Consequences of Oversizing: Nerve-to-Nerve Tube Diameter Mismatch

Isaacs, Jonathan; Mallu, Satya; Yan, Wei; Little, Barrett

doi:10.2106/jbjs.m.01420

Cited by 26 publications

(28 citation statements)

References 29 publications

(29 reference statements)

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“…2,3,6,25 Few studies have been conducted for large diameter nerve repairs, and many have reported the inferiority of the use of any conduit in comparison with autografts. 3,6,7,34,35 In this study, we were able to demonstrate at least comparable results for segmental gaps of 10 mm with a conduit diameter of 1.5 mm. The need to study this model in larger gaps, with larger diameter nerves, is necessary to evaluate the UBM conduit’s potential against autografts in larger animals.…”

Section: Discussionsupporting

confidence: 63%

Bridging the Gap

Nguyen¹,

Afshari²,

Kelm³

et al. 2017

Annals of Plastic Surgery

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Purpose This study aims to compare engineered nerve conduits constructed from porcine-derived urinary bladder matrix (UBM) with the criterion-standard nerve autografts, for segmental loss peripheral nerve repairs. Methods Forty-eight Sprague-Dawley rats were divided into 2 groups. All underwent a 10-mm sciatic nerve gap injury. This was repaired using either (1) reverse autograft—the 10-mm cut segment was oriented 180 degrees and used to coapt the proximal and distal stumps or (2) UBM conduit—the 10-mm nerve gap was bridged with UBM conduit. Behavior assessments such as sciatic function index and foot fault asymmetry scores were performed weekly. At 3- or 6-week time endpoints, the repaired nerves and bilateral gastrocnemius/soleus muscles were harvested from each animal. Nerves were evaluated using immunohistochemistry for motor and sensory axon staining and with diffusion tensor imaging. The net wet muscle weights were calculated to assess the degree of muscle atrophy. Results The UBM group demonstrated significantly improved foot fault asymmetry scores at 2 and 4 weeks, whereas there was no difference in sciatic function index. The net muscle weights were similar between both groups. Motor axon counts proximal/inside/distal to the conduit/graft were similar between UBM conduits and reverse autografts, whereas sensory axon counts within and distal to the conduit were significantly higher than those of the autograft at 6 weeks. Sensory axonal regeneration seemed to be adherent to the inner surface of the UBM conduit, whereas it had a scattered appearance in autografts. Diffusion tensor imaging parameters between groups were similar. Conclusions Urinary bladder matrix conduits prove to be at least similar to nerve autografts for the repair of peripheral nerve injuries with a short gap. The matrix perhaps serves as a scaffold to augment sensory nerve growth. Clinical Relevance In a clinical setting, UBM may eliminate the donor site morbidity and increased operative time associated with nerve autografting.

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Section: Discussionsupporting

confidence: 63%

Bridging the Gap

Nguyen¹,

Afshari²,

Kelm³

et al. 2017

Annals of Plastic Surgery

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“…Cell migration within the fibrin matrix creates some linear bands-bands of Büngner-that steer the growth of the nerve cone [78,86]. The mechanism through which neurite growth cone forms within the lumen of the conduit depends on the volumetric ratio [87,88]. If the gap is too long or the diameter of the inner lumen is too large, the growth cables are too thin, and due to the fibrin matrix, the growth cone takes on an hourglass figure that affects axonal regeneration.…”

Section: Nerve Conduitsmentioning

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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“…With an interpositional graft, it is important to utilize a graft of similar diameter; however, even then, it is not possible to correctly match the proximal donor fascicles with the distal stump recipient. Furthermore, regenerating axons must cross two neurorrhaphy sites instead of only one.…”

Section: Management Of Severe Upper Extremity Traumamentioning

confidence: 99%

Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

Kusnezov

Dunn

et al. 2015

Orthopaedic Surgery

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In the setting of near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure.

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Consequences of Oversizing: Nerve-to-Nerve Tube Diameter Mismatch

Abstract: Accurate sizing of nerve conduits to the nerve-stump diameter improves nerve recovery.

Cited by 26 publications

References 29 publications

Bridging the Gap

Bridging the Gap

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

Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature

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