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.

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.

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.

EXPERIMENTAL NERVE GRAFTING — TOWARDS FUTURE SOLUTIONS OF A CLINICAL PROBLEM

Hand Surgery ◽  
1998 ◽  
Vol 03 (02) ◽  
pp. 165-173 ◽  
Author(s):  
Lars B Dahlin ◽  
Göran Lundborg
Keyword(s):  
Present Article ◽  
Nerve Repair ◽  
Clinical Problem ◽  
Graft Material ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Close Collaboration ◽  
Autologous Graft ◽  
Nerve Grafts

Restoration of function following complete nerve injuries with subsequent nerve repair is still not satisfactory and in many cases poor, especially when a gap has to be bridged by a graft. In such situations, there may be insufficient access to autologous graft material. Alternatives have to be developed and a close collaboration between basic scientists and clinicians is required. In the present article, current studies on experimental nerve grafts are discussed and some new alternatives to autologous nerve grafts are reviewed.

Exosomes as a promising therapeutic strategy for peripheral nerve injury

2021 ◽  
Vol 19 ◽  
Author(s):  
Tianhao Yu ◽  
Yingxi Xu ◽  
Muhammad Arslan Ahmad ◽  
Rabia Javed ◽  
Haruo Hagiwara ◽  
...  
Keyword(s):  
Schwann Cell ◽  
Peripheral Nerve ◽  
Nerve Regeneration ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Peripheral Nerve Repair ◽  
Nerve Grafts ◽  
Axonal Regrowth ◽  
Vascular Regeneration

Peripheral nerve injury has a high incidence and often leads to severe losses of sensory and motor functions in the afflicted limb. Autologous nerve grafts are widely accepted as the gold standard for peripheral nerve repair, but the presence of inherent drawbacks dramatically reduces their usability. Numerous tissue engineering nerve grafts are developed as alternatives of autologous nerve grafts, and a variety of cells and neurotrophic factors were introduced into these grafts for improvement. However, they are still difficult to obtain satisfactory clinical results. Peripheral nerve regeneration following injury remains a significant challenge for researchers and clinicians. Exosomes are extracellular membranous nanovesicles that are secreted by most cells. As the key players of intercellular communication, exosomes play a fundamental role in the physiological and pathological processes of the nervous system. Accumulating evidence has suggested that exosomes can exert neurotherapeutic effects via mediating axonal regrowth, Schwann cell activation, vascular regeneration, and inflammatory regulation. Exosomes are emerging as a promising approach for treating peripheral nerve injury. Furthermore, they also provide possibilities for enhancing the repair capacity of various nerve grafts. This review primarily highlights the regenerative effects of exosomes on peripheral nerve injury. The exosomes from distinct sources reported so far in literature are summarized to understand their roles in the process of nerve repair. Moreover, the challenges that must be addressed in their clinical transformation are outlined as well. This review also provides further insight into the potential application of exosomes for peripheral nerve repair. Keywords: Exosome, nerve regeneration, peripheral nerve injury, Schwann cell, axonal regrowth, inflammation, vascular regeneration.

A Comparative Study of Nerve Reconstruction Techniques in Phrenic Nerve Tranfer for Treatment of Brachial Plexus Root Avulsion Injuries

Hand Surgery ◽  
1997 ◽  
Vol 02 (01) ◽  
pp. 25-33 ◽  
Author(s):  
Yu-Dong Gu ◽  
Jian-Jun Ma
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Recovery Of Function ◽  
Nerve Transfer ◽  
Nerve Grafting ◽  
Root Avulsion ◽  
Sprague Dawley ◽  
Nerve Reconstruction ◽  
Sprague Dawley Rats ◽  
Nerve Implantation

This experimental study investigated the effectiveness of three methods of neurorrhaphy, nerve grafting and nerve implantation in phrenic nerve transfer for treatment of brachial plexus root avulsion injuries. 180 Sprague-Dawley rats were used. The electrophysiological, histological and muscle functional evaluations were performed at 1, 2, 3, 4, 5 and 6-month postoperatively. Variable recovery in each group was found at different postoperative intervals. At six months after operation, the following results were observed in descending order of superiority: neurorrhaphy, nerve grafting, nerve implantation. Nerve implantation demonstrated a recovery of function of 75.76% and the characteristic electrical activity of the phrenic nerve might contribute to the motor endplate regeneration. Our experimental results will serve as the basis for our clinical practice.

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.

Prolonging Nerve Grafts Using Chemical Extracted Muscle-in-vein with Vein Window Method Chemical acellular nerve grafts

2018 ◽  
Vol 68 (12) ◽  
pp. 2936-2940
Author(s):  
Irina Mihaela Jemnoschi Hreniuc ◽  
Camelia Tamas ◽  
Sorin Aurelian Pasca ◽  
Bogdan Ciuntu ◽  
Roxana Ciuntu ◽  
...  
Keyword(s):  
Classical Group ◽  
Donor Site ◽  
Good Alternative ◽  
Nerve Graft ◽  
Male Rats ◽  
Chemical Extraction ◽  
Nerve Grafting ◽  
Nerve Grafts ◽  
Local Resources ◽  
Window Method

Nerve injuries are a common pathology in hand trauma. The consequences are drastic both for patients and doctors/medical system. In many cases direct coaptation is impossible. A nerve graft should be used in the case of a neuroma, trauma or tumor, for restoration of nervous influx. The aim of this study is demonstrate that by grafting restant nerve stumps with muscle-in-vein nerve grafts we obtain good result in terms of functional and sensibility recovery and also our method �window-vein� is a good way of prolonging nerve grafts. The method of study is experimental. We worked in the laboratory in optimal conditions for carrying out of muscles-in-vein nerve grafts (nerve grafts size 1.5 cm-3 cm). We used acellular muscle grafts with the chemical extraction method.The study was conducted on experimental animals (Wistar male rats).We used 30 experience animals in 3 equal groups (classical group and muscle-in-vein nerve grafts-2 nerve grafts of 1,5 cm central sutured and the third group with muscle-in-vein nerve grafts, window-vein method, 3 cm). At 4 and respectively 6 weeks postoperative at the quality tests we observed the progress with the footprint test. The operated hind in comparison with the healthy hind was 86% recovered and similar with classic nerve grafts. Quantitatively the number of regenerated axons in the group with muscle-in-vein nerve grafts was significant bigger in comparison with the classical group (15%).The method using muscle-in-vein nerve graft with windows-vein it�s a good alternative for nerve grafting in comparison with classical nerve grafting. When the local possibilities are limited, this method is good for prolonging the grafts. The relationship between cost and benefit in this case it�s an advantage because we use the local resources of the affected area. The motor results of nerve grafting ingroup 2 in comparison with group 3 were similar and in some cases better in group 1. Grafting with MVNG offers a better alternative for donor site regeneration in comparison with classical nerve grafts. This method is useful to prolong nerve grafts without adding morbidity.

scholarly journals Schwann cell plasticity regulates neuroblastic tumor cell differentiation via epidermal growth factor-like protein 8

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Tamara Weiss ◽  
Sabine Taschner-Mandl ◽  
Lukas Janker ◽  
Andrea Bileck ◽  
Fikret Rifatbegovic ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Primary Repair ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
Neuroblastoma Cells ◽  
Tumor Development ◽  
Matricellular Protein ◽  
Neuroblastic Tumor ◽  
Plastic Potential ◽  
Neuroblastic Tumors

AbstractAdult Schwann cells (SCs) possess an inherent plastic potential. This plasticity allows SCs to acquire repair-specific functions essential for peripheral nerve regeneration. Here, we investigate whether stromal SCs in benign-behaving peripheral neuroblastic tumors adopt a similar cellular state. We profile ganglioneuromas and neuroblastomas, rich and poor in SC stroma, respectively, and peripheral nerves after injury, rich in repair SCs. Indeed, stromal SCs in ganglioneuromas and repair SCs share the expression of nerve repair-associated genes. Neuroblastoma cells, derived from aggressive tumors, respond to primary repair-related SCs and their secretome with increased neuronal differentiation and reduced proliferation. Within the pool of secreted stromal and repair SC factors, we identify EGFL8, a matricellular protein with so far undescribed function, to act as neuritogen and to rewire cellular signaling by activating kinases involved in neurogenesis. In summary, we report that human SCs undergo a similar adaptive response in two patho-physiologically distinct situations, peripheral nerve injury and tumor development.

Outcome of axillary nerve injuries treated with nerve grafts

2011 ◽  
Vol 36 (7) ◽  
pp. 535-540 ◽  
Author(s):  
M. Okazaki ◽  
A. Al-Shawi ◽  
C. R. Gschwind ◽  
D. J. Warwick ◽  
M. A. Tonkin
Keyword(s):  
Reliable Method ◽  
Axillary Nerve ◽  
Nerve Grafting ◽  
Nerve Injuries ◽  
Nerve Grafts ◽  
The Mean

This study evaluates the outcome of axillary nerve injuries treated with nerve grafting. Thirty-six patients were retrospectively reviewed after a mean of 53 months (minimum 12 months). The mean interval from injury to surgery was 6.5 months. Recovery of deltoid function was assessed by the power of both abduction and retropulsion, the deltoid bulk and extension lag. The deltoid bulk was almost symmetrical in nine of 34 cases, good in 22 and wasted in three. Grade M4 or M5* was achieved in 30 of 35 for abduction and in 32 of 35 for retropulsion. There was an extension lag in four patients. Deltoid bulk continued to improve with a longer follow-up following surgery. Nerve grafting to the axillary nerve is a reliable method of regaining deltoid function when the lesion is distal to its origin from the posterior cord.

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