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Puerto Rico Health Sciences Journal May 2022Restoring function to damaged peripheral nerves with a gap remains challenging, with <50% of patients who undergo nerve repair surgery recovering function. Further,... (Review)
Review
Restoring function to damaged peripheral nerves with a gap remains challenging, with <50% of patients who undergo nerve repair surgery recovering function. Further, despite enormous efforts to improve existing techniques and develop new ones, the percentage of patients who recover function and their extent of recovery has not increased in almost 70 years. Thus, although sensory nerve grafts remain the clinical "gold standard" technique for attempting to restore function to nerves with a gap, they have significant limitations. They are effective in restoring good to excellent function only for gaps <3-5 cm, repairs performed <3-5 months post-trauma, and patients <20-25 years old. As the value of any of these variables increases, the extent of recovery decreases precipitously, and if the values of two or all three variables increase, there is little to no recovery. Therefore, novel techniques are required that increase the percentage of patients who recover function and the extent of their recovery. This review discusses the limitations of sensory nerve grafts and other techniques currently being used to repair nerves. It also discusses the use of autologous platelet-rich plasma (PRP), which appears to be the most promising technique for inducing sensory and motor recovery even when the values of all three variables are significantly greater than when sensory nerve grafts alone are not effective. Thus, there is finally the promise that patients who presently have limited to no chance of any recovery may recover good to excellent sensory and motor function.
Topics: Adult; Humans; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Young Adult
PubMed: 35704527
DOI: No ID Found -
Shinkei Kenkyu No Shimpo. Advances in... Nov 1969
Review
Topics: Biopsy; Humans; Methods; Nerve Fibers, Myelinated; Nervous System Diseases; Peripheral Nerves
PubMed: 4904670
DOI: No ID Found -
Tissue Engineering. Part B, Reviews Feb 2012Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps >5 mm is the autologous... (Review)
Review
Currently, surgical treatments for peripheral nerve injury are less than satisfactory. The gold standard of treatment for peripheral nerve gaps >5 mm is the autologous nerve graft; however, this treatment is associated with a variety of clinical complications, such as donor site morbidity, limited availability, nerve site mismatch, and the formation of neuromas. Despite many recent advances in the field, clinical studies implementing the use of artificial nerve guides have yielded results that are yet to surpass those of autografts. Thus, the development of a nerve guidance conduit, which could match the effectiveness of the autologous nerve graft, would be beneficial to the field of peripheral nerve surgery. Design strategies to improve surgical outcomes have included the development of biopolymers and synthetic polymers as primary scaffolds with tailored mechanical and physical properties, luminal "fillers" such as laminin and fibronectin as secondary internal scaffolds, surface micropatterning, stem cell inclusion, and controlled release of neurotrophic factors. The current article highlights approaches to peripheral nerve repair through a channel or conduit, implementing chemical and physical growth and guidance cues to direct that repair process.
Topics: Animals; Biocompatible Materials; Guided Tissue Regeneration; Humans; Nerve Regeneration; Peripheral Nerves; Tissue Scaffolds
PubMed: 21812591
DOI: 10.1089/ten.TEB.2011.0240 -
Zentralblatt Fur Neurochirurgie Aug 2007The severe functional deficits in patients suffering from traumatic peripheral nerve damage underline the necessity of an optimal therapy. The development of... (Review)
Review
The severe functional deficits in patients suffering from traumatic peripheral nerve damage underline the necessity of an optimal therapy. The development of microsurgical techniques in the sixties contributed significantly to the progress in nerve repair. Since then, no major clinical innovation has become established. However, with an increased understanding of cellular and molecular mechanisms underlying nerve regeneration, various tubulization concepts have been developed which yield possible alternatives to direct suturing and to autologous nerve grafting in cases of short nerve defects. The vast knowledge gathered in the field of nerve regeneration needs to be further exploited in order to develop alternative therapeutic strategies to nerve autografting, which can result in donor-site defects and often lead to inappropriate results. Considering the encouraging results from preclinical studies, innovative nerve repair strategies are likely to improve the outcome of reconstructive surgical interventions. This paper outlines, in addition to the fundamentals of nerve regeneration, the current treatment options for defects of peripheral nerves. This article also reviews the developments in the use of alternative nerve guides and demonstrates new perspectives in the field of peripheral nerve reconstruction.
Topics: Animals; Cell Transplantation; Humans; Nerve Tissue; Neurons; Neurosurgical Procedures; Peripheral Nerve Injuries; Peripheral Nerves; Sutures; Wound Healing
PubMed: 17665337
DOI: 10.1055/s-2007-984453 -
Progress in Neurology and Psychiatry 1967
Review
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Electromyography; Female; Humans; Infant; Male; Middle Aged; Muscles; Nerve Endings; Peripheral Nerves
PubMed: 4879409
DOI: 10.1016/b978-1-4831-9662-6.50018-4 -
Journal of Neural Engineering Apr 2018Nowadays, the high incidence of peripheral nerve injuries and the low success ratio of surgical treatments are driving research to the generation of novel alternatives... (Review)
Review
Nowadays, the high incidence of peripheral nerve injuries and the low success ratio of surgical treatments are driving research to the generation of novel alternatives to repair critical nerve defects. In this sense, tissue engineering has emerged as a possible alternative with special attention to decellularization techniques. Tissue decellularization offers the possibility to obtain a cell-free, natural extracellular matrix (ECM), characterized by an adequate 3D organization and proper molecular composition to repair different tissues or organs, including peripheral nerves. One major problem, however, is that there are no standard quality control methods to evaluate decellularized tissues. Therefore, in this review, a brief description of current strategies for peripheral nerve repair is given, followed by an overview of different decellularization methods used for peripheral nerves. Furthermore, we extensively discuss the available and currently used methods to demonstrate the success of tissue decellularization in terms of the cell removal, preservation of essential ECM molecules and maintenance or modification of biomechanical properties. Finally, orientative guidelines for the evaluation of decellularized peripheral nerve allografts are proposed.
Topics: Allografts; Animals; Humans; Peripheral Nerve Injuries; Peripheral Nerves; Quality Control; Tissue Engineering; Tissue Scaffolds
PubMed: 29244032
DOI: 10.1088/1741-2552/aaa21a -
Pain Medicine (Malden, Mass.) Aug 2020To present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial.
OBJECTIVE
To present a technical note on how to perform upper extremity peripheral nerve stimulators for three major nerves: median, ulnar, and radial.
DESIGN
Literature review and expert opinion.
SETTING
Single academic center.
RESULTS
Peripheral nerve stimulation has recently become popular with the development and availability of peripheral nerve stimulators with an external pulse generator. Here, we describe ultrasound anatomy and technical details for peripheral nerve stimulation in the upper extremity for three major nerves: median, ulnar, and radial.
CONCLUSIONS
Upper extremity peripheral nerve stimulation can be considered as an option for refractory neuropathic upper extremity pain.
Topics: Arm; Humans; Median Nerve; Peripheral Nerves; Radial Nerve; Ulnar Nerve; Upper Extremity
PubMed: 32804231
DOI: 10.1093/pm/pnaa185 -
Clinics in Plastic Surgery Jan 1997The basic tenets of peripheral nerve repair as outlined in the introduction remain valid. Advances in the field of peripheral nerve repair have become focused on... (Review)
Review
The basic tenets of peripheral nerve repair as outlined in the introduction remain valid. Advances in the field of peripheral nerve repair have become focused on enhancement of the rate, completeness, and accuracy of neural regeneration on a cellular and molecular level. It is hoped that, within the next decade, techniques that have shown promise experimentally will become mainstays of treatment.
Topics: Gap Junctions; Humans; Microsurgery; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves
PubMed: 9211029
DOI: No ID Found -
The Orthopedic Clinics of North America Jul 2000Tissue engineering in the peripheral nervous system unites efforts by physicians, engineers, and biologists to create either natural or synthetic tubular nerve guidance... (Review)
Review
Tissue engineering in the peripheral nervous system unites efforts by physicians, engineers, and biologists to create either natural or synthetic tubular nerve guidance channels as alternatives to nerve autografts for the repair of peripheral nerve defects. Guidance channels help direct axons sprouting from the regenerating nerve end, provide a conduit for diffusion of neurotropic and neurotrophic factors secreted by the damaged nerve stumps, and minimize infiltration of fibrous tissue. In addition to efforts to control these physical characteristics of nerve guidance channels, researchers are optimizing the incorporation of biologic factors and engineering interactive biomaterial that can specifically stimulate the regeneration process. Current and future research will ultimately result in biologically active and interactive nerve guidance channels that can support and enhance peripheral nerve regeneration over longer, more clinically relevant defect lengths.
Topics: Animals; Biocompatible Materials; Humans; Nerve Growth Factors; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Prostheses and Implants
PubMed: 10882473
DOI: 10.1016/s0030-5898(05)70166-8 -
Macromolecular Bioscience Apr 2016The repair of large crushed or sectioned segments of peripheral nerves remains a challenge in regenerative medicine due to the complexity of the biological environment... (Review)
Review
The repair of large crushed or sectioned segments of peripheral nerves remains a challenge in regenerative medicine due to the complexity of the biological environment and the lack of proper biomaterials and architecture to foster reconstruction. Traditionally such reconstruction is only achieved by using fresh human tissue as a surrogate for the absence of the nerve. However, recent focus in the field has been on new polymer structures and specific biofunctionalization to achieve the goal of peripheral nerve regeneration by developing artificial nerve prostheses. This review presents various tested approaches as well their effectiveness for nerve regrowth and functional recovery.
Topics: Biocompatible Materials; Chitosan; Collagen; Guided Tissue Regeneration; Humans; Nerve Growth Factors; Nerve Regeneration; Peripheral Nerve Injuries; Peripheral Nerves; Polymers; Regenerative Medicine; Tissue Engineering; Tissue Scaffolds; Tissue Transplantation; Transplantation, Autologous; Transplantation, Homologous
PubMed: 26748820
DOI: 10.1002/mabi.201500367