Nerve grafting for peripheral nerve injuries with extended defect sizes

Kornfeld, Tim; Vogt, Peter M.; Radtke, Christine

doi:10.1007/s10354-018-0675-6

Cited by 172 publications

(164 citation statements)

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“…However, these conduits are generally similar in their principles and features, as they are biodegradable through various mechanisms and promote regeneration by means of first the formation of endogenous ECM within the empty tube structure. Extensive reviews of the wide range of conduit material properties are available …”

Section: Bridging Materials To Repair Nerve Defectsmentioning

confidence: 99%

“…As the body of work on experimental alternatives is substantial, this section will highlight specific recent areas that show promise for translation. For a more comprehensive review of bioengineered nerve graft alternatives, see Pfister et al, Boecker et al, and Kornfeld et al…”

Section: Experimental Nerve Graft Alternativesmentioning

confidence: 99%

“…Animal studies have yet to demonstrate that nerve graft alternatives can reliably facilitate axon regeneration across longer defects (>30 mm), despite their robust abilities to promote regeneration across shorter defects . A review of this specific topic is available: see Kornfeld et al However, there is limited understanding as to why few axons regenerate across these long graft alternatives despite cues to promote axon growth and regeneration that succeed at shorter lengths. Effectively, alternatives are functionally limited by length.…”

Section: Future Research Needed To Improve Alternative Designsmentioning

confidence: 99%

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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: Bridging Materials To Repair Nerve Defectsmentioning

confidence: 99%

Section: Experimental Nerve Graft Alternativesmentioning

confidence: 99%

Section: Future Research Needed To Improve Alternative Designsmentioning

confidence: 99%

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

2020

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“…Therefore, sensory nerve grafts are only considered reliable for "short" nerve gaps (≤3 cm) [55,68]. Furthermore, no material is Food and Drug Administration (FDA)-approved for repairing nerve gaps >3 cm in length [55,69,70].…”

Section: Decreasing Recovery With Increasing Gap Lengthmentioning

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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“…Recently, pressure sensing mat technology has been developed as a more accurate and precise tool for quantifying gait patterns (13)(14)(15).We utilized a commonly used pressure sensing mat tool to measure the kinematic and timing variables in both the forelimb and hindlimb of rats to quantify the repair of peripheral nerve damage. Lewis and Sprague Dawley rats are the most widely used animal models for assessing nerve regeneration in critical size nerve defects (16,17). Lewis rats are more often used as the subjects in critical nerve defect models over other alternative rodent strains due to minimal occurrence of autotomy behavior after an extended period post-transection of the sciatic nerve gap (18).…”

Section: Introductionmentioning

confidence: 99%

Biometric Data Comparison Between Lewis and Sprague Dawley Rats

et al. 2019

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Introduction: Pressure mapping systems are often used for indirect assessment of kinematic gait parameter differences after repair of critical peripheral nerve defects in small animal models. However, there does not appear to be any literature that studies the differences in normal gait pattern of Sprague Dawley rats compared to Lewis rats using a Tekscan VH4 pressure mat system. The purpose of this study is to assess the gait profile of Lewis and Sprague Dawley rats generated by Tekscan's VH4 system to detect similarities and/or differences in gait parameters involving both force and temporal variables. Materials and Methods: The gait profile of 14 Lewis and 14 Sprague Dawley rats was recorded using a Tekscan VH4 pressure map system with two successful walks per animal and gait parameter data was normalized for mean variance between the two rodent strains. Results: The results showed that temporal and normalized force parameters were not significantly different between the two types of rats. Maximum force, contact area, stride length, and adjusted pressure variables were significantly different between the two strains, likely attributed to the body size and weight differential between the strains. Variation in some of these parameters were considered due to differences in overall body size between the two strains, variations in gait kinematics between individual rodent subjects, and the limitations of the current experimental design. Conclusion : For future in vivo models, either Sprague Dawley or Lewis rat strains would be acceptable animal models when comparing base-line gait profiles using the Tekscan VH4 pressure map system when assessing critical defect repairs of peripheral nerves.

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Nerve grafting for peripheral nerve injuries with extended defect sizes

Cited by 172 publications

References 100 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

Restoration of Neurological Function Following Peripheral Nerve Trauma

Biometric Data Comparison Between Lewis and Sprague Dawley Rats

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