Nerve Conduits for Peripheral Nerve Surgery

Pabari, Amit; Lloyd-Hughes, Hawys; Seifalian, Alexander M.; Mosahebi, Afshin

doi:10.1097/prs.0000000000000226

Cited by 109 publications

(83 citation statements)

References 87 publications

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“…Recent modifications of this include the use of processed nerve allografts20 and nerve conduits 21. Allografts appear to perform better than nerve conduits, but there are insufficient data to confirm that they are equivalent to nerve autografts, particularly in major mixed motor nerves.…”

Section: Introductionmentioning

confidence: 99%

Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Korus

Ross

Doherty

et al. 2015

J Neurol Neurosurg Psychiatry

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Peripheral nerve injury (PNI) and recent advances in nerve reconstruction (such as neurotization with nerve transfers) have improved outcomes for patients suffering peripheral nerve trauma. The purpose of this paper is to bridge the gap between the electromyographer/clinical neurophysiologist and the peripheral nerve surgeon. Whereas the preceding literature focuses on either the basic science behind nerve injury and reconstruction, or the surgical options and algorithms, this paper demonstrates how electromyography is not just a 'decision tool' when deciding whether to operate but is also essential to all phases of PNI management including surgery and rehabilitation. The recent advances in the reconstruction and rehabilitation of PNI is demonstrated using case examples to assist the electromyographer to understand modern surgical techniques and the unique demands they ask from electrodiagnostic testing.

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Section: Introductionmentioning

confidence: 99%

Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Korus

Ross

Doherty

et al. 2015

J Neurol Neurosurg Psychiatry

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“…Nerve regeneration becomes more evident in SIS if the defects between proximal and distal stumps are less than 10 mm (14,16). Data regarding the effectiveness of SIS are still lacking and there are no comparisons with other conduits (29). …”

Section: Discussionmentioning

confidence: 99%

“…SIS is a commercially available product that was FDA approved in 2003 (29). However, in experimental studies on neural regeneration, the investigators have preferred to prepare SIS grafts in their own facilities (14,15,25).…”

Section: Discussionmentioning

confidence: 99%

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

et al. 2017

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Background:Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described.Aims:To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects.Study Design:Animal experimentation.Methods:Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week.Results:Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group.Conclusion:Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.

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“…Later time point (ie, 15 weeks) observations may show experimental and control groups to be equivalent because of the enhanced regenerative capacity of the rodent nervous system, and this could mask any differences seen between groups. 3,6,31,32 At 6 weeks, Wallerian degeneration is complete, yet axonal regeneration is still ongoing, providing the ability to more accurately compare recovery differences between both groups. Therefore, this time point strengthens the validity of improved sensory axons at least early in the nerve recovery process when utilizing the UBM conduit.…”

Section: Discussionmentioning

confidence: 99%

“…3–5 Current Food and Drug Administration–approved biodegradable conduits in the market have had variable results in comparison with autografts both clinically and experimentally. These variable results have precluded conduit-based repair full acceptance in bridging segmental peripheral nerve loss, 2,3,6,7 leading bioengineers continue to search for conduit material that will consistently outperform autografts.…”

mentioning

confidence: 99%

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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Nerve Conduits for Peripheral Nerve Surgery

Cited by 109 publications

References 87 publications

Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

Bridging the Gap

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