Peripheral Nerve Repair and Reconstruction
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Abstract:
➤ When possible, direct repair remains the current standard of care for the repair of peripheral nerve lacerations. ➤ In large nerve gaps, in which direct repair is not possible, grafting remains the most viable option. ➤ Nerve scaffolds include autologous conduits, artificial nonbioabsorbable conduits, and bioabsorbable conduits and are options for repair of digital nerve gaps that are <3 cm in length. ➤ Experimental studies suggest that the use of allografts may be an option for repairing larger sensory nerve gaps without associated donor-site morbidity.Keywords:
Epineurial repair
Nerve repair
Digital nerve
Nerve guidance conduit
Standard of care
Peripheral nerve injury
Electrical conduit
Clinically optimal situations for primary nerve repair are rarely observed. Crushed nerve ends result in either suboptimal repair or a need for nerve grafting. Functional results after nerve surgery are relatively poor, including major sensory deficits, which may be due to the death of primary sensory neurons that follows the nerve injury. The aim of this study was to determine if using polyhydroxybutyrate (PHB), a resorbable nerve conduit, could be an alternative to primary nerve repair in reducing loss of neurons. The superficial radial nerves in 20 cats were sectioned bilaterally and primarily repaired microsurgically by the use of two different strategies; either wrapping the nerve ends in sheets of PHB or epineurally suturing of the nerve. After 6 or 12 months, the surviving neurons within the dorsal root ganglia [C5–T1] were counted. No statistically significant differences were found between the two methods. This may imply a future possibility of using PHB as a synthetic nerve graft in situations where suboptimal primary repair or nerve grafts are the alternatives. © 1999 Wiley-Liss, Inc. MICROSURGERY 19:259–264 1999
Nerve repair
Nerve guidance conduit
Epineurial repair
Nerve Injury
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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.
Epineurial repair
Nerve repair
Nerve guidance conduit
Peripheral nerve injury
Nerve Injury
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Currently a wide variety of polymer materials are being applied to fabricate nerve guide tubes to repair injured peripheral nerves. In this study we have examined whether collagen—chitosan nerve guides promotes nerve repair compared to chitosan nerve guides using histological analysis. Results indicates that the enclosed structure of the nerve guide both promotes and supports axonal sprouting. Collagen—chitosan guides improved axonal maturation measured by a significant increase in axon diameter and axon area. These findings indicate that the collagen—chitosan nerve guides can be applied to repair severed peripheral nerve ends.
Epineurial repair
Nerve guidance conduit
Nerve repair
Sprouting
Peripheral nerve injury
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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.
Nerve repair
Epineurial repair
Nerve guidance conduit
Peripheral nerve injury
Nerve Injury
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Peripheral nerve injuries are often associated with loss of nerve tissue and require autologous nerve grafts to provide a physical substrate for axonal growth. This thesis investigates the use of f ...
Nerve guidance conduit
Epineurial repair
Nerve repair
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Nerve guidance conduit
Digital nerve
Epineurial repair
Sensation
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Great progress was made on the study of injury and rehabilitating of peripheral nerve by tissue engineering in the recent years. The aim is to explore an ideal nerve graft substitute, nerve conduits and seed cells through a great deal of animal experiments and clinical studies. The nerve conduits include biodegradable nerve graft conduit and autologous nerve grafts. The nerve grafts are divided into allogeneic nerve grafts and heterogenous nerve grafts those have their benefits or disbenefits in bridging nerve gaps respectively. In addition, amount of cultured and highly purified Schwann cells play a key role as a seed cell in rehabilitating of peripheral nerve injury because of their secreting numerous neurotrophic factors.
Epineurial repair
Nerve guidance conduit
Peripheral nerve injury
Nerve Injury
Nerve repair
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Instead of nerve autografts,tissue-engineered nerve conduits are being used for the treatment of peripheral nerve graft repair.These nerve tubes are made of different biomaterials or artificial synthetic materials with different physical properties.In order to increase the nerve gap that can be bridged,several modifications to the common hollow nerve tube(for example,the addition of Schwann cells,growth factors,and internal frameworks)are being investigated in laboratory.Some have been used clinically.
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Epineurial repair
Nerve repair
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Clinically optimal situations for primary nerve repair are rarely observed. Crushed nerve ends result in either suboptimal repair or a need for nerve grafting. Functional results after nerve surgery are relatively poor, including major sensory deficits, which may be due to the death of primary sensory neurons that follows the nerve injury. The aim of this study was to determine if using polyhydroxybutyrate (PHB), a resorbable nerve conduit, could be an alternative to primary nerve repair in reducing loss of neurons. The superficial radial nerves in 20 cats were sectioned bilaterally and primarily repaired microsurgically by the use of two different strategies; either wrapping the nerve ends in sheets of PHB or epineurally suturing of the nerve. After 6 or 12 months, the surviving neurons within the dorsal root ganglia [C5–T1] were counted. No statistically significant differences were found between the two methods. This may imply a future possibility of using PHB as a synthetic nerve graft in situations where suboptimal primary repair or nerve grafts are the alternatives. © 1999 Wiley-Liss, Inc. MICROSURGERY 19:259–264 1999
Nerve repair
Nerve guidance conduit
Epineurial repair
Nerve Injury
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When primary repair of transected peripheral nerves is not possible due to large gaps, nerve grafts or repair using conduits are other options to bridge the gap such that the nerve is repaired without tension. When nerve gaps are repaired primarily, there is a worry about tension, failure, and poor healing. In this biomechanical study comparing nerves repaired primarily versus those repaired with conduits, we hypothesized that conduit repair provided greater mechanical breaking strength.We dissected fresh cadaveric sheep hooves and transacted their peripheral nerves. Subsequently, we divided these transacted nerves into 2 groups: primary repair versus repair using a nerve conduit. After repair using a standardized technique, we tensioned each of these repairs via a load tester and recorded the force required till repair failure occurred.Six nerves using primary nerve repair and 6 nerves repaired with a nerve conduit (10 mm length × 2.5 mm diameter) were studied. The average breaking strength of the nerves repaired with the nerve conduit was 0.92 N and that using the primary nerve repair technique was 0.46 N (P = 0.001). All the nerves repaired using nerve conduit repair had an additional 5 mm added to their total length as compared with the nerves in the other group.Nerve repair using a nerve conduit ensures a higher breaking strength and potentially a greater tension-free repair as compared with primary nerve repairs in a sheep model. This study supports the use of conduits in the bridging of nerve gaps.
Electrical conduit
Epineurial repair
Nerve guidance conduit
Nerve repair
Cadaveric spasm
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