerve defect has been, and remains, the nerve autograft. Alternatives to the nerve autograft include biological conduits and vessels. Adding stem cells in the lumen of a nerve conduit has been the subject of multiple studies. The purpose of the present meta-analysis was to summarize animal experimental studies on the effect of stem cells as a luminal additive when reconstructing a peripheral nerve defect with a nerve graft. METHODS A literature search of the MEDLINE and Embase databases was performed from inception to April 2012, searching for animal experiments on peripheral nerve reconstruction models in which a nerve conduit was used with and without the support of 3 different types of stem cells. Stem cells were analyzed according to their origin: bone marrow, adipose tissue, and other origins. Included studies had consistent outcome measurements: walking track analysis, muscle mass ratio, and electrophysiology. RESULTS Forty-four studies were included in the final analysis. Forest plots of the 3 outcome measurements (walking track analysis, muscle mass ratio, and electrophysiology) showed positive effects of stem cells on the regeneration of peripheral nerves at different time points. Almost all comparisons showed significant differences for all 3 stem cells groups compared with a control group in which stem cells were not used. CONCLUSIONS The present report systematically analyzed the different studies that used stem cells as a luminal additive when bridging a large peripheral nerve defect. All 3 different stem cell groups showed a beneficial effect when used in the reconstruction compared with control groups in which stem cells were not used.
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Hinüber C, Chwalek K, Pan-Montojo FJ, Nitschke M, Vogel R, Brünig H, Heinrich G, Werner C. Hierarchically structured nerve guidance channels based on poly-3-hydroxybutyrate enhance oriented axonal outgrowth. Acta Biomater 2014; 10:2086-95. [PMID: 24406197 DOI: 10.1016/j.actbio.2013.12.053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 12/07/2013] [Accepted: 12/26/2013] [Indexed: 01/19/2023]
Abstract
Traumatic peripheral nerve lesions can cause local anesthesia, paralysis and loss of autonomic control. Reconstruction using engineered nerve guidance conduits (NGCs) is rarely successful due to the sub-optimal characteristics of the conduits. To address the demands of clinical practice, we developed a hierarchically structured NGC from slowly resorbing poly(3-hydroxybutyric acid) (P3HB). The NGC consists of a permeable single-lumen tube and melt-spun fibrillar lumen fillers. Permeable tubes were constructed from P3HB/poly(ɛ-caprolactone) (PCL) blends or poly(3-hydroxybutyric acid-co-4-hydroxybutyric acid) (P(3HB-co-4HB)). Polyvinylpyrrolidone was used as a porogen in solvent-free thermoplastic processing, followed by selective polymer leaching. All tested material compositions showed hydrolytic degradation after 16weeks in phosphate buffered saline, whereas P3HB/PCL tubes maintained mechanical strength compared to (P(3HB-co-4HB)). The porous scaffolds allowed diffusion of large molecules (∼70kDa). In vitro studies demonstrated that mouse fibroblasts survived and proliferated inside closed porous tubes. An in vitro model of axonal regeneration using dorsal root ganglia and sympathetic cervical ganglia demonstrated that the NGCs successfully supported neuron survival and neurite outgrowth. The introduction of fibrillar lumen fillers promoted oriented neurite growth and coating with extracellular matrix proteins further increased ganglia attachment and cell migration. In this study we show that P3HB-based NGCs scaffolds have potential in long gap peripheral nerve repair strategies.
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Affiliation(s)
- C Hinüber
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany; Technische Universität Dresden, Institute of Material Science, Helmholtzstrasse 7, 01069 Dresden, Germany.
| | - K Chwalek
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany
| | - F J Pan-Montojo
- Technische Universität Dresden, Institute of Anatomy/University Hospital Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Germany
| | - M Nitschke
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany
| | - R Vogel
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany
| | - H Brünig
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany
| | - G Heinrich
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany; Technische Universität Dresden, Institute of Material Science, Helmholtzstrasse 7, 01069 Dresden, Germany
| | - C Werner
- Leibniz-Institut für Polymerforschung Dresden e.V., Hohe Strasse 6, 01069 Dresden, Germany; Technische Universität Dresden, Center for Regenerative Therapies Dresden, Tatzberg 47, 01187 Dresden, Germany
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Breast Reinnervation: DIEP Neurotization Using the Third Anterior Intercostal Nerve. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2013; 1:e72. [PMID: 25289267 PMCID: PMC4186303 DOI: 10.1097/gox.0000000000000008] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/10/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this article is to evaluate a new method of DIEP flap neurotization using a reliably located recipient nerve. We hypothesize that neurotization by this method (with either nerve conduit or direct nerve coaptation) will have a positive effect on sensory recovery. METHODS Fifty-seven deep inferior epigastric perforator (DIEP) flaps were performed on 35 patients. Neurotizations were performed to the third anterior intercostal nerve by directly coapting the flap donor nerve or coapting with a nerve conduit. Nine nonneurotized DIEP flaps served as controls and received no attempted neurotization. All patients were tested for breast sensibility in 9 areas of the flap skin-island and adjacent postmastectomy skin. Testing occurred at an average of 111 weeks (23-309) postoperatively. RESULTS At a mean of 111 weeks after breast reconstruction, neurotization of the DIEP flap resulted in recovery of sensibility that was statistically significantly better (lower threshold) in the flap skin (P < 0.01) and statistically significantly better than in the native mastectomy skin into which the DIEP flap was inserted (P < 0.01). Sensibility recovered in DIEP flaps neurotized using the nerve conduit was significantly better (lower threshold) than that in the corresponding areas of the DIEP flaps neurotized by direct coaptation (P < 0.01). CONCLUSION DIEP flap neurotization using the third anterior intercostal nerve is an effective technique to provide a significant increase in sensory recovery for breast reconstruction patients, while adding minimal surgical time. Additionally, the use of a nerve conduit produces increased sensory recovery when compared direct coaptation.
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Jesuraj NJ, Santosa KB, Macewan MR, Moore AM, Kasukurthi R, Ray WZ, Flagg ER, Hunter DA, Borschel GH, Johnson PJ, Mackinnon SE, Sakiyama-Elbert SE. Schwann cells seeded in acellular nerve grafts improve functional recovery. Muscle Nerve 2013; 49:267-76. [PMID: 23625513 DOI: 10.1002/mus.23885] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2013] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study evaluated whether Schwann cells (SCs) from different nerve sources transplanted into cold-preserved acellular nerve grafts (CP-ANGs) would improve functional regeneration compared with nerve isografts. METHODS SCs isolated and expanded from motor and sensory branches of rat femoral and sciatic nerves were seeded into 14mm CP-ANGs. Growth factor expression, axonal regeneration, and functional recovery were evaluated in a 14-mm rat sciatic injury model and compared with isografts. RESULTS At 14 days, motor or sensory-derived SCs increased expression of growth factors in CP-ANGs versus isografts. After 42 days, histomorphometric analysis found CP-ANGs with SCs and isografts had similar numbers of regenerating nerve fibers. At 84 days, muscle force generation was similar for CP-ANGs with SCs and isografts. SC source did not affect nerve fiber counts or muscle force generation. CONCLUSIONS SCs transplanted into CP-ANGs increase functional regeneration to isograft levels; however SC nerve source did not have an effect.
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Affiliation(s)
- Nithya J Jesuraj
- Department of Biomedical Engineering, Washington University, Campus Box 1097, One Brookings Drive, St. Louis, Missouri, 63130, USA
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Sahakyants T, Lee JY, Friedrich PF, Bishop AT, Shin AY. Return of motor function after repair of a 3-cm gap in a rabbit peroneal nerve: a comparison of autograft, collagen conduit, and conduit filled with collagen-GAG matrix. J Bone Joint Surg Am 2013; 95:1952-8. [PMID: 24196465 DOI: 10.2106/jbjs.m.00215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the motor nerve recovery in a rabbit model after repair of a 3-cm gap in the peroneal nerve with a conduit filled with a collagen-GAG (glycosaminoglycan) matrix and compare the results with those after reconstruction with an autograft or an empty collagen conduit. METHODS Forty-two male New Zealand rabbits were divided into three experimental groups. In each group, a unilateral 3-cm peroneal nerve defect was repaired with a nerve autograft, an empty collagen conduit, or a conduit filled with a collagen-GAG matrix. At six months, nerve regeneration was evaluated on the basis of the compound muscle action potentials, maximum isometric tetanic force, and wet muscle weight of the tibialis anterior muscle as well as nerve histomorphometry. RESULTS The autograft group had significantly better motor recovery than the conduit groups. The empty collagen conduits and conduits filled with the collagen-GAG matrix led to results that were similar to each other. CONCLUSIONS On the basis of this rabbit model, autologous nerve grafting remains the gold standard in the reconstruction of 3-cm segmental motor nerve defects. CLINICAL RELEVANCE Segmental motor nerve defects should be reconstructed with autograft nerves. The use of a collagen conduit filled with a collagen-GAG matrix for motor nerve reconstruction should be limited until additional animal studies are performed.
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Affiliation(s)
- Tatevik Sahakyants
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for A.Y. Shin:
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Binan L, Ajji A, De Crescenzo G, Jolicoeur M. Approaches for Neural Tissue Regeneration. Stem Cell Rev Rep 2013; 10:44-59. [DOI: 10.1007/s12015-013-9474-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Berrocal YA, Almeida VW, Gupta R, Levi AD. Transplantation of Schwann cells in a collagen tube for the repair of large, segmental peripheral nerve defects in rats. J Neurosurg 2013; 119:720-32. [DOI: 10.3171/2013.4.jns121189] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Segmental nerve defects pose a daunting clinical challenge, as peripheral nerve injury studies have established that there is a critical nerve gap length for which the distance cannot be successfully bridged with current techniques. Construction of a neural prosthesis filled with Schwann cells (SCs) could provide an alternative treatment to successfully repair these long segmental gaps in the peripheral nervous system. The object of this study was to evaluate the ability of autologous SCs to increase the length at which segmental nerve defects can be bridged using a collagen tube.
Methods
The authors studied the use of absorbable collagen conduits in combination with autologous SCs (200,000 cells/μl) to promote axonal growth across a critical size defect (13 mm) in the sciatic nerve of male Fischer rats. Control groups were treated with serum only–filled conduits of reversed sciatic nerve autografts. Animals were assessed for survival of the transplanted SCs as well as the quantity of myelinated axons in the proximal, middle, and distal portions of the channel.
Results
Schwann cell survival was confirmed at 4 and 16 weeks postsurgery by the presence of prelabeled green fluorescent protein–positive SCs within the regenerated cable. The addition of SCs to the nerve guide significantly enhanced the regeneration of myelinated axons from the nerve stump into the proximal (p < 0.001) and middle points (p < 0.01) of the tube at 4 weeks. The regeneration of myelinated axons at 16 weeks was significantly enhanced throughout the entire length of the nerve guide (p < 0.001) as compared with their number in a serum–only filled tube and was similar in number compared with the reversed autograft. Autotomy scores were significantly lower in the animals whose sciatic nerve was repaired with a collagen conduit either without (p < 0.01) or with SCs (p < 0.001) when compared with a reversed autograft.
Conclusions
The technique of adding SCs to a guidance channel significantly enhanced the gap distance that can be repaired after peripheral nerve injury with long segmental defects and holds promise in humans. Most importantly, this study represents some of the first essential steps in bringing autologous SC-based therapies to the domain of peripheral nerve injuries with long segmental defects.
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Affiliation(s)
- Yerko A. Berrocal
- 1The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Vania W. Almeida
- 1The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
| | - Ranjan Gupta
- 2Department of Orthopedic Surgery, University of California–Irvine, California
| | - Allan D. Levi
- 1The Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida; and
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