The role of peripheral nerve surgery in a tissue reinnervation

Abstract

In modern neuroscience, the most relevant is the study of the problem of reinnervation of tissues after severe injuries. Complete restoration of lost physiological functions is still impossible with lesions of peripheral nerves with the formation of extensive diastasis between their proximal and distal sites. In this case, the standard neurorrhaphy cannot be carried out because of the eruption of the filaments during tension and convergence of the ends. To solve this problem, a technique was developed for autotransplantation of the nerve sections, which is still the gold standard for the reconstruction of extensive nerve defects. However, the presence of significant shortcomings led to the development of the doctrine of the direction of regeneration with the help of conduits. Currently, the use of nerve channels is the most promising technology for peripheral nerve repair after trauma. The most actively developing now is the direction of reinnervation, such as neurotization. Neurotization, in some way, combined all the methods of restoring nerves. The overall goal of all these methods-the restoration of extensive nerve defects-allows them to be combined into a new industry: reinnervating neurosurgery.

Modern Methods of Surgical Treatment of Peripheral Nervous System Injuries

“…The advantages of conduits are: peculiarities of structure prevent scar tissue from entering its cavity; flexibility, elasticity, biocompatibility and biodegradability [10].…”

“…Nerve conduits with PGA, such as Neurotube (Synovis Micro Companies Alliance, Birmingham, Alabama) are dense mesh tubes (2-4 cm long and 2-8 mm in diameter) of a porous structure, permeable to nutrients and neurotrophic factors, but preventing penetration into the fibroblast growth area. It has the only drawback associated with the risk of extrusion of polyglycol conduits before their complete resorption [10].…”

The role of anatomical and topographic features of angioarchitectonics and nerve gliding for its recovery

“…Для любого угла сгиба Q локтевого сустава длина срединного нерва равна сумме трех длин: S = A + B + C, где A -длина нерва вдоль плечевой кости (проксимальная точка отсчета -акромиально-ключичное сочленение, дистальная -наружный мыщелок плечевой кости); B -длина вдоль локтевой кости (дистальная точка -шиловидный отросток локтевой кости, проксимальная -внутренний мыщелок плечевой кости); C -длина вдоль окружности локтевого сустава (рисунок) [5]. Длины A и B в процессе сгибания и разгибания не меняются.…”

Current treatment of traumatic brachial plexus and peripheral nerve injuries

“…La transferencia nerviosa selectiva es una técnica utilizada para restaurar la función motora y sensorial en pacientes con lesiones nerviosas graves (31). La recuperación funcional exitosa depende tanto de la re-inervación periférica como del proceso de re-aprendizaje motor que implica plasticidad cortical (31,32,33).…”