Functional and electrophysiological outcome after autogenous vein wrapping of primary repaired ulnar nerves

Sadek, Ahmed Fathy; Fouly, Ezzat H.; Hamdy, Mahmoud

doi:10.1002/micr.22207

Cited by 16 publications

(15 citation statements)

References 23 publications

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“…Several clinical studies have demonstrated promising results, including the reduction of allodynia, using the vein wrapping technique for the treatment of recurrent compressive neuropathy and traumatic peripheral nerve injury. [3][4][5][6][7][8][9][10] Previous experiments by our group in a rat model revealed that vein wrapping after CCI decreased pain-associated behavior and nerve damage. 34 Here, vein wrapping also inhibited the development of allodynia following CCI.…”

Section: Discussionmentioning

confidence: 86%

“…The technique of using autologous veins as a protective material is called “vein wrapping.” Masear et al first reported the successful use of vein wrapping for reducing recurrent symptoms secondary to nerve scarring. Several basic and clinical studies have shown that in patients with recurrent compressive neuropathy, such as carpal tunnel, cubital tunnel, radial tunnel, and tarsal tunnel syndromes, and traumatic peripheral nerve injury, vein wrapping improves nerve function and the symptoms associated with these disorders . However, despite the therapeutic potential of autologous vein wrapping, the underlying mechanisms of this technique have not been resolved.…”

mentioning

confidence: 99%

“…Several basic and clinical studies have shown that in patients with recurrent compressive neuropathy, such as carpal tunnel, cubital tunnel, radial tunnel, and tarsal tunnel syndromes, and traumatic peripheral nerve injury, vein wrapping improves nerve function and the symptoms associated with these disorders. [3][4][5][6][7][8][9][10] However, despite the therapeutic potential of autologous vein wrapping, the underlying mechanisms of this technique have not been resolved.…”

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confidence: 99%

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Vein wrapping facilitates basic fibroblast growth factor‐induced heme oxygenase‐1 expression following chronic nerve constriction injury

Hirosawa

Uchida

Kuniyoshi

et al. 2017

Journal Orthopaedic Research

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The clinical efficacy of autologous vein wrapping for recurrent compressive neuropathy has been demonstrated; however, the underlying mechanisms of this technique remain unclear. Rats were divided into chronic constriction injury (CCI) and CCI + vein wrapping (CCI + VW) groups. Mechanical allodynia was evaluated using von Frey filaments. To identify the neuroprotective factors released from veins, basic fibroblast growth factor (bFGF) mRNA expression in veins was compared to that in the sciatic nerve. The response of heme oxygenase-1 (HO-1) expression to vein wrapping was evaluated by RT-PCR and enzyme-linked immunosorbent assays. The effects of exogenous bFGF on HO-1 expression were evaluated using a sciatic nerve cell culture. Vein wrapping significantly increased the withdraw threshold levels compared to the untreated CCI group. bFGF mRNA expression in veins was higher than that in untreated sciatic nerves. HO-1 mRNA expression was induced at higher levels in sciatic nerve cells in the presence of exogenous bFGF compared to untreated control cells. HO-1 mRNA and protein expression in the sciatic nerve were also higher in the CCI + VW group compared with the CCI group. Our results suggest that vein-derived bFGF contributes to the therapeutic benefit of vein wrapping through the induction of HO-1 in the sciatic nerve. Vein wrapping is a useful technique for reducing neuropathic pain. Further understanding of the neurotrophic factors released from veins may help to optimize current procedures for treating recurrent compressive neuropathy and traumatic peripheral nerve injury, and lead to the development of new therapeutic methods using recombinant neurotrophic factors. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:898-905, 2018.

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Section: Discussionmentioning

confidence: 86%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Vein wrapping facilitates basic fibroblast growth factor‐induced heme oxygenase‐1 expression following chronic nerve constriction injury

Hirosawa

Uchida

Kuniyoshi

et al. 2017

Journal Orthopaedic Research

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“…Autologous vein wrapping has improved treatment for neuropathic pain resulting from recurrent compressive neuropathy and traumatic peripheral nerve injury . Vein wrapping has been used to improve recurrent symptoms arising from nerve scarring since the early 1990s .…”

mentioning

confidence: 99%

“…To overcome this problem, collagen materials have recently been developed as an alternative to autologous veins . Vein wrapping was first employed in the upper extremity to avoid scarring in peripheral nerve injury . Realization that vein tissue produced several trophic factors that play an important role in the relief of pain was another important milestone .…”

mentioning

confidence: 99%

Wrapping With Basic Fibroblast Growth Factor‐Impregnated Collagen Sheet Reduces Rat Sciatic Nerve Allodynia

Mukai

Uchida

Hirosawa

et al. 2019

Journal Orthopaedic Research

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Autologous vein wrapping is used to treat recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, its use is restricted due to the inability to obtain sufficiently long veins for larger grafts. We previously reported that vein‐derived basic fibroblast growth factor (bFGF) promotes heme oxygenase‐1 (HO‐1), which reduces allodynia via its anti‐inflammatory properties. To mimic vein wrapping, we developed a collagen sheet impregnated with bFGF. Chronic constriction injury (CCI) was induced in male Wistar rats as a model of sciatic nerve injury, and the rats were divided into three groups: (i) untreated after CCI surgery (control group), (ii) treated with a collagen sheet wrap impregnated with phosphate‐buffered saline (PBS/CS group), and (iii) treated with a collagen sheet wrap impregnated with bFGF (bFGF/CS group). Pain behavior (von Frey test) was evaluated on postoperative days (PODs) 1, 5, 7, and 14. Quantitative polymerase chain reaction was conducted on sciatic nerve RNA to quantify HO‐1 gene, Hmox1, expression. Enzyme‐linked immunosorbent assay were used to determine HO‐1 protein levels on POD 1. von Frey testing showed significantly greater pain hypersensitivity in the control and PBS/CS groups than the bFGF/CS group. In the bFGF/CS group, Hmox1 messenger RNA and HO‐1 protein levels were significantly increased in the sciatic nerve compared with the control and PBS/CS groups on PODs 1 and 5 and POD 1, respectively. The bFGF/CS group showed decreased allodynia and HO‐1 induction, as observed with vein wrapping. Therefore, local application of bFGF may be an alternative treatment strategy for compressive neuropathy and peripheral nerve trauma in clinical settings. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2258–2263, 2019

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Comparison of results obtained with standard and inside out vein graft techniques and their implication on neurotrophin expression in repair of nerve defect: An experimental study

Ahmed

Rosa²,

Shinohara

et al. 2014

Microsurgery

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Standard vein graft (SVG) and inside out vein graft (IOVG) techniques to promote peripheral nerve regeneration have been widely studied since last two decades. In this experimental study, we attempted to compare these two techniques and analyze the differences in the expression of the neurotrophins during peripheral nerve regeneration. Thirty-six male Wistar rats were used in this sciatic nerve transection model and were divided into two experimental groups (SVG and IOVG) and one sham operated control group. An overall defect of 10 mm was made in the sciatic nerve of the animals in the experimental groups. Each group consisted of two time intervals of 6 and 12 weeks (n = 6). After each experimental interval, sciatic functional index (SFI) along with area and diameter of the axons and fibers of each group were calculated. Muscle mass measurements were also evaluated to see any functional recovery in the groups. Expression of neurotrophins in the graft and distal stump were analyzed with the help of RT-PCR. SFI obtained from walking track analysis showed poor motor recovery in the experimental groups during both time intervals. No significant differences in the histological, morphometric (P > 0.05), and muscle mass measurements (P > 0.05) between the two experimental groups were observed. Analysis of RT-PCR data exhibited an increase in the expression of NT-3 with time in both the grafts (6 weeks 0.428 ± 0.392, 12 weeks 1.089 ± 0.455, P < 0.05) and distal stump (6 weeks 0.411 ± 0.306, 12 weeks 0.807 ± 0.303, P < 0.05) of the SVG group. The study concludes that there is no substantial difference in the nerve regeneration ability between both the techniques. Also, the difference in the level of NT-3 between SVG and IOVG suggests a distinct regulation of NT-3 in peripheral nerve regeneration.

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Functional and electrophysiological outcome after autogenous vein wrapping of primary repaired ulnar nerves

Abstract: Vein wrapping is a simple technique that could be used reliably to augment primary neurorrhaphy particularly in cases with associated vascular or tendon injuries to prevent scarring and enhance functional and electrophysiological recovery.

Cited by 16 publications

References 23 publications

Vein wrapping facilitates basic fibroblast growth factor‐induced heme oxygenase‐1 expression following chronic nerve constriction injury

Vein wrapping facilitates basic fibroblast growth factor‐induced heme oxygenase‐1 expression following chronic nerve constriction injury

Wrapping With Basic Fibroblast Growth Factor‐Impregnated Collagen Sheet Reduces Rat Sciatic Nerve Allodynia

Comparison of results obtained with standard and inside out vein graft techniques and their implication on neurotrophin expression in repair of nerve defect: An experimental study

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