Ultrasound-Guided Needle Localization Wires in Peripheral Nerve Injuries With Long Segmental Defects: Technical Case Report

2020 ◽  
Vol 20 (1) ◽  
pp. E60-E65
Author(s):  
Anthony Diaz ◽  
S Shelby Burks ◽  
Jean Jose ◽  
Allan D Levi
Keyword(s):  
Case Report ◽  
Peripheral Nerve ◽  
Nerve Repair ◽  
Femoral Nerve ◽  
Severe Injury ◽  
Distal Stump ◽  
Segmental Defect ◽  
Wire Localization ◽  
Musculoskeletal Radiology ◽  
Needle Localization

Abstract BACKGROUND AND IMPORTANCE In cases of severe nerve trauma with significant local soft tissue damage, identification and subsequent repair of nerve stumps can pose a technical challenge. Ultrasound (US) localization in peripheral nerve surgery has recently become popular. We present a case report illustrating the use of needle-wire localization systems to identify proximal and several distal branches of an injured femoral nerve with a large segmental defect in order to illustrate how such techniques can be used to make surgical repair more efficient, particularly with identifying the distal stump(s). CLINICAL PRESENTATION We illustrate a case of a 16-yr-old female involved in a traumatic accident that lead to a severe injury of the femoral nerve and artery. The patient presented with a 7.3-cm defect between the proximal and distal aspect of the femoral nerve and its branches, respectively. High-resolution US was used to identify the proximal, large femoral nerve, and 3 distal stumps. By enlisting our musculoskeletal radiology team, we were able to trace distal branches of the femoral nerve and see their target muscles. Three separate US flexible needles were used to locate small muscular branches of the femoral nerve and 1 to locate the proximal stump. Intraoperatively, the localization wires allowed for safe and efficient dissection of proximal and distal nerve stumps in a significantly scarred and edematous plane. CONCLUSION US-guided needle-wire localization has shown promise in identifying the distal stumps and minimizing tissue dissection. Preoperative US guidance significantly aided in nerve repair for this severe injury without increasing morbidity.

scholarly journals Machine intelligence for nerve conduit design and production

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Caleb E. Stewart ◽  
Chin Fung Kelvin Kan ◽  
Brody R. Stewart ◽  
Henry W. Sanicola ◽  
Jangwook P. Jung ◽  
...  
Keyword(s):  
Tissue Engineering ◽  
Peripheral Nerve ◽  
Nerve Repair ◽  
Peripheral Nerve Regeneration ◽  
Scar Tissue ◽  
Machine Intelligence ◽  
Rapid Expansion ◽  
Patient Specific ◽  
Distal Stump ◽  
Promising Alternative

Abstract Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence can innovate bottlenecks in neural tissue engineering.

Obturator Nerve Transfer as an Option for Femoral Nerve Repair

2010 ◽  
Vol 66 (suppl_2) ◽  
pp. onsE375-onsE375 ◽  
Author(s):  
Ashley A. Campbell ◽  
Frederic E. Eckhauser ◽  
Allan Belzberg ◽  
James N. Campbell
Keyword(s):  
Nerve Repair ◽  
Femoral Nerve ◽  
Nerve Transfer ◽  
Obturator Nerve ◽  
Nerve Lesion ◽  
Distal Stump ◽  
Post Injury ◽  
Nerve Transfers ◽  
Important Addition ◽  
Quadriceps Function

Abstract OBJECTIVE Nerve transfers have proved to be an important addition to the armamentarium in the repair of brachial plexus lesions, but have been used sparingly for lower extremity nerve repair. Here, we present what is believed to be the first description of a successful transfer of the obturator nerve to the femoral nerve. CLINICAL PRESENTATION A 45-year-old woman presented with a complete femoral nerve lesion after removal of a large (15-cm) schwannoma of the retroperitoneum involving the lumbar plexus. INTERVENTION The obturator nerve was transferred to the distal stump of the femoral nerve in the retroperitoneal space at the inguinal ligament three months post-injury. At 2 years post-repair, the patient demonstrated 4 out of 5 return (Medical Research Council grade) of quadriceps function and was able to walk nearly normally. CONCLUSION In cases in which there are extensive gaps in the femoral nerve, transfer of the obturator nerve provides an option to traditional nerve graft repair.

Techniques of Peripheral Nerve Repair

1991 ◽  
Vol 2 (1) ◽  
pp. 93-104 ◽  
Author(s):  
Mark E. Harris ◽  
Suzie C. Tindall
Keyword(s):  
Peripheral Nerve ◽  
Nerve Repair ◽  
Peripheral Nerve Repair

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.

The effects of sensory re-education on hand function recovery after peripheral nerve repair: A systematic review

2021 ◽  
pp. 1-12
Author(s):  
Weili Xia ◽  
Zhongfei Bai ◽  
Rongxia Dai ◽  
Jiaqi Zhang ◽  
Jiani Lu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Nerve ◽  
Nerve Repair ◽  
Hand Function ◽  
Current Evidence ◽  
Motor Deficits ◽  
Peripheral Nerve Repair ◽  
Hand Functions ◽  
Function Recovery ◽  
Short And Long Term

BACKGROUND: Peripheral nerve injury can result in both sensory and motor deficits, and these impairments can last for a long period after nerve repair. OBJECTIVE: To systematically review the effects of sensory re-education (SR) on facilitating hand function recovery after peripheral nerve repair. METHODS: This systematic review was limited to articles published from 1970 to 20 December 2020. Electronic searching was performed in CINAHL, Embase, PubMed, Web of Science, and Medline databases to include trials investigating the effects of SR training on hand function recovery after peripheral nerve repair and included only those studies with controlled comparisons. RESULTS: Sixteen articles were included in final data synthesis. We found that only four studies could be rated as having good quality and noted obvious methodological limitations in the remaining studies. The current evidence showed that early SR with mirror visual feedback and the combinational use of classic SR and topical temporary anesthetic seemed to have long- and short-term effects, respectively on improving the sensibility and reducing the disabilities of the hand. The evidence to support the effects of conventional classical SR on improving hand functions was not strong. CONCLUSIONS: Further well-designed trials are needed to evaluate the effects of different SR techniques on hand function after nerve repair over short- and long-term periods.

Sign in / Sign up

Export Citation Format

Share Document