Bridging of Peripheral Nerve Defects by Autologous Nerve Grafting Personal Experience

Vasileiadis, Antony

doi:10.15406/mojor.2016.05.00183

Cited by 4 publications

(9 citation statements)

References 6 publications

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THEORETICAL MEDICINE / ÒÅÎÐÅÒÈ×ÍÀ ÌÅÄÈÖÈÍÀ Relevance. In accordance with last investigations on trauma epidemiology both combat-and noncombatrelated extremity injuries are often accompanied with nerve injuries [1,2,3].Severe nerve trunk injuries were often observed among military personnel who with ballistic and blast soft tissue injuries that are more prevalent during ongoing armed conflicts [4].These injuries disproportionately affect young healthy civilians and military officers who are most at risk of traumatic injuries [2] and has a devastating impact on a patients' quality of life [5].

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confidence: 79%

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Long-Term Outcomes of Rat Sciatic Nerve Injury and Its Grafting With Silicon Wires-Based Conduit: Distal Nerve Stump Histology and Electromyography Results

et al. 2019

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Relevance. The investigations on trauma epidemiology have shown that both combat- and noncombat-related extremity injuries are often accompanied by nerve injuries. These injuries disproportionately affect young healthy civilians and military officers and has a devastating impact on a patients’ quality of life. Severe nerve injuries, such as nerve trunk injury in continuity (Sunderland 5), that cannot be treated by neurorraphy without tension, require use of nerve gap bridging strategies with different materials and techniques. Objective. This study was aimed to evaluate any positive or negative impact of implanted silicon wires on the quality of nerve fibers at distal nerve stump. Materials and Methods. An experiment was performed on 40 male Whistar rats 2-4 month that were divided to the next groups: I, (n=10) sham-operated, only surgical access to sciatic nerve was performed. II (n=10) with 10 mm sciatic nerve gap that was bridged with autoneurografting. III (n=10) with 10 mm nerve gap that was bridged with allogenic decell aorta filled with 4% carboxymethylcellulose hydrogel. IV (n=10) with 10 mm nerve gap that was bridged with allogenic decell aorta filled with 4% carboxymethylcellulose hydrogel and aligned p-type silicon microvires. Decellularization of allogenic aortas was performed by freeze-thaw cycles. Silicon whiskers were fabricated by Vapor-Liquid-Solid (VLS) method in a cold wall Catalytic Chemical Vapor Deposition (Cat-CVD) chamber, pre-cleaned with hydrofluoric acid and sterilized via 180*C dry heat. 12 weeks after surgery under general anesthesia all rats underwent invasive needle electroneurpmyography with proximal nerve stump stimulation and registration from gastrocnemius muscle. Myograms were recorded and compared by the shape of M-reflex and its amplitude. After myography rats were euthanized under thiopentone overdosage and distal stumps of injured sciatic nerves were harvested for light microscopy. Sciatic nerve transverse slices were stained with nitric silver by modified Bielschowsky method Nerve fiber diameter, axon diameter, myelin sheath thickness and axon-to-nerve fiber diameter ratio (g-ratio) were measured. Results. Performed analysis showed that rats from ІІ and IV groups demonstrated the best quality of nerve fibers in distal nerve stump. That was evidenced by bigger nerve fibers diameter in rats from autologous nerve grafting group and aorta with gel and wires grafting group in comparison with aorta with gel grafting group. Rats from IV demonstrated higher voltage and lower latency of M-reflexes during electromyography. Conclusions. It can be concluded about the possible pro-regenerative impact of implanted silicon wires that was evidenced by better nerve fibers quality at distal nerve stump.

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mentioning

confidence: 79%

“…These injuries disproportionately affect young healthy civilians and military officers who are most at risk of traumatic injuries [2] and has a devastating impact on a patients' quality of life [5].…”

mentioning

confidence: 99%

Long-Term Outcomes of Rat Sciatic Nerve Injury and Its Grafting With Silicon Wires-Based Conduit: Distal Nerve Stump Histology and Electromyography Results

et al. 2019

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Section: Introductionmentioning

confidence: 99%

“…Thus, optimal surgical therapies should contain a matrix-rich scaffold and neurotrophic growth factors to facilitate this critical axon regeneration process [4][5][6]. The current standard of care is surgical transplantation of autologous sensory nerve procured from a donor site of the same patient, typically the sural or fibular nerve [6]. Though treatment of motor or mixed-modal nerve bundles with sensory nerves is less than ideal, achieving satisfactory functional recovery in only ∼50% of patients [7], it remains the clinical standard because sacrifice of a motor nerve from the patient represents a clinical and ethical challenge.…”

Section: Introductionmentioning

confidence: 99%

“…Other treatments include allogeneic transplants from human cadaver nerve, biological conduits made from collagen [8], and resorbable nonbiological conduits made from synthetic polymers [9]. However, all clinically available treatments have numerous shortcomings: human autologous and allogeneic transplantation have supply limitations; autologous sensory nerve transplantation is limited by comorbidity and additional surgery may not be feasible in cases of severe injury [5][6][7]; non-decellularized allogeneic transplantation requires immunosuppressive therapy and risks infectious disease transmission; decellularized allogeneic or nonbiological conduits lack neurotrophic growth factors; and collagen conduits may also lack endoneurial matrix and superstructure [1,10]. For injuries spanning ≥4 cm of nerve (large-gap), there are no reported treatment alternatives to autologous nerve transplantion [2].…”

Section: Introductionmentioning

confidence: 99%

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Large-gap Peripheral Nerve Repair Using Xenogeneic Transplants in Primates

Holzer¹,

Chang²,

Tarlton³

et al. 2021

Preprint

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Early surgical intervention is required to successfully treat severe, large-gap peripheral nerve injuries. However, all existing treatments have shortcomings, and for large-gap injuries (≥4 cm), there is no reported alternative to autologous nerve. We report preclinical repair of large (4 cm), complete transectional radial nerve damage in Rhesus macaques using viable, whole sciatic nerve from genetically engineered, designated pathogen free porcine donors. Porcine nerves are physiologically similar to human nerves, contain neurotrophic growth factors and a matrix-rich scaffold, and offer greater clinical availability. We demonstrate regeneration of the transected nerve, distal muscle reinnervation, and recovery of conduction velocity and compound muscle action potential across xenogeneic transplants resulting in functional recovery comparable to autologous controls. We also show the lack of systemic porcine cell migration and the elimination of detectable transplanted porcine tissue. Our findings support the safety and efficacy of neural porcine therapeutics and the broader clinical potential of xenotransplantation.

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Large‐gap peripheral nerve repair using xenogeneic transplants in rhesus macaques

Holzer

Chang²,

Rogers³

et al. 2023

Xenotransplantation

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Surgical intervention is required to successfully treat severe, large-gap (≥4 cm) peripheral nerve injuries. However, all existing treatments have shortcomings and an alternative to the use of autologous nerves is needed. Human andporcine nerves are physiologically similar, with comparable dimensions and architecture, presence and distribution of Schwann cells, and conserved features of the extracellular matrix (ECM). We report the repair of fully transected radial nerves in 10 Rhesus Macaques using viable, whole sciatic nerve from genetically engineered (GalT-KO), designated pathogen free (DPF) porcine donors. This resulted in the regeneration of the transected nerve, recovery of wrist extension function, distal muscle reinnervation, and recovery of nerve conduction velocities and compound muscle action potentials statistically equivalent to autologous controls. We also demonstrate the absence of immune rejection, systemic porcine cell migration, and detectable residual porcine material. Our ndings support the safety and e cacy of viable porcine nerve transplants, suggest the interchangeable therapeutic use of crossspecies cells, and highlight the broader clinical potential of xenotransplantation.

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Bridging of Peripheral Nerve Defects by Autologous Nerve Grafting Personal Experience

Cited by 4 publications

References 6 publications

Long-Term Outcomes of Rat Sciatic Nerve Injury and Its Grafting With Silicon Wires-Based Conduit: Distal Nerve Stump Histology and Electromyography Results

Long-Term Outcomes of Rat Sciatic Nerve Injury and Its Grafting With Silicon Wires-Based Conduit: Distal Nerve Stump Histology and Electromyography Results

Large-gap Peripheral Nerve Repair Using Xenogeneic Transplants in Primates

Large‐gap peripheral nerve repair using xenogeneic transplants in rhesus macaques

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