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 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.

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.

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.

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 Human relevance of pre-clinical studies in stem cell therapy: systematic review and meta-analysis of large animal models of ischaemic heart disease

2011 ◽  
Vol 91 (4) ◽  
pp. 649-658 ◽  
Author(s):  
T. I. G. van der Spoel ◽  
S. J. Jansen of Lorkeers ◽  
P. Agostoni ◽  
E. van Belle ◽  
M. Gyongyosi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Stem Cell ◽  
Heart Disease ◽  
Animal Models ◽  
Cell Therapy ◽  
Stem Cell Therapy ◽  
Clinical Studies ◽  
Meta Analysis ◽  
Large Animal ◽  
Large Animal Models

scholarly journals Material advancement in tissue-engineered nerve conduit

2021 ◽  
Vol 10 (1) ◽  
pp. 488-503
Author(s):  
Wufei Dai ◽  
Yating Yang ◽  
Yumin Yang ◽  
Wei Liu
Keyword(s):  
Peripheral Nerve ◽  
Animal Studies ◽  
Nerve Repair ◽  
Donor Site ◽  
Life Quality ◽  
Nerve Grafts ◽  
Synthetic Materials ◽  
Nerve Conduits ◽  
Extracellular Matrix Components

Abstract Peripheral nerve injuries resulting from various traumatic events can cause mobility problems and sensory impairment, jeopardizing patients’ life quality and bringing serious economic burdens. Due to the shortcomings of autologous nerve grafts, such as limited tissue sources, unmatched size, and loss of innervation at the donor site, tissue-engineered nerve grafts using both natural and synthetic materials have been employed in the treatment of peripheral nerve defect and to promote nerve regeneration. Apart from traditional advantages such as good biocompatibility and controllable degradation, the development of fabrication technology and the advancement in material science have endowed tissue-engineered nerve conduits with upgraded properties such as biomimetic surface topography, extracellular matrix components, neurotrophic factors, and cell seeding, or a conduit with micropores on the surface for substance exchange and/or with fillers inside for microenvironment simulation. This article reviews recent progress in the biomaterials employed in fabricating tissue-engineered nerve conduits, in vitro characterization, and their applications in nerve repair in animal studies as well as in clinical trials.

scholarly journals Approaches to Peripheral Nerve Repair: Generations of Biomaterial Conduits Yielding to Replacing Autologous Nerve Grafts in Craniomaxillofacial Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-18 ◽  
Author(s):  
Robert Gaudin ◽  
Christian Knipfer ◽  
Anders Henningsen ◽  
Ralf Smeets ◽  
Max Heiland ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Nerve Repair ◽  
Treatment Options ◽  
Donor Site ◽  
Nerve Reconstruction ◽  
Craniomaxillofacial Surgery

Peripheral nerve injury is a common clinical entity, which may arise due to traumatic, tumorous, or even iatrogenic injury in craniomaxillofacial surgery. Despite advances in biomaterials and techniques over the past several decades, reconstruction of nerve gaps remains a challenge. Autografts are the gold standard for nerve reconstruction. Using autografts, there is donor site morbidity, subsequent sensory deficit, and potential for neuroma development and infection. Moreover, the need for a second surgical site and limited availability of donor nerves remain a challenge. Thus, increasing efforts have been directed to develop artificial nerve guidance conduits (ANCs) as new methods to replace autografts in the future. Various synthetic conduit materials have been testedin vitroandin vivo,and several first- and second-generation conduits are FDA approved and available for purchase, while third-generation conduits still remain in experimental stages. This paper reviews the current treatment options, summarizes the published literature, and assesses future prospects for the repair of peripheral nerve injury in craniomaxillofacial surgery with a particular focus on facial nerve regeneration.

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