scholarly journals A systematic review and meta-analysis of studies comparing muscle-in-vein conduits with autologous nerve grafts for nerve reconstruction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Johannes C. Heinzel ◽  
Mai Quyen Nguyen ◽  
Laura Kefalianakis ◽  
Cosima Prahm ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Nerve Repair ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
The Body ◽  
Large Animal ◽  
Nerve Reconstruction ◽  
Gold Standard Method ◽  
Nerve Grafts ◽  
Segmental Nerve

AbstractThe gold-standard method for reconstruction of segmental nerve defects, the autologous nerve graft, has several drawbacks in terms of tissue availability and donor site morbidity. Therefore, feasible alternatives to autologous nerve grafts are sought. Muscle-in-vein conduits have been proposed as an alternative to autologous nerve grafts almost three decades ago, given the abundance of both tissues throughout the body. Based on the anti-inflammatory effects of veins and the proregenerative environment established by muscle tissue, this approach has been studied in various preclinical and some clinical trials. There is still no comprehensive systematic summary to conclude efficacy and feasibility of muscle-in-vein conduits for reconstruction of segmental nerve defects. Given this lack of a conclusive summary, we performed a meta-analysis to evaluate the potential of muscle-in-vein conduits. This work’s main findings are profound discrepancies regarding the results following nerve repair by means of muscle-in-vein conduits in a preclinical or clinical setting. We identified differences in study methodology, inter-species neurobiology and the limited number of clinical studies to be the main reasons for the still inconclusive results. In conclusion, we advise for large animal studies to elucidate the feasibility of muscle-in-vein conduits for repair of segmental defects of critical size in mixed nerves.

Nerve reconstruction with muscle-in-vein conduits VS autologous nerve grafts - a systematic review and meta-analysis of preclinical and clinical studies

2021 ◽  
Author(s):  
Johannes C. Heinzel ◽  
Mai Q. Nguyen ◽  
Laura Kefalianakis ◽  
Cosima Prahm ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Clinical Studies ◽  
Meta Analysis ◽  
Nerve Repair ◽  
Donor Site ◽  
The Body ◽  
Large Animal ◽  
Nerve Reconstruction ◽  
Gold Standard Method ◽  
Nerve Grafts ◽  
Segmental Nerve

Abstract The gold-standard method for reconstruction of segmental nerve defects, the autologous nerve graft, has several drawbacks in terms of tissue availability and donor site morbidity. Therefore, feasible alternatives to autologous nerve grafts are sought. Muscle-in-vein conduits have been proposed as an alternative to autologous nerve grafts almost three decades ago, given the abundance of both tissues throughout the body. Based on the anti-inflammatory effects of veins and the proregenerative environment established by muscle tissue, this approach has been studied in various preclinical and some clinical trials. There is still no comprehensive systematic summary to conclude efficacy and feasibility of muscle-in-vein conduits for reconstruction of segmental nerve defects. Given this lack of a conclusive summary, we performed a meta-analysis to evaluate the potential of muscle-in-vein conduits. This work’s main findings are profound discrepancies regarding the results following nerve repair by means of muscle-in-vein conduits in a preclinical or clinical setting. We identified differences in study methodology, inter-species neurobiology and the limited number of clinical studies to be the main reasons for the still inconclusive results. In conclusion, we advise for large animal studies to elucidate the feasibility of muscle-in-vein conduits for repair of segmental defects of critical size in mixed nerves.

scholarly journals Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Felix J. Paprottka ◽  
Petra Wolf ◽  
Yves Harder ◽  
Yasmin Kern ◽  
Philipp M. Paprottka ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Nerve Repair ◽  
Donor Site ◽  
Surgical Techniques ◽  
Graft Material ◽  
Digital Nerve ◽  
Nerve Reconstruction ◽  
Level Of Evidence ◽  
Sensory Recovery ◽  
End To End

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair.

A Comparison of Immediate and Delayed Nerve Repair Using Autologous Freeze-Thawed Muscle Grafts in a Large Animal Model

1995 ◽  
Vol 20 (5) ◽  
pp. 663-700 ◽  
Author(s):  
G. M. LAWSON ◽  
M. A. GLASBY
Keyword(s):  
Animal Model ◽  
Nerve Repair ◽  
Large Animal Model ◽  
Large Animal ◽  
Nerve Reconstruction ◽  
Nerve Blood Flow ◽  
Nerve Grafts ◽  
Group A ◽  
Group B ◽  
The Right

Freeze-thawed muscle grafts (FTMG) have been suggested as an alternative to nerve grafts in reconstruction of peripheral nerve defects. This study compares the results of immediate and delayed nerve repair with freeze-thawed muscle graft in a large animal model. Under general anaesthesia, ten adult sheep underwent excision of 3 cm of the right median nerve. Five had immediate nerve reconstruction with FTMGs (Group A) and five were repaired after 4 weeks (Group B). At 6 months, both the right (repaired) and left (“control”) median nerves of each sheep were assessed. Nerve blood flow distal to the graft in both groups of repaired nerves was approximately 60% of that in their respective control nerves. Peak nerve conduction velocities were significantly slower in the repaired nerves. The mean fibre diameters of the immediate and delayed repairs were 5.06 and 3.90 μ respectively compared to a control mean of 8.58 μ. G-ratios confirmed that the repaired nerves in both groups were well myelinated. The authors conclude that the FTMG can be used in delayed as well as immediate nerve reconstruction with minimal impairment of final results.

Segmental Defects in Peripheral Nerves Xenotransplantation

2018 ◽  
Vol 2 (5) ◽  
pp. 01-02
Author(s):  
Ryan William
Keyword(s):  
Graft Rejection ◽  
Peripheral Nerves ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Clinical Use ◽  
Nerve Grafts ◽  
Surgery Research ◽  
The Ideal

Segmental defects in peripheral nerves that cannot be sutured directly require the use of nerve grafts. The ideal option for repair is nerve auto grafting, but there are some obvious disadvantages related to its use, such as lack of availability and donor site morbidity. The next step to consider for reconstruction is the use of nerve allografts, but they are also limited for clinical use, and they present with the added problem of graft rejection. Considering these limitations to the use of nerve autografts and allografts, clinical surgery research has turned to nerve xenotransplantation, which offers a potentially unlimited source of donor nerves.

Free Flaps in the Reconstruction of Hand and Distal Forearm Injuries

1992 ◽  
Vol 17 (2) ◽  
pp. 185-188 ◽  
Author(s):  
A. REIGSTAD ◽  
K. R. HETLAND ◽  
K. BYE ◽  
M. RØKKUM
Keyword(s):  
Donor Site ◽  
Hand Surgery ◽  
Free Flaps ◽  
Donor Site Morbidity ◽  
Medium Size ◽  
Nerve Grafts ◽  
Partial Necrosis ◽  
Tendon Grafts ◽  
Large Skin ◽  
Forearm Injuries

We report a series of 32 free flap reconstructions following acute hand and forearm trauma. The series consists of two dorsalis pedis flaps, four scapular flaps and 26 lateral arm flaps. One flap became infected and failed completely, and a partial necrosis occurred in another flap. The transfers covered large skin defects, exposed tendons, tendon grafts, bone, bone grafts, joints, nerves and nerve grafts. The donor site morbidity was negligible. Our study shows that free microvascular flaps are a safe and convenient alternative to conventional flaps in hand surgery. The lateral arm flap seems very suitable for small and medium size defects.

Nerve grafts and transfers

2021 ◽  
pp. 275-282
Author(s):  
Robert Bains ◽  
Simon Kay
Keyword(s):  
Recovery Of Function ◽  
Primary Repair ◽  
Nerve Repair ◽  
Nerve Grafting ◽  
Nerve Reconstruction ◽  
Nerve Grafts ◽  
Axonal Regrowth ◽  
Bone Shortening ◽  
Eighteenth And Nineteenth Centuries ◽  
Nerve Autograft

Following Cruickshank’s (1795) ingenious (and at first disbelieved) demonstration of the regenerative capacity of mammalian nerves, the eighteenth and nineteenth centuries saw a pan-European enthusiasm to redress the nihilism surrounding nerve injury. The first recorded experimental nerve grafts were performed by Philipeaux and Vulpian who attempted both nerve autografting as well as allografting in dogs. At that time, and for many years, allografts were thought to behave similarly to autografts, a belief that persisted well into the twentieth century in some clinics and laboratories. These early attempts at nerve grafting yielded poor results and most surgeons aimed for primary nerve repair despite nerve gaps. Other techniques to allow direct repair involved alteration of position, transposition of the nerve, and even sometimes bone shortening. Although primary repair was frequently possible, after these measures the repair was under tension and mechanical failure was common. Spurling (1945), Whitcomb (1946), and Woodall (1956) showed failure rates of 4%, 7.5%, and 22.4% respectively. Some recovery of function following nerve grafting was documented by Sanders (1942), Seddon (1954), and Brooks (1955). Millesi subsequently published his results for nerve grafting for injuries to the upper limb in 1984. These papers demonstrated more significant recovery of function and highlighted the detriment of delay in treatment to final outcome. Microsurgical advances were central to Millesi’s results, and he emphasized atraumatic dissection and the deleterious effect of tension at the repair site resulting in fibrosis preventing axonal regrowth. Nerve autograft is now the standard for orthotopic nerve reconstruction when primary repair cannot be achieved.

Alternative flaps for microsurgical breast reconstruction

2021 ◽  
pp. 1107-1114
Author(s):  
Hinne A. Rakhorst
Keyword(s):  
Breast Reconstruction ◽  
Standard Care ◽  
Donor Site ◽  
Perforator Flap ◽  
Donor Site Morbidity ◽  
The Body ◽  
Diep Flap ◽  
Deep Inferior Epigastric Perforator ◽  
Muscle Sparing ◽  
Breast Reconstructive Surgery

Microsurgery in general has made dramatic improvements over the past decades. This applies to microsurgery in general and to breast reconstructive surgery especially. The demand for autologous breast reconstruction has risen. Since the introduction of the free transverse rectus abdominis myocutaneous (TRAM) flaps, through the muscle-sparing TRAM, flaps designs have evolved into the current gold standard, the deep inferior epigastric perforator (DIEP) flap. From experiences and increasing numbers of flap procedures performed by surgeons, techniques became more familiar and part of standard care. These factors gave rise to the development of a growing number of areas of the body where tissues of interest can be harvested using perforator flap-based techniques. This chapter discusses the most common as well as the ‘rising stars’ in terms of flaps to be used as alternative flaps to the DIEP flap for breast reconstruction. It discusses practical issues on dissection as well as donor site morbidity.

scholarly journals Peripheral Nerve Reconstruction after Injury: A Review of Clinical and Experimental Therapies

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
D. Grinsell ◽  
C. P. Keating
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
Surgical Techniques ◽  
The Body ◽  
Sensory Function ◽  
Nerve Reconstruction ◽  
Nerve Transfers ◽  
Experimental Therapies ◽  
Surgical Options

Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.

scholarly journals Biomedical Application of Dental Tissue-Derived Induced Pluripotent Stem Cells

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Jung-Hwan Lee ◽  
Seog-Jin Seo
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
Induced Pluripotent Stem Cells ◽  
Pluripotent Stem Cells ◽  
Biomedical Application ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
The Body ◽  
Dental Tissue ◽  
Induced Pluripotent

The academic researches and clinical applications in recent years found interest in induced pluripotent stem cells (iPSCs-) based regenerative medicine due to their pluripotency able to differentiate into any cell types in the body without using embryo. However, it is limited in generating iPSCs from adult somatic cells and use of these cells due to the low stem cell potency and donor site morbidity. In biomedical applications, particularly, dental tissue-derived iPSCs have been getting attention as a type of alternative sources for regenerating damaged tissues due to high potential of stem cell characteristics, easy accessibility and attainment, and their ectomesenchymal origin, which allow them to have potential for nerve, vessel, and dental tissue regeneration. This paper will cover the overview of dental tissue-derived iPSCs and their application with their advantages and drawbacks.

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