Enhancing the Outcome of Traumatic Sensory Nerve Lesions of the Hand by Additional Use of a Chitosan Nerve Tube in Primary Nerve Repair: A Randomized Controlled Bicentric Trial

Neubrech, Florian; Sauerbier, Michael; Moll, Wibke; Seegmüller, Jessica; Heider, Sina; Harhaus, Leila; Bickert, Berthold; Kneser, Ulrich; Kremer, Thomas

doi:10.1097/prs.0000000000004574

Cited by 58 publications

(61 citation statements)

References 24 publications

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“…Furthermore, the nerve autograft alternative itself could be designed to promote macrophage polarization to the more M2‐like phenotype through its inherent biomaterial properties, which has been observed upon conduit materials such as chitosan . Indeed, these conduits are now undergoing clinical trials to determine their efficacy in nerve repair …”

Section: Experimental Nerve Graft Alternativesmentioning

confidence: 99%

Advances in the repair of segmental nerve injuries and trends in reconstruction

2020

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Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system. K E Y W O R D S acellular nerve allograft, autograft, nerve gap, nerve guidance conduit, peripheral nerve 2 | BIOLOGY OF NERVE REGENERATION ACROSS A DEFECT Peripheral nerve is capable of robust regeneration following injury. The molecular and cellular mechanisms have primarily been studied in rodent models. Following injury, neurons and their axons and the nonneuronal cellular environment distal to the injury undergo immediate morphological and molecular changes. Within the axon, there is a rapid influx of ions, principally calcium, as well as a disruption of transport proteins signaling a disruption to homeostasis with its end-organ. This multifactorial injury response from axon damage is rapidly transported to the neuron cell Abbreviations: ANA, acellular nerve allograft; ECM, extracellular matrix; FDA, Food and Drug Administration; FK506, tacrolimus; GDNF, glial cell line-derived neurotrophic factor; GFRα1, glial cell line-derived neurotrophic factor family receptor alpha-1; MRC, Medical Research

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Section: Experimental Nerve Graft Alternativesmentioning

confidence: 99%

Advances in the repair of segmental nerve injuries and trends in reconstruction

2020

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“…-Chitosan: supports axonal regrowth and reduces scar formation (Haastert-Talini et al, 2013;Stenberg et al, 2016;Neubrech et al, 2018). -Degradation products positively influence nerve regeneration (Gong et al, 2009;Zhao et al, 2017).…”

Section: Chitin and Chitosanmentioning

confidence: 99%

“…-Different strategies to increase its mechanical strength: double layered conduits (Wang et al, 2008a,b) or biomaterial blending (Fan et al, 2008;Boecker et al, 2019). -Transparency, flexibility and resistance to collapse (Neubrech et al, 2016(Neubrech et al, , 2018).…”

Section: Chitin and Chitosanmentioning

confidence: 99%

Natural-Based Biomaterials for Peripheral Nerve Injury Repair

Fornasari

Carta

Gambarotta

et al. 2020

Front. Bioeng. Biotechnol.

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Peripheral nerve injury treatment is a relevant problem because of nerve lesion high incidence and because of unsatisfactory regeneration after severe injuries, thus resulting in a reduced patient's life quality. To repair severe nerve injuries characterized by substance loss and to improve the regeneration outcome at both motor and sensory level, different strategies have been investigated. Although autograft remains the gold standard technique, a growing number of research articles concerning nerve conduit use has been reported in the last years. Nerve conduits aim to overcome autograft disadvantages, but they must satisfy some requirements to be suitable for nerve repair. A universal ideal conduit does not exist, since conduit properties have to be evaluated case by case; nevertheless, because of their high biocompatibility and biodegradability, natural-based biomaterials have great potentiality to be used to produce nerve guides. Although they share many characteristics with synthetic biomaterials, natural-based biomaterials should also be preferable because of their extraction sources; indeed, these biomaterials are obtained from different renewable sources or food waste, thus reducing environmental impact and enhancing sustainability in comparison to synthetic ones. This review reports the strengths and weaknesses of natural-based biomaterials used for manufacturing peripheral nerve conduits, analyzing the interactions between natural-based biomaterials and biological environment. Particular attention was paid to the description of the preclinical outcome of nerve regeneration in injury repaired with the different natural-based conduits.

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“…Axon regeneration is extensive through conduits composed of fibrin [145,153], hydrogel tubes [154], alginate/chitosan polyelectrolyte [155][156][157], poly epsilon-caprolactone [158,159], polyglycolic acid [160], poly(lactic-co-glycolic acid) or silk-based [161][162][163][164]. Conduits composed of decellularized human umbilical artery [165] and muscles [166] are also effective in promoting axon regeneration across nerve gaps.…”

Section: Conduit Compositionmentioning

confidence: 99%

Restoration of Neurological Function Following Peripheral Nerve Trauma

Kuffler

Foy

2020

IJMS

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Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.

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Enhancing the Outcome of Traumatic Sensory Nerve Lesions of the Hand by Additional Use of a Chitosan Nerve Tube in Primary Nerve Repair: A Randomized Controlled Bicentric Trial

Abstract: Therapeutic, I.

Cited by 58 publications

References 24 publications

Advances in the repair of segmental nerve injuries and trends in reconstruction

Advances in the repair of segmental nerve injuries and trends in reconstruction

Natural-Based Biomaterials for Peripheral Nerve Injury Repair

Restoration of Neurological Function Following Peripheral Nerve Trauma

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