Long-Term Follow-Up Study of Peripheral Nerve Repair by Non-Nerve Tissues

This paper reported a long-term follow-up of seven cases (eight nerves) with peripheral nerve repair by non-nerve tissues. The injured nerves involved three median, two radial, one ulnar and one tibial nerves. These patients were treated 3 to 10 months after injuries. In five cases, pedicled muscles grafts were used to repair nerve gaps from 3 to 6 cm. Follow-up between 4 years and 10 months and 6 years and 8 months showed functional recovery ranged from MOS1 to M2 + S3. Two cases of nerve gaps 3 and 4 cm in length repaired by empty muscle membrane tubes recovered to M3S4 and M4S4. Liu concluded that pedicled muscle graft is not an ideal substitute for nerve graft. They peculated that inner structures in the muscle graft prevented growth of regenerating axons, which made the graft not function as effectively as an empty tube. One should be cautious in using non-nerve tissues to repair peripheral nerve gaps.

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First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Neurosurgical FOCUS ◽

10.3171/2016.12.focus16474 ◽

2017 ◽

Vol 42 (3) ◽

pp. E2 ◽

Cited By ~ 11

Author(s):

Zachary C. Gersey ◽

S. Shelby Burks ◽

Kim D. Anderson ◽

Marine Dididze ◽

Aisha Khan ◽

...

Keyword(s):

Sciatic Nerve ◽

Peripheral Nerve ◽

Sural Nerve ◽

Gunshot Wound ◽

Nerve Repair ◽

Nerve Graft ◽

Sensory Function ◽

Long Term Follow Up

OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

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