Clinical evaluation of a resorbable wrap-around implant as an alternative to nerve repair: A prospective, assessor-blinded, randomised clinical study of sensory, motor and functional recovery after peripheral nerve repair

Åberg, Maria; Ljungberg, Christina; Edin, E; Millqvist, H; Nordh, Erik; Theorin, Anna; Terenghi, Giorgio; Wiberg, Mikael

doi:10.1016/j.bjps.2008.06.041

Cited by 59 publications

(51 citation statements)

References 46 publications

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“…The rationale that nerve guides should degrade after implantation is supported by data showing that a breakdown rate of 18e24 months matches the rate of tissue regeneration [29]. While it is not generally accepted to use non-degradable nerve guide materials, the use of PEG as a non-degradable material may have clinical applicability for certain specialist repairs (e.g.…”

Section: Discussionmentioning

confidence: 97%

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Nerve guides manufactured from photocurable polymers to aid peripheral nerve repair

et al. 2015

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The peripheral nervous system has a limited innate capacity for self-repair following injury, and surgical intervention is often required. For injuries greater than a few millimeters autografting is standard practice although it is associated with donor site morbidity and is limited in its availability. Because of this, nerve guidance conduits (NGCs) can be viewed as an advantageous alternative, but currently have limited efficacy for short and large injury gaps in comparison to autograft. Current commercially available NGC designs rely on existing regulatory approved materials and traditional production methods, limiting improvement of their design. The aim of this study was to establish a novel method for NGC manufacture using a custom built laser-based microstereolithography (μSL) setup that incorporated a 405 nm laser source to produce 3D constructs with ∼ 50 μm resolution from a photocurable poly(ethylene glycol) resin. These were evaluated by SEM, in vitro neuronal, Schwann and dorsal root ganglion culture and in vivo using a thy-1-YFP-H mouse common fibular nerve injury model. NGCs with dimensions of 1 mm internal diameter × 5 mm length with a wall thickness of 250 μm were fabricated and capable of supporting re-innervation across a 3 mm injury gap after 21 days, with results close to that of an autograft control. The study provides a technology platform for the rapid microfabrication of biocompatible materials, a novel method for in vivo evaluation, and a benchmark for future development in more advanced NGC designs, biodegradable and larger device sizes, and longer-term implantation studies.

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Section: Discussionmentioning

confidence: 97%

“…fabrication of devices made from materials more suitable for regeneration (e.g. poly(3-hydroxybutyrate) [29]), or containing coatings (e.g. ECM [30] or plasma polymers [31,32]).…”

Section: Discussionmentioning

confidence: 99%

Nerve guides manufactured from photocurable polymers to aid peripheral nerve repair

et al. 2015

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“…Recently, Axongen Pharmaceuticals has a pending approval order of a PHB conduit. A study in which PHB wrap implants were used in human patients showed promising results compared to epineural suture [172].…”

Section: Polyhydroxybutyratementioning

confidence: 99%

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

Pedrosa¹,

Caseiro²,

Santos³

et al. 2017

Scaffolds in Tissue Engineering - Materials, Technologies and Clinical Applications

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Human adult peripheral nerve injuries are a high incidence clinical problem that greatly affects patients' quality of life. Although peripheral nervous system has intrinsic regenerative capacity, this occurs in an incomplete or poorly functional manner. When a nerve fiber loses its continuity with consequent damage of the basal lamina tubes, axon spontaneous regeneration is disorganized and mismatched. These phenomena translate in an inadequate nerve functional recovery and consequent musculoskeletal incapacity. Nerve grafts still remain the gold standard in peripheral injuries treatment. However, this approach contains its disadvantages such as the necessity of primary surgery to harvest the autografts, loss of a functional nerve, donor site morbidity and longer surgery procedures. Therefore, biomaterials and tissue engineering can provide efficient resources and alternatives to nerve injury repair not only by the development of biocompatible structures but also, introducing neurotrophic factors and cellular systems to stimulate optimum clinical outcome. In this chapter, a comprehensive state-of-the art picture of tissue-engineered nerve grafts scaffolds, their application in nerve regeneration along with latest advances in peripheral nerve repair and future perspectives will be discussed, including our own large experience in this field of knowledge.

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“…A collagen-based sheath referred to as a "nerve wrap" may also be used to prevent recurrent adhesions around the neurolyzed nerve segment. 46 Specific cases are highlighted below to demonstrate how the surgical correlation of these small peripheral nerve lesions may be surmised from the imaging appearance on high-resolution MRN.…”

Section: Typical Protocol For 3t Mr Imaging Sequences Used For Mrn Ofmentioning

confidence: 99%

Peripheral Nerve Surgery: The Role of High-Resolution MR Neurography

Thawait¹,

Wang

Subhawong

et al. 2011

AJNR Am J Neuroradiol

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SUMMARY:High-resolution MRN is becoming increasingly available due to recent technical advancements, including higher magnetic field strengths (eg, 3T), 3D image acquisition, evolution of novel fat-suppression methods, and improved coil design. This review describes the MRN techniques for obtaining high-quality images of the peripheral nerves and their small branches and imaging findings in normal as well as injured nerves with relevant intraoperative correlations. Various microsurgical techniques in peripheral nerves, such as neurolysis, nerve repairs by using nerve grafts, and conduits are discussed, and MRN findings of surgically treated nerves are demonstrated.ABBREVIATIONS: AP ϭ anteroposterior; CPN ϭ common peroneal nerve; IV ϭ intravenous; LPN ϭ lateral plantar nerve; LR ϭ left-to-right; MIP ϭ maximum intensity projection; MPN ϭ medial plantar nerve; MPR ϭ multiplanar reconstruction; MRN ϭ MR neurography; SI ϭ signal intensity; SNR ϭ signal-to-noise ratio; SPACE ϭ sampling perfection with application-optimized contrasts by using different flip angle evolutions; SPAIR ϭ spectral-attenuated inversion recovery; STIR ϭ short tau inversion recovery; T1WI ϭ T1-weighted imaging; T2WI ϭ T2-weighted imaging; TSE ϭ turbo spin-echo

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Clinical evaluation of a resorbable wrap-around implant as an alternative to nerve repair: A prospective, assessor-blinded, randomised clinical study of sensory, motor and functional recovery after peripheral nerve repair

Cited by 59 publications

References 46 publications

Nerve guides manufactured from photocurable polymers to aid peripheral nerve repair

Nerve guides manufactured from photocurable polymers to aid peripheral nerve repair

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

Peripheral Nerve Surgery: The Role of High-Resolution MR Neurography

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