What is new in peripheral nerve repair?

Abstract

In the last few years, several new techniques have been added in the repair of peripheral nerves. Some of them are convincing and are gaining popularity amongst peripheral nerve surgeons. Magnification has certainly improved the results of nerve repair. Although autografts are the gold standard for repair of peripheral nerves, allografts have been practiced as an alternative, by incorporation of new immunosuppressive agents such as FK- 506. In select patients with a paucity of autografts, allograft nerve transplantation may be of some utility. For small defects (< 3 cm), nerve conduits made of biological materials or autologous vein, have produced promising results. As an alternative to simple suture repair, fibrin glue is being used for nerve coaptation. Narakas found a 30% decrease in operation time with slightly superior functional outcome relative to traditional suture based coaptation. End - to - side neurorraphy may be helpful when the proximal nerve stump is not available.

Limitations of nerve repair of segmental defects using acellular conduits

“…4,31,35 Processed donor nerve allografts and artificial conduits in PNI repair can be used, but their application should be restricted to the bridging of small-diameter, short nerve defects. 5,14,15,26,34,35 In a 2011 letter, Mackinnon stated, "acellularized nerve allografts have largely replaced conduits in my practice, but I still restrict their use to noncritical, small-diameter sensory nerves with gaps less than 4 cm." 24 In the future, the use of autologous cultured Schwann cells may increase the potential for nerve repair using acellular nerve grafts/ conduits without the use of immunosuppression.…”

“…Surgical reconstruction of long, large-diameter peripheral nerve gaps (range 12-37 cm) with cadaveric nerve allografts and immunosuppression is a viable alternative when no other options exist. 5,14,15,26,34,35 Large-caliber nerves that have been successfully repaired include the sciatic, posterior tibial, median, ulnar, and radial nerves. The use of multiple, small-diameter nerve allografts improves revascularization of the construct.…”

Efektivitas Membran Amnion Liofilisasi (Handmade Tubular) sebagai Nerve Conduit pada Perbaikan Cedera Saraf Perifer Tikus dengan Gap 5 mm

“…2,7 Metode perbaikan saraf dengan menggunakan nerve graft mempunyai beberapa kekurangan, seperti waktu operasi yang panjang, peningkatan morbiditas pada saraf donor dengan terjadi nyeri akibat neuroma atau terbentuknya jaringan parut, serta akibat kekurangan panjang dan diameter saraf donor sehingga akan kurang optimal dalam penyambungan saraf. 2,3,[8][9][10][11] Hasil pemakaian nerve graft untuk perbaikan saraf bervariasi mulai sangat buruk hingga baik, namun beberapa penelitian mencatat hasil yang kurang memuaskan. 2 Dalam usaha mengatasi masalah tersebut, banyak penelitian memfokuskan pengembangan pengganti metode autograft saraf konvensional.…”

“…2,11 Salah satu usaha dengan menggunakan tubular nerve guidance channel atau nerve conduit baik berbahan alami atau sintetik atau disebut juga teknik entubulasi. [1][2][3][8][9][10] Saluran tersebut akan memiliki fungsi untuk memandu pertumbuhan akson dari ujung saraf yang beregenerasi, sebagai saluran untuk difusi dari faktor neurotropik yang disekresikan oleh ujung saraf yang terluka tadi dan juga membantu melindunginya terhadap infiltrasi dari jaringan fibrosa.…”

Novel Technique for Repair of Severed Peripheral Nerves in Rats Using Polyurea Crosslinked Silica Aerogel Scaffold

“…Complications associated with use of sutures include hemorrhaging, extended surgery time, and the need for a high level of surgeon skill and training [5,[10][11][12]. Therefore, sutureless nerve repair techniques [13][14][15][16][17][18] have also been investigated in recent years with mixed degrees of effectiveness.…”