Nerve lengthening and subsequent end‐to‐end repair yield more favourable outcomes compared with autograft repair of rat sciatic nerve defects

Howarth, Holly; Kadoor, Adarsh; Salem, Rayeheh; Nicolds, Brogan; Adachi, Stephanie Y.; Kanaris, Achilles; Lovering, Richard M.; Brown, Justin M.; Shah, Sameer B.

doi:10.1002/term.2980

Cited by 14 publications

(12 citation statements)

References 41 publications

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“…Autologous nerve interposition grafting was used as the positive control, because it is the gold-standard method for peripheral nerve injury repair in clinical practice. 22,23 Over a 12-week recovery period, the nerve guidance conduit served as a scaffold to guide regenerating axons across the nerve gap for functional reinnervation of the target whisker pad muscles, and facilitated axonal regrowth and remyelination without causing dislocation of the grafts or the formation of neuroma. Therefore, the nerve guidance conduit promoted peripheral nerve regeneration after severe injury.…”

Section: Discussionmentioning

confidence: 99%

Nerve guidance conduit promoted peripheral nerve regeneration in rats

Long

et al. 2021

Artificial Organs

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Nerve growth factor (NGF) is important for peripheral nerve regeneration. However, its short half‐life and rapid diffusion in body fluids limit its clinical efficacy. Collagen has favorable biocompatibility and biodegradability, and weak immunogenicity. Because it possesses an NGF binding domain, we cross‐linked heparin to collagen tubes to construct nerve guidance conduits for delivering NGF. The conduits were implanted to bridge a facial nerve defect in rats. Histological and functional analyses were performed to assess the effect of the nerve guidance conduit on facial nerve regeneration. Heparin enhanced the binding of NGF to collagen while retaining its bioactivity. Also, the nerve guidance conduit significantly promoted axonal growth and Schwan cell proliferation at 12 weeks after surgery. The nerve regeneration and functional recovery outcomes using the nerve guidance conduit were similar to those of autologous nerve grafting. Therefore, the nerve guidance conduit may promote safer nerve regeneration.

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Section: Discussionmentioning

confidence: 99%

Nerve guidance conduit promoted peripheral nerve regeneration in rats

Long

et al. 2021

Artificial Organs

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“…In the SHE0.2 group, the SFI returned to approximately −30 in only 6 weeks. However, the SFI of simple sutures generally returns to approximately −50 for more than 12 weeks 47,51,52 . Regarding the nerve recovery efficacy in function, the SHE0.2 group was superior to the suture, PCL conduit and fibrin-glue groups.…”

Section: Discussionmentioning

confidence: 99%

Self-healing polyurethane-elastomer with mechanical tunability for multiple biomedical applications in vivo

et al. 2021

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The unique properties of self-healing materials hold great potential in the field of biomedical engineering. Although previous studies have focused on the design and synthesis of self-healing materials, their application in in vivo settings remains limited. Here, we design a series of biodegradable and biocompatible self-healing elastomers (SHEs) with tunable mechanical properties, and apply them to various disease models in vivo, in order to test their reparative potential in multiple tissues and at physiological conditions. We validate the effectiveness of SHEs as promising therapies for aortic aneurysm, nerve coaptation and bone immobilization in three animal models. The data presented here support the translation potential of SHEs in diverse settings, and pave the way for the development of self-healing materials in clinical contexts.

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“…Recently, another clever—albeit more invasive—way to avoid the problems that we observed in our series has been proposed, entailing bone shortening and using external fixators to slowly overcome bone defects without introducing tension to nerves (Allan Belzberg—personal communication). Other “nerve lengthening “ techniques have recently been described in rats, providing further promising strategies in the mid-term future [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Use of ultrasound and targeted physiotherapy to manage nerve sutures placed under joint flexion: a case series

Socolovsky

Bataglia

Barousse³

et al. 2022

Acta Neurochir

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Background Joint flexion to diminish the gap and avoid nerve grafts fell into disuse for decades, but recently attention for using this technique was regained. We report a case series of nerve suture under joint flexion, ultrasound monitoring, and physiotherapy. Our main objective was to determine how effective this multimodality treatment is. Methods A retrospective review of 8 patients treated with direct repair with joint flexion was done. Depending on the affected nerve, either the knee or the elbow was flexed intraoperatively to determine if direct suturing was possible. After surgery, the limb was held immobilized. Through serial ultrasounds and a physiotherapy program, the limb was fully extended. If a nerve repair rupture was observed, the patient was re-operated and grafts were used. Results Of the eight nerve sutures analyzed, four sustained a nerve rupture revealed by US at an early stage, while four did not show any sign of dehiscence. In the patients in whom the nerve suture was preserved, an early and very good response was observed. Ultrasound was 100% accurate at identifying nerve suture preservation. Early detection of nerve failure permitted early re-do surgery using grafts without flexion, ultimately determining good final results. Conclusions We observed a high rate of dehiscence in our group of patients treated with direct repair and joint flexion. We believe this was due to an incorrect use of the immobilization device, excessive movement, or a broken device. In opposition to this, we observed that applying direct nerve sutures and joint flexion offers unusually good and fast results. If this technique is employed, it is mandatory to closely monitor suture status with US, together with physiotherapy providing progressive, US-guided extension of the flexed joint. If nerve rupture occurs, the close monitoring dictated by this protocol should ensure the timely application of a successful graft repair.

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Nerve lengthening and subsequent end‐to‐end repair yield more favourable outcomes compared with autograft repair of rat sciatic nerve defects

Cited by 14 publications

References 41 publications

Nerve guidance conduit promoted peripheral nerve regeneration in rats

Nerve guidance conduit promoted peripheral nerve regeneration in rats

Self-healing polyurethane-elastomer with mechanical tunability for multiple biomedical applications in vivo

Use of ultrasound and targeted physiotherapy to manage nerve sutures placed under joint flexion: a case series

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