Peripheral nerve regeneration, repair, and grafting

doi:10.1016/S0894-1130(98)80007-0

Journal of Hand Therapy

Volume 11, Issue 2, April–June 1998, Pages 111-117

https://doi.org/10.1016/S0894-1130(98)80007-0 Get rights and content

Abstract

Peripheral nerve injuries are a major source of chronic disability. Advances in microsurgery and a better understanding of nerve healing have greatly improved the outcomes of nerve repair in the past two decades. This paper reviews the current thoughts on peripheral nerve regeneration and repair. Controversial topics such as the timing of nerve repair, new techniques of nerve repair (fibrin glue, lasers, and tubulization), nerve grafting, and the treatment of neuroma are discussed. A general approach to postoperative care is presented and shown to be governed by an understanding of not only nerve healing but tissue healing in general. A summary of current clinical results of upper extremity nerve repairs is given to provide benchmarks of practice for hand therapy units to achieve and supersede.

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Cited by (73)

Electrophysiological, functional and histopathological assessments of high dose melatonin on regeneration after blunt sciatic nerve injury
2020, Journal of Clinical Neuroscience
The aim of this study was to determine the curative effects of high-dose (100 mg/kg) melatonin on peripheral nerve injury. Forty male Wistar albino rats were randomized into four groups as sham, vehicle, melatonin, and ischemia and their right sciatic nerves were exposed. The process was terminated in the sham group. In the other groups, nerve injury was induced by clip compression. The vehicle group was intraperitoneally administered ethanol 0.1 cc (melatonin solvent), while the melatonin group was intraperitoneally administered a single dose of melatonin (100 mg/kg). Following the surgery, sciatic nerve functional index (SFI) was measured using walking track analysis on days 7, 14, and 21, and latency, amplitude, and muscle action potentials (MAP) field values were measured using electroneuromyography (ENMG) on day 21. Histopathologically, edema, axonal degeneration, myelin damage, and inflammatory response were evaluated in all groups. SFI values were noted to be statistically significantly different among the vehicle, melatonin, and ischemia groups, and the melatonin group showed a faster recovery. In the ENMG evaluations, higher amplitude and field values in the melatonin group indicated that melatonin accelerated peripheral nerve recovery. Histopathologically, although fibers with loss of myelin were identified in the melatonin group, the myelin sheath was preserved in general and the axonal structure was noted to be normal. A single injection of high-dose melatonin was found to preserve myelin sheath, prevent axonal loss, and accelerate functional recovery during the nerve regeneration in peripheral nerve injury.
Silicone-based simulation models for peripheral nerve microsurgery
2019, Journal of Plastic, Reconstructive and Aesthetic Surgery
Citation Excerpt :
Although technological aids such as operating microscopes and microsurgical suture materials provided significant improvements in peripheral nerve microsurgery, the repair of these nerves still remains as a challenge due to the complex nature of these structures.41,42 Treatment plan necessitates an accurate classification of the nerve injury43 and the most severe type of these nerve injuries is the fifth-degree (Seddon's neurotmesis)44,45 injuries, in which all of the sub-structures of the peripheral nerve (i.e., endoneurium, the fascicles, Schwann cells, axons, and the epineurium) are completely ruptured. Precise alignment at the fascicular level with shorter operation, dissection, and anesthetic times are also crucial for the post-operative functional repair of the nerves.
There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the “gold standard” of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons.
Several formulations of silicone were utilized for the design and fabrication of a model which realizes the hierarchical structure of peripheral nerves. The mechanical properties were characterized via the Universal Testing Machine; the damage caused by the needle on the entry sites was assessed through scanning electron microscopy (SEM).
Mechanical properties of the formulations of silicone were tested to mimic human peripheral nerves. A formulation with 83.3 wt% silicone oil and 0.1 wt% cotton fiber was chosen to be used as nerve fascicles. Both 83.3 wt% silicone oil with cotton fiber and 66.6 wt% silicone oil without fiber provided a microsuturing response similar to that of epineurium at a wall thickness of 1 mm. SEM also confirmed that the entry of the needle did not introduce significant holes at the microsuturing sites.
The proposed peripheral nerve model mimicked human tissues mechanically and cosmetically, and a simulation of the repair of a fifth-degree nerve injury was achieved.
Nerve Repair
2016, Hand and Upper Extremity Rehabilitation: A Practical Guide
Retrograde response in axotomized motoneurons: Nitric oxide as a key player in triggering reversion toward a dedifferentiated phenotype
2014, Neuroscience
Citation Excerpt :
Under these conditions, the accumulation of fibrotic scar tissue at the site of injury presents a physical obstacle for regenerating axons. Likewise, complete disruption of the connective sheaths in the distal stump of the injured nerve involves the loss of a structural and molecular guide that otherwise would instruct and support axonal regeneration (Dagum, 1998; Nguyen et al., 2002). Besides the regenerative and degenerative responses initiated locally at the site of injury in severed axons, axotomy of peripheral fibers leads to a characteristic retrograde reaction that proximally affects cell bodies, dendrites, and surrounding environment of the lesioned neurons (Lieberman, 1971; Bishop, 1982; Kreutzberg, 1995; Hanz and Fainzilber, 2006).
The adult brain retains a considerable capacity to functionally reorganize its circuits, which mainly relies on the prevalence of three basic processes that confer plastic potential: synaptic plasticity, plastic changes in intrinsic excitability and, in certain central nervous system (CNS) regions, also neurogenesis. Experimental models of peripheral nerve injury have provided a useful paradigm for studying injury-induced mechanisms of central plasticity. In particular, axotomy of somatic motoneurons triggers a robust retrograde reaction in the CNS, characterized by the expression of plastic changes affecting motoneurons, their synaptic inputs and surrounding glia. Axotomized motoneurons undergo a reprograming of their gene expression and biosynthetic machineries which produce cell components required for axonal regrowth and lead them to resume a functionally dedifferentiated phenotype characterized by the removal of afferent synaptic contacts, atrophy of dendritic arbors and an enhanced somato-dendritic excitability. Although experimental research has provided valuable clues to unravel many basic aspects of this central response, we are still lacking detailed information on the cellular/molecular mechanisms underlying its expression. It becomes clear, however, that the state-switch must be orchestrated by motoneuron-derived signals produced under the direction of the re-activated growth program. Our group has identified the highly reactive gas nitric oxide (NO) as one of these signals, by providing robust evidence for its key role to induce synapse elimination and increases in intrinsic excitability following motor axon damage. We have elucidated operational principles of the NO-triggered downstream transduction pathways mediating each of these changes. Our findings further demonstrate that de novo NO synthesis is not only “necessary” but also “sufficient” to promote the expression of at least some of the features that reflect reversion toward a dedifferentiated state in axotomized adult motoneurons.
Pudendal neuralgia
2014, Obstetrics and Gynecology Clinics of North America
Local delivery of FK506 to a nerve allograft is comparable to systemic delivery at suppressing allogeneic graft rejection
2023, PLoS ONE

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Peripheral nerve regeneration, repair, and grafting

Abstract

J Hand Surg.

J Hand Surg.

J Hand Surg.

Clin Plast Surg.

J Hand Surg.

J Hand Surg.

Hand Clin.

Nerve injury: healing, repair and grafting

Anatomic basis for the repair of ulnar and median nerves in the distal part of the forearm by group fascicular suture and nerve grafting

J Bone Joint Surg.

Structure and function of the intraneural mi-crovessels as related to trauma, edema formation, and nerve function

J Bone Joint Surg.

Trophism, tropism, and specificity in nerve regeneration

J Reconstr Microsurg.

Three types of nerve injury

Brain