Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Neuroplasticity is analyzed in this article as the capacity of the CNS to adapt to external and internal stimuli. It is being increasingly recognized as an important factor for the successful outcome of nerve transfers. Better-known factors are the number of axons that cross the coaptation site, the time interval between trauma and repair, and age. Neuroplasticity is mediated initially by synaptic and neurotransmitter changes. Over time, the activation of previously existing but lowly active connections in the brain cortex contributes further. Dendritic sprouting and axonal elongation might also take place but are less likely to be prominent.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors reviewed different factors that play roles in neuroplasticity and functional regeneration after specific nerve transfers.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The authors found that these different factors include, among others, the distance between cortical areas of the donor and receptor neurons, the presence versus absence of preexisting lowly active interneuronal connections, gross versus fine movement restoration, rehabilitation, brain trauma, and age.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>The potential for plasticity should be taken into consideration by surgeons when planning surgical strategy and postoperative rehabilitation, because its influence on results cannot be denied.</jats:p></jats:sec>

Peripheral nerve surgery: the road less traveled

“…Moreover, since most patients with peripheral nerve injuries and brachial plexus injuries belong to the working-age population, peripheral nerve surgery also has substantial socioeconomic implications [8,9]. Contrary to the previously held view, the peripheral nerve system has been shown to have a huge regeneration potential, with significant results enhanced by different modalities of stimulation [5,6], whereby recent research on brain plasticity indicates that experience-dependent reorganization of neural networks plays an important role in functional recovery [3,4,13,14]. For all these reasons, systematic research, education, and practice in peripheral nerve surgery is definitely worth the effort.…”

Convergent end‐to‐end neurorrhaphy: An alternative technique for dual innervation of the gastrocnemius muscle in rats

“…The association of nerves with antagonistic functions could compromise muscle functioning at an early stage (Rodriguez et al, ). However, over time, cortical adaptation, and cerebral plasticity overcome this barrier (Kemp, Alant, Walsh, Webb, & Midha, ; Socolovsky, Malessy, Lopez, Guedes, & Flores, ). We could observe this phenomenon when the animals from our experimental groups reestablished gait after the association of the tibial and peroneal nerves to the same target muscle.…”

Plasticity in the Brain after a Traumatic Brachial Plexus Injury in Adults

“…Socolovsky et al [63] recently reviewed different factors that could play a role in neuroplasticity and functional regeneration after nerve transfer. Distance between cortical territories of the donor and receptor nerves, the presence of preexisting brain connections, gross versus fine movement restoration, rehabilitation, brain trauma and age at lesion were listed as influencing functional restoration [63].…”