1
|
Widodo W, Widyahening IS, Pratama IK, Kuncoro MW. Prospect of Mesenchymal Stem Cells in Enhancing Nerve Regeneration in Brachial Plexus Injury in Animals: A Systematic Review. THE ARCHIVES OF BONE AND JOINT SURGERY 2024; 12:149-158. [PMID: 38577510 PMCID: PMC10989726 DOI: 10.22038/abjs.2024.68053.3224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/14/2024] [Indexed: 04/06/2024]
Abstract
Objectives Brachial plexus injuries (BPI), although rare, often results in significant morbidity. Stem cell was thought to be one of BPI treatment modalities because of their nerve-forming regeneration potential. Although there is a possibility for the use of mesenchymal stem cells as one of BPI treatment, it is still limited on animal studies. Therefore, this systematic review aimed to analyze the role of mesenchymal stem cells in nerve regeneration in animal models of brachial plexus injury. Method This study is a systematic review with PROSPERO registration number CRD4202128321. Literature searching was conducted using keywords experimental, animal, brachial plexus injury, mesenchymal stem cell implantation, clinical outcomes, electrophysiological outcomes, and histologic outcomes. Searches were performed in the PubMed, Scopus, and ScienceDirect databases. The risk of bias was assessed using SYRCLE's risk of bias tool for animal studies. The data obtained were described and in-depth analysis was performed. Result Four studies were included in this study involving 183 animals from different species those are rats and rabbits. There was an increase in muscle weight and shortened initial onset time of muscle contraction in the group treated with stem cells. Electrophysiological results showed that mesenchymal stem cells exhibited higher (Compound muscle action potential) CMAP amplitude and shorter CMAP latency than control but not better than autograft. Histological outcomes showed an increase in axon density, axon number, and the formation of connections between nerve cells and target muscles. Conclusion Mesenchymal stem cell implantation to animals with brachial plexus injury showed its ability to regenerate nerve cells as evidenced by clinical, electrophysiological, and histopathological results. However, this systematic study involved experimental animals from various species so that the results cannot be uniformed, and conclusion should be drawn cautiously.
Collapse
Affiliation(s)
- Wahyu Widodo
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Indah Suci Widyahening
- Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Irfan Kurnia Pratama
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Mohamad Walid Kuncoro
- Department of Orthopaedic and Traumatology Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| |
Collapse
|
2
|
Potential of Fibrin Glue and Mesenchymal Stem Cells (MSCs) to Regenerate Nerve Injuries: A Systematic Review. Cells 2022; 11:cells11020221. [PMID: 35053336 PMCID: PMC8773549 DOI: 10.3390/cells11020221] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/04/2023] Open
Abstract
Cell-based therapy is a promising treatment to favor tissue healing through less invasive strategies. Mesenchymal stem cells (MSCs) highlighted as potential candidates due to their angiogenic, anti-apoptotic and immunomodulatory properties, in addition to their ability to differentiate into several specialized cell lines. Cells can be carried through a biological delivery system, such as fibrin glue, which acts as a temporary matrix that favors cell-matrix interactions and allows local and paracrine functions of MSCs. Thus, the aim of this systematic review was to evaluate the potential of fibrin glue combined with MSCs in nerve regeneration. The bibliographic search was performed in the PubMed/MEDLINE, Web of Science and Embase databases, using the descriptors ("fibrin sealant" OR "fibrin glue") AND "stem cells" AND "nerve regeneration", considering articles published until 2021. To compose this review, 13 in vivo studies were selected, according to the eligibility criteria. MSCs favored axonal regeneration, remyelination of nerve fibers, as well as promoted an increase in the number of myelinated fibers, myelin sheath thickness, number of axons and expression of growth factors, with significant improvement in motor function recovery. This systematic review showed clear evidence that fibrin glue combined with MSCs has the potential to regenerate nervous system lesions.
Collapse
|
3
|
González Rodríguez A, González Porto SA, Comellas Melero N, Arufe MC. Acellular nerve graft enriched with mesenchymal stem cells in the transfer of the phrenic nerve to the musculocutaneous nerve in a C5-C6 brachial plexus avulsion in a rat model. Microsurgery 2022; 42:57-65. [PMID: 34661312 DOI: 10.1002/micr.30829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/14/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Phrenic nerve transfer has been shown to achieve good nerve regeneration in brachial plexus avulsion. Acellular nerve allografts (ANAs) showed inferior results to autografts, which is why its use with mesenchymal stem cells (MSCs) is currently being studied. The aim is to study the effect of BM-MSCs associated with ANAs in a rat model of phrenic nerve transfer to the musculocutaneous nerve in a C5-C6 avulsion. MATERIAL AND METHODS 42 Wistar-Lewis rats underwent a C5-C6 lesion in the right forelimb by excising a 3 mm segment from both roots, followed by a phrenic nerve transfer to the musculocutaneous nerve associated with the interposition of a three types of nerve graft (randomly distributed): control (autograft) group (n = 12), ANAs group (n = 12), and ANAs + BM-MSCs group (n = 18) After 12 weeks, amplitude and latency of the NAP and the compound motor action potential (CMAP) were measured. Biceps muscles were studied by histological analysis and nerve grafts by electron microscopy and fluorescence analysis. RESULTS Statistically significant reductions were found in latency of the CMAP between groups control (2.48 ± 0.47 ms) and experimental (ANAs: 4.38 ± 0.78 ms, ANAs + BM-MSCs: 4.08 ± 0.85 ms) and increases in the amplitude of the CMAP between groups control (0.04388 ± 0.02 V) and ANAs + BM-MSCs (0.02275 ± 0.02 V), as well as in the thickness of the myelin sheath between groups control (0.81 ± 0.07 μm) and experimental (ANAs: 0.72 ± 0.08 μm, ANAs + BM-MSCs: 0.72 ± 0.07 μm) and in the area of the myelin sheath between groups control (13.09 ± 2.67 μm2 ) and ANAs (10.01 ± 2.97 μm2 ) (p < .05). No statistically significant differences have been found between groups ANAs and ANAs + BM-MSCs. CONCLUSIONS This study presents a model for the study of lesions of the upper trunk and validates the autologous graft as the gold standard.
Collapse
Affiliation(s)
- Alba González Rodríguez
- Research Group on Cell Therapy and Regenerative Medicine; Physiotherapy, Biomedical Sciences and Medicine Department, A Coruña University (CHUAC. INIBIC), A Coruña, Spain
| | | | - Nerea Comellas Melero
- Research Group on Cell Therapy and Regenerative Medicine; Physiotherapy, Biomedical Sciences and Medicine Department, A Coruña University (CHUAC. INIBIC), A Coruña, Spain
| | - María C Arufe
- Research Group on Cell Therapy and Regenerative Medicine; Physiotherapy, Biomedical Sciences and Medicine Department, A Coruña University (CHUAC. INIBIC), A Coruña, Spain
| |
Collapse
|
4
|
Li C, Zhang M, Liu SY, Zhang FS, Wan T, Ding ZT, Zhang PX. Chitin Nerve Conduits with Three-Dimensional Spheroids of Mesenchymal Stem Cells from SD Rats Promote Peripheral Nerve Regeneration. Polymers (Basel) 2021; 13:polym13223957. [PMID: 34833256 PMCID: PMC8620585 DOI: 10.3390/polym13223957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 12/17/2022] Open
Abstract
Peripheral nerve injury (PNI) is an unresolved medical problem with limited therapeutic effects. Epineurium neurorrhaphy is an important method for treating PNI in clinical application, but it is accompanied by inevitable complications such as the misconnection of nerve fibers and neuroma formation. Conduits small gap tubulization has been proved to be an effective suture method to replace the epineurium neurorrhaphy. In this study, we demonstrated a method for constructing peripheral nerve conduits based on the principle of chitosan acetylation. In addition, the micromorphology, mechanical properties and biocompatibility of the chitin nerve conduits formed by chitosan acetylation were further tested. The results showed chitin was a high-quality biological material for constructing nerve conduits. Previous reports have demonstrated that mesenchymal stem cells culture as spheroids can improve the therapeutic potential. In the present study, we used a hanging drop protocol to prepare bone marrow mesenchymal stem cell (BMSCs) spheroids. Meanwhile, spherical stem cells could express higher stemness-related genes. In the PNI rat model with small gap tubulization, BMSCs spheres exhibited a higher ability to improve sciatic nerve regeneration than BMSCs suspension. Chitin nerve conduits with BMSCs spheroids provide a promising therapy option for peripheral nerve regeneration.
Collapse
Affiliation(s)
- Ci Li
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Meng Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Song-Yang Liu
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Feng-Shi Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Teng Wan
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Zhen-Tao Ding
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
| | - Pei-Xun Zhang
- Department of Orthopedics and Trauma, Peking University People’s Hospital, Beijing 100044, China; (C.L.); (M.Z.); (S.-Y.L.); (F.-S.Z.); (T.W.); (Z.-T.D.)
- Key Laboratory of Trauma and Neural Regeneration, Peking University, Beijing 100044, China
- National Center for Trauma Medicine, Peking University People’s Hospital, Beijing 100044, China
- Correspondence:
| |
Collapse
|
5
|
Piao C, Li Z, Ding J, Qin Z. Biomechanical Analysis of Poly Lactic-co-glycolic Acid Catheter Combined with Bone Marrow Mesenchymal Stem Cells and Extracellular Matrix Transplantation for Long Sciatic Nerve Defect Repair. J HARD TISSUE BIOL 2018. [DOI: 10.2485/jhtb.27.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Chengdong Piao
- Department of Orthopedics, the Second Hospital of Jilin University
| | - Zhengwei Li
- Department of Orthopedics, the Second Hospital of Jilin University
| | - Jie Ding
- Department of Stomatology, the Affiliated Hospital of Changchun University of Traditional Chinese Medicine
| | - Zhigang Qin
- Department of Neurosurgery, China-Japan Union Hospital of Jilin University
| |
Collapse
|
6
|
Ren W, Ma X, Liu X, Li Y, Jiang Z, Zhao Y, Li C, Li X. Moderate hypothermia induces protein SUMOylation in bone marrow stromal cells and enhances their tolerance to hypoxia. Mol Med Rep 2017; 16:7006-7012. [PMID: 28901483 DOI: 10.3892/mmr.2017.7425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 06/13/2017] [Indexed: 11/05/2022] Open
Abstract
Acute cerebral infarction can progress rapidly, and there are limited specific and effective treatments. Small ubiquitin‑like modifiers (SUMOs) provide an important post‑translational modification of proteins. Following cerebral infarction, multiple proteins can combine with SUMOs to protect nerve cells. Furthermore, moderate hypothermia (core body temperature, 33‑34˚C) can increase the level of SUMOylation on multiple proteins. In the present study, it was examined whether moderate hypothermia increases the survival rate of bone marrow stromal stem cells (BMSCs) implanted in the cerebral ischemic penumbra via SUMOylation of multiple proteins. Firstly, BMSCs were exposed to oxygen‑glucose deprivation (OGD) under moderate hypothermic (33˚C) conditions. Subsequently, adult rats with middle cerebral artery occlusion were treated with a combination of BMSCs and moderate hypothermia (32‑34˚C). The results demonstrated that hypothermia promoted the combination of multiple proteins with SUMOs in BMSCs, and induced transport of SUMOs from the cytoplasm to the nucleus. Moderate hypothermia additionally reduced damage to BMSCs following OGD and improved BMSC survival following transplantation into the penumbra. These data suggest that moderate hypothermia may protect against BMSC injury via rapid SUMOylation of intracellular proteins. Thus, BMSC transplantation combined with moderate hypothermia may be a potential therapeutic strategy to treat cerebral infarction.
Collapse
Affiliation(s)
- Wenbo Ren
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| | - Xiaofang Ma
- Central Laboratory, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Xiaozhi Liu
- Central Laboratory, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Yanxia Li
- Central Laboratory, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Zhongmin Jiang
- Department of Pathology, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Yujun Zhao
- Department of Neurology, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Chen Li
- Department of Neurology, The Fifth Central Hospital of Tianjin, Tianjin 300450, P.R. China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin 300211, P.R. China
| |
Collapse
|
7
|
Turner NJ, Johnson SA, Foster LJR, Badylak SF. Sutureless nerve repair with ECM bioscaffolds and laser-activated chitosan adhesive. J Biomed Mater Res B Appl Biomater 2017; 106:1698-1711. [DOI: 10.1002/jbm.b.33975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Neill J. Turner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Scott A. Johnson
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Leslie J. R. Foster
- Biopolymer Research Group; School of Biotechnology and Bimolecular Sciences, The University of New South Wales; Sydney Australia
- Save Sight Institute, Faculty of Medicine, University of Sydney; Sydney Australia
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania 15260
| |
Collapse
|
8
|
Systemic Transplantation of Bone Marrow Mononuclear Cells Promotes Axonal Regeneration and Analgesia in a Model of Wallerian Degeneration. Transplantation 2017; 101:1573-1586. [DOI: 10.1097/tp.0000000000001478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
|
9
|
Biscola NP, Cartarozzi LP, Ulian-Benitez S, Barbizan R, Castro MV, Spejo AB, Ferreira RS, Barraviera B, Oliveira ALR. Multiple uses of fibrin sealant for nervous system treatment following injury and disease. J Venom Anim Toxins Incl Trop Dis 2017; 23:13. [PMID: 28293254 PMCID: PMC5348778 DOI: 10.1186/s40409-017-0103-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/23/2017] [Indexed: 12/14/2022] Open
Abstract
Lesions to the nervous system often produce hemorrhage and tissue loss that are difficult, if not impossible, to repair. Therefore, scar formation, inflammation and cavitation take place, expanding the lesion epicenter. This significantly worsens the patient conditions and impairment, increasing neuronal loss and glial reaction, which in turn further decreases the chances of a positive outcome. The possibility of using hemostatic substances that also function as a scaffold, such as the fibrin sealant, reduces surgical time and improve postoperative recovery. To date, several studies have demonstrated that human blood derived fibrin sealant produces positive effects in different interventions, becoming an efficient alternative to suturing. To provide an alternative to homologous fibrin sealants, the Center for the Study of Venoms and Venomous Animals (CEVAP, Brazil) has proposed a new bioproduct composed of certified animal components, including a thrombin-like enzyme obtained from snake venom and bubaline fibrinogen. Thus, the present review brings up to date literature assessment on the use of fibrin sealant for nervous system repair and positions the new heterologous bioproduct from CEVAP as an alternative to the commercial counterparts. In this way, clinical and pre-clinical data are discussed in different topics, ranging from central nervous system to peripheral nervous system applications, specifying positive results as well as future enhancements that are necessary for improving the use of fibrin sealant therapy.
Collapse
Affiliation(s)
- Natalia Perussi Biscola
- Graduate Program in Tropical Diseases, Botucatu Medical School, Univ Estadual Paulista (UNESP), Botucatu, SP Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), Univ Estadual Paulista (UNESP), Botucatu, SP Brazil.,Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil
| | - Luciana Politti Cartarozzi
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil
| | - Suzana Ulian-Benitez
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil.,Neuro Development Lab, School of Biosciences, University of Birmingham, Birmingham, England UK
| | - Roberta Barbizan
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil.,The School of Medicine at Mucuri (FAMMUC), Federal University of Jequitinhonha and Mucuri Valleys (UFVJM), 39803-371 Teófilo Otoni, MG Brazil
| | - Mateus Vidigal Castro
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil
| | - Aline Barroso Spejo
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil
| | - Rui Seabra Ferreira
- Graduate Program in Tropical Diseases, Botucatu Medical School, Univ Estadual Paulista (UNESP), Botucatu, SP Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), Univ Estadual Paulista (UNESP), Botucatu, SP Brazil
| | - Benedito Barraviera
- Graduate Program in Tropical Diseases, Botucatu Medical School, Univ Estadual Paulista (UNESP), Botucatu, SP Brazil.,Center for the Study of Venoms and Venomous Animals (CEVAP), Univ Estadual Paulista (UNESP), Botucatu, SP Brazil
| | - Alexandre Leite Rodrigues Oliveira
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas (UNICAMP), Laboratory of Nerve Regeneration, CEP 13083-970 Campinas, SP Brazil
| |
Collapse
|
10
|
Reichenberger MA, Mueller W, Hartmann J, Diehm Y, Lass U, Koellensperger E, Leimer U, Germann G, Fischer S. ADSCs in a fibrin matrix enhance nerve regeneration after epineural suturing in a rat model. Microsurgery 2015; 36:491-500. [DOI: 10.1002/micr.30018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/14/2015] [Accepted: 12/08/2015] [Indexed: 01/05/2023]
Affiliation(s)
- Matthias A. Reichenberger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Wolf Mueller
- University Hospital Leipzig, Department of Neuropathology; University of Leipzig; Leipzig Germany
| | - Jennifer Hartmann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Yannick Diehm
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
| | - Ulrike Lass
- Clinical Cooperation Unit Neuropathology; German Cancer Research Center; Heidelberg Germany
| | - Eva Koellensperger
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Uwe Leimer
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Günter Germann
- ETHIANUM-Clinic for Plastic and Reconstructive Surgery; Aesthetic and Preventive Medicine at Heidelberg University Hospital; Heidelberg Germany
| | - Sebastian Fischer
- BG Trauma Centre Ludwigshafen; Clinic for Hand, Plastic and Reconstructive Surgery, Burn Centre, Hand and Plastic Surgery of the University of Heidelberg; Heidelberg Germany
| |
Collapse
|