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The Bone & Joint Journal Feb 2019Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based... (Review)
Review
Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.
Topics: Adult; Axilla; Female; Humans; Male; Median Nerve; Middle Aged; Musculocutaneous Nerve; Nerve Transfer; Peripheral Nerve Injuries; Peripheral Nerves; Shoulder Dislocation; Ulnar Nerve; Upper Extremity; Young Adult
PubMed: 30700118
DOI: 10.1302/0301-620X.101B2.BJJ-2018-0839.R1 -
Neurological Research Mar 2004Biological nerve grafts have been extensively utilized in the past to repair peripheral nerve injuries. More recently, the use of synthetic guidance tubes in repairing... (Review)
Review
Biological nerve grafts have been extensively utilized in the past to repair peripheral nerve injuries. More recently, the use of synthetic guidance tubes in repairing these injuries has gained in popularity. This review focuses on artificial conduits, nerve regeneration through them, and an account of various synthetic materials that comprise these tubes in experimental animal and clinical trials. It also lists and describes several biomaterial considerations one should regard when designing, developing, and manufacturing potential guidance channel candidates. In the future, it it likely that the most successful synthetic nerve conduit will be one that has been fabricated with some of these strategies in mind.
Topics: Animals; Biocompatible Materials; Clinical Trials as Topic; Humans; Implants, Experimental; Nerve Regeneration; Peripheral Nerves; Transplants
PubMed: 15072634
DOI: 10.1179/016164104225013798 -
Acta Neurochirurgica Sep 2017From time to time it is thoughtful and productive to review a medical field and reflect upon what are the major issues that need to be addressed and what is being done... (Review)
Review
From time to time it is thoughtful and productive to review a medical field and reflect upon what are the major issues that need to be addressed and what is being done to do so. This review article is not meant to be all-inclusive but rather focuses on four evolving areas in the field of peripheral nerve disorders and treatments: (1) nerve surgery under ultrasound guidance using a new ultra-minimally invasive thread technique; (2) evolving magnetic resonance imaging (MRI) and ultrasound imaging techniques that are helping to both diagnose and treat a variety of peripheral nerve problems including entrapment neuropathies, traumatic nerve injuries, and masses arising from nerves; (3) promoting recovery after nerve injury using electrical stimulation; and (4) developing animal models to reproduce a severe nerve injury (neurotmetic grade in continuity) that requires a surgical intervention and repair. In each area we first describe the current challenges and then discuss new and emerging techniques and approaches. It is our hope that this article will bring added attention and resources to help better address peripheral nerve problems that remain a challenge for both patients and physicians.
Topics: Animals; Humans; Nerve Regeneration; Peripheral Nerves; Peripheral Nervous System Diseases
PubMed: 28500566
DOI: 10.1007/s00701-017-3203-3 -
The European Journal of Neuroscience Feb 2016The study of peripheral nerve repair and regeneration is particularly relevant in the light of the high clinical incidence of nerve lesions. However, the clinical... (Review)
Review
The study of peripheral nerve repair and regeneration is particularly relevant in the light of the high clinical incidence of nerve lesions. However, the clinical outcome after nerve lesions is often far from satisfactory and the functional recovery is almost never complete. Therefore, a number of therapeutic approaches are being investigated, ranging from local delivery of trophic factors and other molecules to bioactive biomaterials and complex nerve prostheses. Translation of the new therapeutic approaches to the patient always requires a final pre-clinical step using in vivo animal models. The need to limit as much as possible animal use in biomedical research, however, makes the preliminary use of in vitro models mandatory from an ethical point of view. In this article, the different types of in vitro models available today for the study of peripheral nerve regeneration have been ranked by adopting a three-step stair model based on their increasing ethical impact: (i) cell line-based models, which raise no ethical concern; (ii) primary cell-based models, which have low ethical impact as animal use, although necessary, is limited; and (iii) organotypic ex vivo-based models, which raise moderate ethical concerns as the use of laboratory animals is required although with much lower impact on animal wellbeing in comparison to in vivo models of peripheral nerve regeneration. This article aims to help researchers in selecting the best experimental approach for their scientific goals driven by the 'Three Rs' (3Rs) rules (Replacement, Reduction or Refinement of animal use in research) for scientific research.
Topics: Animals; Culture Techniques; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 26309051
DOI: 10.1111/ejn.13054 -
Hand Clinics Aug 2013Since the last update on nerve conduits and allograft in 2000, investigations have established the efficacy of these alternatives to autograft in the repair of small... (Review)
Review
Since the last update on nerve conduits and allograft in 2000, investigations have established the efficacy of these alternatives to autograft in the repair of small sensory neural gaps. However, limited insights into the biology of the regenerating nerve continue to preclude intelligent conduit design. Ongoing discoveries in neuroscience and biomaterial engineering hold promise for the eventual development of allograft and conduits with potential of surpassing nerve autografts in clinical efficacy. In this review, we summarize the history, recent advances, and emerging developments in nerve conduits and allograft.
Topics: Allografts; Biocompatible Materials; Cell-Free System; Chitosan; Collagen Type I; Fibrin; Guided Tissue Regeneration; History, 19th Century; History, 20th Century; Humans; Microsurgery; Nerve Regeneration; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Polyesters; Polyglycolic Acid; Prostheses and Implants; Tissue Engineering; Tissue Scaffolds; Transplantation, Autologous; Vascular Grafting
PubMed: 23895714
DOI: 10.1016/j.hcl.2013.04.003 -
Neurosurgery Clinics of North America Oct 2017Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of... (Review)
Review
Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions.
Topics: Humans; Monitoring, Intraoperative; Peripheral Nerves; Transcutaneous Electric Nerve Stimulation; Ultrasonography, Interventional
PubMed: 28917290
DOI: 10.1016/j.nec.2017.05.013 -
Biomaterials Jul 2006Peripheral nerve regeneration presents a significant clinical challenge and the current state of the art using autografts to repair long peripheral nerve gaps is... (Review)
Review
Peripheral nerve regeneration presents a significant clinical challenge and the current state of the art using autografts to repair long peripheral nerve gaps is unsatisfactory. In this manuscript, the analytical framework that determines the fate of grafts (autografts or biomaterial-based grafts) is discussed. Also outlined are parameters and variables that might be manipulated to enhance the efficacy of scaffolds designed for peripheral nerve regeneration. The importance of using appropriate animal models and outcome measures in evaluating biomaterials-based scaffolds or other engineered constructs suitability for bridging peripheral nerve gaps is highlighted.
Topics: Animals; Anisotropy; Biocompatible Materials; Humans; Models, Animal; Models, Neurological; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Tissue Engineering; Transplantation, Autologous
PubMed: 16533522
DOI: 10.1016/j.biomaterials.2006.02.030 -
Hand Clinics May 2015This article provides an overview of the management of traumatic peripheral nerve injuries. It examines the basic pathophysiology of peripheral nerve injuries, along... (Review)
Review
This article provides an overview of the management of traumatic peripheral nerve injuries. It examines the basic pathophysiology of peripheral nerve injuries, along with the clinical presentation, diagnostic work-up, and treatment options and outcomes for the various classifications of traumatic peripheral nerve injuries.
Topics: Humans; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 25934193
DOI: 10.1016/j.hcl.2015.01.007 -
Journal of the American Veterinary... Oct 1972
Review
Topics: Animals; Axons; Dog Diseases; Dogs; Hemostasis; Methods; Nerve Regeneration; Neuroma; Peripheral Nerve Injuries; Peripheral Nerves; Radial Nerve; Sciatic Nerve; Silicone Elastomers; Suture Techniques; Sutures; Transplantation, Homologous
PubMed: 4591665
DOI: No ID Found -
Scandinavian Journal of Surgery : SJS :... 2008Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus... (Review)
Review
Nerve injuries extend from simple nerve compression lesions to complete nerve injuries and severe lacerations of the nerve trunks. A specific problem is brachial plexus injuries where nerve roots can be ruptured, or even avulsed from the spinal cord, by traction. An early and correct diagnosis of a nerve injury is important. A thorough knowledge of the anatomy of the peripheral nerve trunk as well as of basic neurobiological alterations in neurons and Schwann cells induced by the injury are crucial for the surgeon in making adequate decisions on how to repair and reconstruct nerves. The technique of peripheral nerve repair includes four important steps (preparation of nerve end, approximation, coaptation and maintenance). Nerves are usually repaired primarily with sutures applied in the different tissue components, but various tubes are available. Nerve grafts and nerve transfers are alternatives when the injury induces a nerve defect. Timing of nerve repair is essential. An early repair is preferable since it is advantageous for neurobiological reasons. Postoperative rehabilitation, utilising the patients' own coping strategies, with evaluation of outcome are additional important steps in treatment of peripheral nerve injuries. in the rehabilitation phase adequate handling of pain, allodynia and cold intolerance are emphasised.
Topics: Humans; Nerve Transfer; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Regeneration; Suture Techniques
PubMed: 19211385
DOI: 10.1177/145749690809700407