Comparison of nerve regeneration through different types of neural prostheses

Abstract

Rat sciatic nerve regeneration through three synthetic neural prostheses was compared with regeneration through nerve allografts. The synthetic prostheses were either nonpermeable nonabsorbable (Silastic), permeable absorbable (polyglactin mesh), or permeable nonabsorbable (polypropylene mesh). Animals were evaluated at 10, 24, and 90 days. Functional analysis of nerve regeneration was performed by noninvasive methods: electromyography and walking tracks. Nerve tissue was examined with routine histologic and immunofluorescent techniques. A compressive neuropathy developed with the use of the Silastic implant. A neutrophilic inflammatory infiltrate was consistently associated with implantation of the polyglactin mesh. A strong connective tissue response was noted around the polypropylene mesh. Early recovery of nerve function was seen with the Silastic implants, however, overall nerve function was best in the nerve allograft and polypropylene mesh groups. Polyglactin implantation increases the local inflammatory response and should not be used for nerve anastomoses. If Silastic entubulation is used, it should be removed between 24 and 90 days.

Peripheral and Spinal Motor Reorganization after Nerve Injury and Repair

“…In contrast, deliberately crossed suture of the tibial and peroneal nerve fascicles resulted in an inability to improve the SFI, whereas repair by direct suture or tubulization showed a similar mild recovery in the ability for plantar flexion-extension and separation of toes during gait at the end of the follow-up period (Evans et al, 1991). A progressive increase of CMAP amplitudes in proximal and distal muscles of the hindlimb is not correlated with recovery of the walking pattern after sciatic nerve section, proving that muscle reinnervation by itself does not recover global function and identifies the limitations of the walking track test to evaluate nerve regeneration (Shenaq et al, 1989;Gibson et al, 1991;Munro et al, 1998;Valero-Cabré and Navarro, 2002).…”

Tissue and Organ Regeneration in Adults

“…A PGA tube was reported to have disappeared by about 26 weeks (Keeley et al 1991;Aldini et al 1996). Tubes constructed from PGL were also reported to have been completely degraded by about 26 weeks (Gibson et al 1991;Aldini et al 1996).…”

“…The intensity of acid release from the implant and some of its consequences have been studied (Gibson et al 1991).…”

The use of a muscle graft to repair a segmentary nerve defect

“…Many different materials have been tested for this purpose: vein graft (Chiu et al, 1982;Risitano et al, 1989;Tada et al, 1991;Wang et al, 1995;Tang, 1995), artery graft (Weiss, 1941;Itoh et al, 1996), pseudo-synovia tubes (Mackinnon et al, 1985), silicone tubes (Lundborg et al, 1982;Santos et al, 1999), bioresorbable tubes (Mackinnon and Dellon, 1990;Ljungberg et al, 1999;Meek et al, 1999), and semi-permeable tubes (Gibson et al, 1991). However, the use of these materials remains confined to laboratories and experimental situations, with clinical use being limited to repair of small defects only.…”