Nerve conduits for treating peripheral nerve injuries: A systematic literature review

Silva, Jefferson Braga; Marchese, Gabriela Meirelles; Cauduro, Carolina; Debiasi, Márcio

doi:10.1016/j.hansur.2016.10.212

Cited by 48 publications

(24 citation statements)

References 41 publications

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“…According to the literature, the beneficial characteristic of synthetic materials compared to natural ones is that the degradation rate and mechanical properties can be controlled, creating an opportunity to individualize the patient’s treatment 5 . As such, OxPVA conduits potential resides in the versatility of the chemical reaction required to prepare the polymeric solution.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, donor-site morbidities (i.e. scarring and neuroma formation, permanent loss of function), size mismatch between the donor nerve and the injured one, poor functional recovery rates and increase in surgery and anesthesia time, have prompted the interest towards the identification of surgical alternatives to this technique 5 – 7 . Currently, the primary option is the use of hollow nerve guide conduits that will create an adequate microenvironment for nutritional support, axon regeneration and acting as a barrier against the surrounding tissue infiltration 8 , 9 .…”

Section: Introductionmentioning

confidence: 99%

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Partially oxidized polyvinyl alcohol conduitfor peripheral nerve regeneration

Stocco

Barbon

Lora

et al. 2018

Sci Rep

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Surgical reconstruction of peripheral nerves injuries with wide substance-loss is still a challenge. Many studies focused on the development of artificial nerve conduits made of synthetic or biological materials but the ideal device has not yet been identified. Here, we manufactured a conduit for peripheral nerve regeneration using a novel biodegradable hydrogel we patented that is oxidized polyvinyl alcohol (OxPVA). Thus, its characteristics were compared with neat polyvinyl alcohol (PVA) and silk-fibroin (SF) conduits, through in vitro and in vivo analysis. Unlike SF, OxPVA and neat PVA scaffolds did not support SH-SY5Y adhesion and proliferation in vitro. After implantation in rat model of sciatic nerve transection, the three conduits sustained the regeneration of the injured nerve filling a gap of 5 mm in 12 weeks. Implanted animals showed a good gait recovery. Morphometric data related to the central portion of the explanted conduit interestingly highlighted a significantly better outcome for OxPVA scaffolds compared to PVA conduits in terms of axon density, also with respect to the autograft group. This study suggests the potential of our novel biomaterial for the development of conduits for clinical use in case of peripheral nerve lesions with substance loss.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Partially oxidized polyvinyl alcohol conduitfor peripheral nerve regeneration

Stocco

Barbon

Lora

et al. 2018

Sci Rep

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“…Multiple independent studies demonstrated meaningful recovery in 80‐89% of digital nerve defect repairs using PNAs meeting similar criteria . And finally, while there is limited data demonstrating a major difference in the degree of recovery when regeneration is successful, evidence demonstrates that autografts and PNAs provide more consistent recovery compared with conduits for treating short length or small diameter sensory nerve defects …”

Section: Guidelines For Nerve Graft Repairsmentioning

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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“…Electrically conductive biodegradable polymer composite materials enhance the rate of neurite outgrowth from cultured PC12 cells [101]. Similarly, electrical stimulation of stem cells seeded onto electrospun conducting polymer nanofibers induces neurite extension [203]. Thus, electrical stimulation of conduits composed of such material may enhance axon regeneration in vivo.…”

Section: Conduit Composition and Electrical Stimulationmentioning

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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Nerve conduits for treating peripheral nerve injuries: A systematic literature review

Cited by 48 publications

References 41 publications

Partially oxidized polyvinyl alcohol conduitfor peripheral nerve regeneration

Partially oxidized polyvinyl alcohol conduitfor peripheral nerve regeneration

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

Restoration of Neurological Function Following Peripheral Nerve Trauma

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