The use of degradable nerve conduits for human nerve repair: A review of the literature
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Abstract:
The management of peripheral nerve injury continues to be a major clinical challenge. The most widely used technique for bridging defects in peripheral nerves is the use of autologous nerve grafts. This technique, however, has some disadvantages. Many alternative experimental techniques have thus been developed, such as degradable nerve conduits. Degradable nerve guides have been extensively studied in animal experimental studies. However, the repair of human nerves by degradable nerve conduits has been limited to only a few clinical studies. In this paper, an overview of the available international published literature on degradable nerve conduits for bridging human peripheral nerve defects is presented for literature available until 2004. Also, the philosophy on the use of nerve guides and nerve grafts is given.Keywords:
Epineurial repair
Nerve repair
Nerve guidance conduit
Peripheral nerve injury
Nerve Injury
The use of a nerve conduit provides an opportunity to regulate cytokines, growth factors and neurotrophins in peripheral nerve regeneration and avoid autograft defects. We constructed a poly-D-L-lactide (PDLLA)-based nerve conduit that was modified using poly{(lactic acid)-co-[(glycolic acid)-alt-(L-lysine)]} and β-tricalcium phosphate. The effectiveness of this bioactive PDLLA-based nerve conduit was compared to that of PDLLA-only conduit in the nerve regeneration following a 10-mm sciatic nerve injury in rats. We observed the nerve morphology in the early period of regeneration, 35 days post injury, using hematoxylin-eosin and methylene blue staining. Compared with the PDLLA conduit, the nerve fibers in the PDLLA-based bioactive nerve conduit were thicker and more regular in size. Muscle fibers in the soleus muscle had greater diameters in the PDLLA bioactive group than in the PDLLA only group. The PDLLA-based bioactive nerve conduit is a promising strategy for repair after sciatic nerve injury.
Nerve guidance conduit
Peripheral nerve injury
Epineurial repair
Nerve Injury
Sciatic nerve injury
Electrical conduit
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Peripheral nerve injury is still an unsolved problem. The cause, pathology, classification of peripheral nerve injury as well as impact factors on repair of peripheral nerve injury were reviewed in this paper. Primary repair should be done as soon as possible by using microsurgical technique. There should be no tension between two ends of the injured nerve while repairing. If large defect exist, there will be tension between the nerve stumps. Several methods such as changing position of extremity,dissecting two nerve stumps, changing the route of the nerve routine, shortening bone or nerve graft can be used to overcome the large defect of peripheral nerve.
Peripheral nerve injury
Epineurial repair
Nerve repair
Nerve Injury
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The use of a nerve conduit provides an opportunity to regulate cytokines, growth factors and neurotrophins in peripheral nerve regeneration and avoid autograft defects. We constructed a poly-D-L-lactide(PDLLA)-based nerve conduit that was modified using poly{(lactic acid)-co-[(glycolic acid)-alt-(L-lysine)]} and β-tricalcium phosphate. The effectiveness of this bioactive PDLLA-based nerve conduit was compared to that of PDLLA-only conduit in the nerve regeneration following a 10-mm sciatic nerve injury in rats. We observed the nerve morphology in the early period of regeneration, 35 days post injury, using hematoxylin-eosin and methylene blue staining. Compared with the PDLLA conduit, the nerve fibers in the PDLLA-based bioactive nerve conduit were thicker and more regular in size. Muscle fibers in the soleus muscle had greater diameters in the PDLLA bioactive group than in the PDLLA only group. The PDLLA-based bioactive nerve conduit is a promising strategy for repair after sciatic nerve injury.
Nerve guidance conduit
Peripheral nerve injury
Epineurial repair
Nerve Injury
Sciatic nerve injury
Electrical conduit
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Citations (0)
Epineurial repair
Nerve guidance conduit
Peripheral nerve injury
Electrical conduit
Axotomy
Nerve Injury
Common peroneal nerve
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Citations (94)
Peripheral nerve injury commonly results in loss of neuromuscular function, often resulting in significant impact upon both quality of life and cost of care for patients. One promising target for improving patient outcomes is the use of a peripheral nerve specific extracellular matrix hydrogel (PNM) as an injectable, regenerative support. It has been long understood that the extracellular matrix (ECM) not only provides structural support but also regulates cell growth, survival, maturation, differentiation, and development of resident cells. The objective of this dissertation was to develop and characterize a decellularized peripheral nerve hydrogel, investigate its effect on key properties of peripheral nerve regeneration, and finally assess its ability to enhance return to function in several peripheral nerve injury models. We found that PNM provides a tissue-specific microenvironment which is conducive to nerve repair, including: nerve specific growth factors that are chemotactic signals for Schwann cells, promote neurite outgrowth, as well as factors that modulate the macrophage inflammatory response to injury. When employed as a lumen filler for conduit repair of peripheral nerve defects, a switch in the ratio of M1:M2 phenotype macrophages was observed, a phenomenon associated with improved nerve growth and promotion of Schwann cell migration across a gap defect. This was associated with improved function over time in non-critical common peroneal and sciatic nerve defects. Furthermore, we provided proof-of-concept for the use of PNM in treating nerve crush injuries. The injection of the PNM hydrogel directly into the nerve injury was found to be safe with no impact on downstream function. The application of PNM to the crush injury resulted in enhanced return to function and a more robust axon regrowth across the injury.
In conclusion, we developed an injectable material that provides a regeneration promoting, tissue-specific microenvironment at the site of injury. The material has shown the ability to promotes recruitment of alternately activated, M2 macrophages, enhance Schwann cell migration, and axon extension. Finally, the use of PNM has enhanced recovery and return to function in numerous peripheral nerve injury models. PNM shows promise in augmenting current surgical practices for peripheral nerve injury and repair and has the potential to significantly improve quality of life for affected patients.
Peripheral nerve injury
Nerve guidance conduit
Epineurial repair
Nerve Injury
Schwann cell
Decellularization
Neurite
Reinnervation
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Peripheral nerve lesions with a long segment defect need a grafting conduit to repair. Autogenous nerve grafts is still considered the best material for bridging nerve defects, but it is accompanied by some disadvantages, including insufficient graft material for the reconstruction of a large mixed nerve and complications setting in the site of donor. The results of this research demonstrate that the nerve grafting can be completed by using different bridging material. These peripheral nerve bridges as vehicle for moderation and modulation of the cellular and molecular ambience for nerve regeneration have different effects on the repair for peripheral nerve injury.
Epineurial repair
Peripheral nerve injury
Nerve repair
Nerve guidance conduit
Nerve Injury
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Restoration with sufficient functional recovery after long-gap peripheral nerve damage remains a clinical challenge. In vitro, keratins, which are derived from human hair, enhance activity and gene expression of Schwann cells. The specific aim of the authors' study was to examine keratin gel as conduit filler for peripheral nerve regeneration in a rat sciatic nerve injury model.Incorporation of glial cell line-derived, neurotrophic factor, double-walled microspheres into polycaprolactone nerve guides has demonstrated an off-the-shelf product alternative to promote nerve regeneration, and this conduit was filled with keratin gel and examined in a rat 15-mm sciatic nerve defect model. As an indicator of recovery, nerve sections were stained with S100 and protein gene product 9.5 antibody.The keratin-treated groups, compared with both saline and empty polycaprolactone (control) groups (p < 0.05), demonstrated a significantly increased density of Schwann cells and axons. Polycaprolactone-based nerve conduits possess optimal mechanical and degradative properties, rendering the biocompatible conduits potentially useful in peripheral nerve repair.From their studies, the authors conclude that polycaprolactone nerve guides with glial cell line-derived, neurotrophic factor-loaded, double-walled microspheres filled with keratin gel represent a potentially viable guiding material for Schwann cell and axon migration and proliferation in the treatment of peripheral nerve regeneration.
Nerve guidance conduit
Peripheral nerve injury
Epineurial repair
Polycaprolactone
Schwann cell
Nerve Injury
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Nerve guidance conduit
Peripheral nerve injury
Epineurial repair
Biomaterial
Nerve Injury
Sensory nerve
Sciatic nerve injury
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Nerve guidance conduit
Electrical conduit
Epineurial repair
Peripheral nerve injury
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Epineurium
Epineurial repair
Peripheral nerve injury
Nerve Injury
Nerve repair
Transplant surgery
Endoneurium
Peripheral Nervous System
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