Recent Advances and Developments in Neural Repair and Regeneration for Hand Surgery

Abstract

<jats:p>End-to-end suture of nerves and autologous nerve grafts are the ‘gold standard’ for repair and reconstruction of peripheral nerves. However, techniques such as sutureless nerve repair with tissue glues, end-to-side nerve repair and allografts exist as alternatives. Biological and synthetic nerve conduits have had some success in early clinical studies on reconstruction of nerve defects in the hand. The effectiveness of nerve regeneration could potentially be increased by using these nerve conduits as scaffolds for delivery of Schwann cells, stem cells, neurotrophic and neurotropic factors or extracellular matrix proteins. There has been extensive<jats:italic>in vitro</jats:italic>and<jats:italic>in vivo</jats:italic>research conducted on these techniques. The clinical applicability and efficacy of these techniques needs to be investigated fully.</jats:p>

Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis

“…In sectioned nerves, the first option of repair is the end-to-end neurorraphy, joining the stumps through suture or through adhesives (e.g fibrin glue) 7,16 . In some cases, according to the extension of the lesion, it is not possible unite the stumps and suture them without causing tension to the nerve, fact that occurs mainly when this rupture involves the loss of tissue.…”

Comparison between suture and fibrin glue on repair by direct coaptation or tubulization of injured mouse sciatic nerve

“…However, excessive handling can cause secondary tissue damage, inducing further degenerative changes. Thus the epineurial suture is the most common technique used because it is less invasive and easier to perform . The purpose of nerve repair is the precise apposition of the two sides of transected nerve using a minimum number of sutures.…”

“…Despite the type of technique used to repair the injured nerve, end‐to‐end neurorrhaphy or tubulization, the conventional form to reconnect these nerves is by suturing them. However, the presence of the suture material could be responsible for affecting the accurate alignment of fascicles and formation of a neuroma in the anastomosis area, due to the granulomatous reaction to the suture string . Furthermore, the number of suture strands crossing the repair site can interfere on the repair results …”

“…End-to-end neurorrhaphy remains the gold standard for repair and reconstruction of peripheral nerves, because it has traditionally provided the best functional outcomes. [5][6][7][8] The current dogma is that to be successful, nerve repair must be tension free. Therefore, autologous nerve grafts is commonly considered the gold standard procedure when there is tissue loss and direct repair is not possible.…”

“…However, the presence of the suture material could be responsible for affecting the accurate alignment of fascicles and formation of a neuroma in the anastomosis area, due to the granulomatous reaction to the suture string. 23,8 Furthermore, the number of suture strands crossing the repair site can interfere on the repair results. 24,8 Alternative methods, such as fibrin glue, can be used to replace the suture in some cases.…”