Current concepts in peripheral nerve surgery

Beris, Alexandros E.; Gkiatas, Ioannis; Gelalis, Ioannis D.; Papadopoulos, Dimitrios V.; Kostas-Agnantis, Ioannis

doi:10.1007/s00590-018-2344-2

Cited by 78 publications

(67 citation statements)

References 45 publications

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“…Currently, the best practice for surgical repair consists of a tension-free direct nerve coaptation or, in case of a gap, an autologous nerve graft (usually the sural nerve) [26]. Unfortunately, particularly with extended lesions, a full recovery is rarely achieved, and donor site morbidity is relevant with scarring, sensory deficit, and potential neuroma formation as recognized complications [27,28]. As the autologous nerve graft technique is far from optimal, the development of alternative approaches for the repair of peripheral nerves is essential.…”

Section: Discussionmentioning

confidence: 99%

Human platelet lysate as a potential clinical-translatable supplement to support the neurotrophic properties of human adipose-derived stem cells

et al. 2020

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Background The autologous nerve graft, despite its donor site morbidity and unpredictable functional recovery, continues to be the gold standard in peripheral nerve repair. Rodent research studies have shown promising results with cell transplantation of human adipose-derived stem cells (hADSC) in a bioengineered conduit, as an alternative strategy for nerve regeneration. To achieve meaningful clinical translation, cell therapy must comply with biosafety. Cell extraction and expansion methods that use animal-derived products, including enzymatic adipose tissue dissociation and the use of fetal bovine serum (FBS) as a culture medium supplement, have the potential for transmission of zoonotic infectious and immunogenicity. Human-platelet-lysate (hPL) serum has been used in recent years in human cell expansion, showing reliability in clinical applications. Methods We investigated whether hADSC can be routinely isolated and cultured in a completely xenogeneic-free way (using hPL culture medium supplement and avoiding collagenase digestion) without altering their physiology and stem properties. Outcomes in terms of stem marker expression (CD105, CD90, CD73) and the osteocyte/adipocyte differentiation capacity were compared with classical collagenase digestion and FBS-supplemented hADSC expansion. Results We found no significant differences between the two examined extraction and culture protocols in terms of cluster differentiation (CD) marker expression and stem cell plasticity, while hADSC in hPL showed a significantly higher proliferation rate when compared with the usual FBS-added medium. Considering the important key growth factors (particularly brain-derived growth factor (BDNF)) present in hPL, we investigated a possible neurogenic commitment of hADSC when cultured with hPL. Interestingly, hADSC cultured in hPL showed a statistically higher secretion of neurotrophic factors BDNF, glial cell-derived growth factor (GDNF), and nerve-derived growth factor (NFG) than FBS-cultured cells. When cocultured in the presence of primary neurons, hADSC which had been grown under hPL supplementation, showed significantly enhanced neurotrophic properties. Conclusions The hPL-supplement medium could improve cell proliferation and neurotropism while maintaining stable cell properties, showing effectiveness in clinical translation and significant potential in peripheral nerve research.

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Section: Discussionmentioning

confidence: 99%

Human platelet lysate as a potential clinical-translatable supplement to support the neurotrophic properties of human adipose-derived stem cells

et al. 2020

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“…e clinical repair of peripheral nerve injuries is a difficult problem for patients and clinicians [1]. e number of serious injury cases in modern society is increasing.…”

Section: Introductionmentioning

confidence: 99%

Customized Scaffold Design Based on Natural Peripheral Nerve Fascicle Characteristics for Biofabrication in Tissue Regeneration

Yao

Yan

Qiu

et al. 2019

BioMed Research International

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Objective. The use of a biofabrication nerve scaffold, which mimics the nerve microstructure, as an alternative for autologous nerve transplantation is a promising strategy for treating peripheral nerve defects. This study aimed to design a customized biofabrication scaffold model with the characteristics of human peripheral nerve fascicles. Methods. We used Micro-MRI technique to obtain different nerve fascicles. A full-length 28 cm tibial nerve specimen was obtained and was divided into 14 two-centimetre nerve segments. 3D models of the nerve fascicles were obtained by three-dimensional reconstruction after image segmentation. The central line of the nerve fascicles was fitted, and the aggregation of nerve fascicles was analysed quantitatively. The nerve scaffold was designed by simulating the clinical nerve defect and extracting information from the acquired nerve fascicle data; the scaffold design was displayed by 3D printing to verify the accuracy of the model. Result. The microstructure of the sciatic nerve, tibial nerve, and common peroneal nerve in the nerve fascicles could be obtained by three-dimensional reconstruction. The number of cross fusions of tibial nerve fascicles from proximal end to distal end decreased gradually. By designing the nerve graft in accordance with the microstructure of the nerve fascicles, the 3D printed model demonstrated that the two ends of the nerve defect can be well matched. Conclusion. The microstructure of the nerve fascicles is complicated and changeable, and the spatial position of each nerve fascicle and the long segment of the nerve fascicle aggregation show great changes at different levels. Under the premise of the stability of the existing imaging techniques, a large number of scanning nerve samples can be used to set up a three-dimensional database of the peripheral nerve fascicle microstructure, integrating the gross imaging information, and provide a template for the design of the downstream nerve graft model.

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“…Los nervios que con mayor frecuencia se ven comprometidos cuando ocurre un trauma de los miembros inferiores son el nervio peroneo y el ciático, seguidos por los nervios femoral y tibial que presentan el mismo porcentaje de lesión; esto se atribuye a su distribución anatómica a través del miembro inferior, que lo hace especialmente susceptible de sufrir traumatismos. (3) A diferencia de la reconstrucción nerviosa del plexo braquial y sus nervios, en la que a pesar de padecer lesiones muy altas existen nervios donantes aledaños (en cuello, hombro o tórax) que nos ayudan a trasmitir información supliendo la perdida, en el miembro inferior estos donantes son escasos. Además en esta zona, cuanto más altas sean las lesiones, la recuperación funcional será de peor pronóstico por los largos recorridos que debe tomar la regeneración nerviosa.…”

Section: Introduccionunclassified

“…Además en esta zona, cuanto más altas sean las lesiones, la recuperación funcional será de peor pronóstico por los largos recorridos que debe tomar la regeneración nerviosa. (3) En el presente estudio mostramos la experiencia de 2 centros hospitalarios, el Hospital Manuel Gea González en México D.F. (México) y el Hospital Universitario Clínica San Rafael en Bogotá (Colombia) en el manejo de lesiones nerviosas en el miembro inferior.…”

Section: Introduccionunclassified