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Connective Tissue Research Jan 2019Peripheral nerve injuries (PNI) resulting from trauma can be severe and permanently debilitating. Despite the armamentarium of meticulous microsurgical repair techniques... (Review)
Review
Peripheral nerve injuries (PNI) resulting from trauma can be severe and permanently debilitating. Despite the armamentarium of meticulous microsurgical repair techniques that includes direct repair, grafting of defects with autograft nerve, and grafting with cadaveric allografts, approximately one-third of all PNI demonstrate incomplete recovery with poor restoration of function. This may include total loss or incomplete recovery of motor and/or sensory function, chronic pain, muscle atrophy, and profound weakness, which can result in lifelong morbidity. Much of this impaired nerve healing can be attributed to perineural scarring and fibrosis at the site of injury and repair. To date, this challenging clinical problem has not been adequately addressed. In this review, we summarize the existing literature surrounding biological aspects of perineural fibrosis following PNI, detail current strategies to limit nerve scarring, present our own work developing reliable nerve injury models in animal studies, and discuss potential future studies which may ultimately lead to new therapeutic strategies.
Topics: Animals; Biomechanical Phenomena; Cicatrix; Humans; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 30187777
DOI: 10.1080/03008207.2018.1489381 -
The Journal of the American Academy of... 2000Peripheral nerve injuries are common, and there is no easily available formula for successful treatment. Incomplete injuries are most frequent. Seddon classified nerve... (Review)
Review
Peripheral nerve injuries are common, and there is no easily available formula for successful treatment. Incomplete injuries are most frequent. Seddon classified nerve injuries into three categories: neurapraxia, axonotmesis, and neurotmesis. After complete axonal transection, the neuron undergoes a number of degenerative processes, followed by attempts at regeneration. A distal growth cone seeks out connections with the degenerated distal fiber. The current surgical standard is epineurial repair with nylon suture. To span gaps that primary repair cannot bridge without excessive tension, nerve-cable interfascicular auto-grafts are employed. Unfortunately, results of nerve repair to date have been no better than fair, with only 50% of patients regaining useful function. There is much ongoing research regarding pharmacologic agents, immune system modulators, enhancing factors, and entubulation chambers. Clinically applicable developments from these investigations will continue to improve the results of treatment of nerve injuries.
Topics: Humans; Injury Severity Score; Nerve Regeneration; Nerve Transfer; Peripheral Nerve Injuries; Peripheral Nerves; Recovery of Function; Suture Techniques; Transplantation, Autologous; Transplantation, Homologous; Treatment Outcome
PubMed: 10951113
DOI: 10.5435/00124635-200007000-00005 -
BioMed Research International 2014Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain... (Review)
Review
Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.
Topics: Animals; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Plastic Surgery Procedures; Recovery of Function; Translational Research, Biomedical
PubMed: 25276813
DOI: 10.1155/2014/698256 -
Neurosurgical Focus May 2004Clinicians caring for patients with brachial plexus and other nerve injuries must possess a clear understanding of the peripheral nervous system's response to trauma. In... (Review)
Review
Clinicians caring for patients with brachial plexus and other nerve injuries must possess a clear understanding of the peripheral nervous system's response to trauma. In this article, the authors briefly review peripheral nerve injury (PNI) types, discuss the common injury classification schemes, and describe the dynamic processes of degeneration and reinnervation that characterize the PNI response.
Topics: Axons; Humans; Ischemia; Nerve Compression Syndromes; Nerve Growth Factors; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Schwann Cells; Stress, Mechanical; Wallerian Degeneration; Wounds and Injuries
PubMed: 15174821
DOI: 10.3171/foc.2004.16.5.2 -
European Journal of Orthopaedic Surgery... Feb 2019The injuries of the peripheral nerves are relatively frequent. Some of them may lead to defects which cannot be repaired with direct end-to-end repair without tension.... (Review)
Review
The injuries of the peripheral nerves are relatively frequent. Some of them may lead to defects which cannot be repaired with direct end-to-end repair without tension. These injuries may cause function loss to the patient, and they consist a challenge for the treating microsurgeon. Autologous nerve grafts remain the gold standard for bridging the peripheral nerve defects. Nevertheless, there are selected cases where alternative types of nerve reconstruction can be performed in order to cover the peripheral nerve defects. In all these types of reconstruction, the basic principles of microsurgery are necessary and the surgeon should be aware of them in order to achieve a successful reconstruction. The purpose of the present review was to present the most current data concerning the surgical options available for bridging such defects.
Topics: Allografts; Autografts; Humans; Nerve Transfer; Peripheral Nerve Injuries; Peripheral Nerves; Plastic Surgery Procedures; Suture Techniques
PubMed: 30483968
DOI: 10.1007/s00590-018-2344-2 -
International Journal of Molecular... Dec 2021Topical advances in studying molecular and cellular mechanisms responsible for regeneration in the peripheral nervous system have highlighted the ability of the nervous... (Review)
Review
Topical advances in studying molecular and cellular mechanisms responsible for regeneration in the peripheral nervous system have highlighted the ability of the nervous system to repair itself. Still, serious injuries represent a challenge for the morphological and functional regeneration of peripheral nerves, calling for new treatment strategies that maximize nerve regeneration and recovery. This review presents the canonical view of the basic mechanisms of nerve regeneration and novel data on the role of exosomes and their transferred microRNAs in intracellular communication, regulation of axonal growth, Schwann cell migration and proliferation, and stromal cell functioning. An integrated comprehensive understanding of the current mechanistic underpinnings will open the venue for developing new clinical strategies to ensure full regeneration in the peripheral nervous system.
Topics: Animals; Axons; Exosomes; Humans; MicroRNAs; Nerve Regeneration; Neurogenesis; Peripheral Nerve Injuries; Peripheral Nerves; Peripheral Nervous System; Schwann Cells; Stromal Cells
PubMed: 34948176
DOI: 10.3390/ijms222413380 -
Neurosurgery Clinics of North America Oct 2014Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve... (Review)
Review
Peripheral nerve stimulation and peripheral nerve field stimulation involve the delivery of electrical stimulation using implanted electrodes either over a target nerve or over the painful area with the goal of modulating neuropathic pain. The selection of appropriate candidates for this therapy hinges on skillful application of inclusion and exclusion criteria, psychological screening, and an invasive screening trial. Patients with significant improvement in pain severity and pain-related disability during the trial are considered candidates for implantation of a permanent system. As with other implanted devices for neuromodulation, risks of mechanical failures, infection, and neurologic complications exist.
Topics: Chronic Pain; Humans; Implantable Neurostimulators; Neuralgia; Neurosurgical Procedures; Peripheral Nerves
PubMed: 25240665
DOI: 10.1016/j.nec.2014.07.003 -
Current Opinion in Neurology Oct 1994Knowledge of the actions of conventional neurotrophic factors on peripheral neurons is accumulating rapidly, and growth factors that were discovered outside the nervous... (Review)
Review
Knowledge of the actions of conventional neurotrophic factors on peripheral neurons is accumulating rapidly, and growth factors that were discovered outside the nervous system have been found to have neurotrophic actions. The nature and initiation of proximal neuronal responses to nerve injury, the interactions of Schwann cells and growth cones, and the functions of macrophages in the peripheral nervous system are all areas of active investigation. Results of the surgical treatment of injuries to the brachial plexus and spinal accessory nerve are reported.
Topics: Accessory Nerve; Accessory Nerve Injuries; Animals; Axons; Brachial Plexus; Humans; Macrophages; Nerve Growth Factors; Nerve Regeneration; Nerve Tissue Proteins; Peripheral Nerve Injuries; Peripheral Nerves; Schwann Cells
PubMed: 7804462
DOI: 10.1097/00019052-199410000-00009 -
Biofabrication Mar 2018After many decades of biomaterials research for peripheral nerve regeneration, a clinical product (the nerve guide), is emerging as a proven alternative for relatively... (Review)
Review
After many decades of biomaterials research for peripheral nerve regeneration, a clinical product (the nerve guide), is emerging as a proven alternative for relatively short injury gaps. This review identifies aspects where 3D printing can assist in improving long-distance nerve guide regeneration strategies. These include (1) 3D printing of the customizable nerve guides, (2) fabrication of scaffolds that fill nerve guides, (3) 3D bioprinting of cells within a matrix/bioink into the nerve guide lumen and the (4) establishment of growth factor gradients along the length a nerve guide. The improving resolution of 3D printing technologies will be an important factor for peripheral nerve regeneration, as fascicular-like guiding structures provide one path to improved nerve guidance. The capability of 3D printing to manufacture complex structures from patient data based on existing medical imaging technologies is an exciting aspect that could eventually be applied to treating peripheral nerve injury. Ultimately, the goal of 3D printing in peripheral nerve regeneration is the automated fabrication, potentially customized for the patient, of structures within the nerve guide that significantly outperform the nerve autograft over large gap injuries.
Topics: Animals; Humans; Mice; Nerve Regeneration; Peripheral Nerves; Printing, Three-Dimensional; Rats; Tissue Engineering; Tissue Scaffolds
PubMed: 29570458
DOI: 10.1088/1758-5090/aaaf50 -
Clinical Neurosurgery 1970
Review
Topics: Axons; Humans; Methods; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Silicones; Surgical Equipment; Suture Techniques; Time Factors; Transplantation, Autologous; Transplantation, Homologous
PubMed: 4939495
DOI: 10.1093/neurosurgery/17.cn_suppl_1.77