Neural regeneration along longitudinal polyglactin sutures across short and extended defects in the rat sciatic nerve

2001 ◽  
Vol 95 (2) ◽  
pp. 316-323 ◽  
Author(s):  
Peter Scherman ◽  
Göran Lundborg ◽  
Martin Kanje ◽  
Lars B. Dahlin
Keyword(s):  
Sciatic Nerve ◽  
Neural Regeneration ◽  
Extended Defects ◽  
Force Measurements ◽  
Neurofilament Protein ◽  
Content Type ◽  
Nerve Grafts ◽  
Rat Sciatic Nerve ◽  
Nerve Segment ◽  
Fine Print

Object. The authors have previously shown that longitudinal sutures without artificial tube support regeneration across a 7-mm gap in the rat sciatic nerve. In the present study, the authors compared this new approach with the use of autologous nerve grafts across short defects and examined whether the approach could be used to support regeneration across extended gaps and whether the interposition of a short nerve segment (the stepping-stone procedure) was applicable in this model. Methods. Longitudinal sutures were used to bridge 7- and 15-mm gaps in the rat sciatic nerve. Contralateral comparisons were made to nerve autografts in the 7-mm group and to sutures plus a short interposed nerve segment in the 15-mm group. Regeneration was evaluated at 2, 4, and 12 weeks by using immunocytochemical analysis for Schwann cells, neurofilament protein, and macrophages and at 12 weeks also by using histological examination, including morphometry in the distal tibial trunk and tetanic force measurements in the gastrocnemius muscle. Conclusions. The authors found that the results of regeneration after repair with longitudinal polyglactin sutures across short defects were not significantly different from those produced by the use of autologous nerve grafts. Regeneration, although poor, occurred along sutures across extended gaps and was significantly enhanced by an interposed nerve segment acting as a Schwann cell resource in this model.

The mechanism of spinal cord cavitation following spinal cord transection

1977 ◽  
Vol 46 (6) ◽  
pp. 757-766 ◽  
Author(s):  
Chun C. Kao ◽  
Louis W. Chang ◽  
James M. B. Bloodworth
Keyword(s):  
Spinal Cord ◽  
Sciatic Nerve ◽  
Spinal Cord Transection ◽  
Spinal Cord Tissue ◽  
Content Type ◽  
Nerve Grafts ◽  
Fine Print

✓ Cavitation adjacent to transection of spinal cords can be successfully eliminated by a second operation 1 week after the initial spinal cord transection. The second operation consists of removal of the necrotic spinal cord tissue, thus producing a gap. Segments of autogenous sciatic nerve are inserted into the gap between the spinal cord stumps. If the spinal cord is injured by retransection at the second operation, cavitation again occurs in the spinal cord stumps resulting in separation of the nerve grafts from the spinal cord. The results of the present experiments support the concept that lysosomal spinal cord autotomy, which causes spinal cord cavitation, is a self-limiting process and that once the spinal cord has completed the autotomy, the process will not occur again unless the spinal cord is again traumatized.

Regeneration of rat sciatic nerve across a LactoSorb bioresorbable conduit with interposed short-segment nerve grafts

2003 ◽  
Vol 99 (3) ◽  
pp. 549-554 ◽  
Author(s):  
Paul C. Francel ◽  
Kevin S. Smith ◽  
F. Alan Stevens ◽  
Soon C. Kim ◽  
James Gossett ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Regeneration ◽  
Peripheral Nerve Regeneration ◽  
Sprague Dawley ◽  
Silicone Tube ◽  
Group V ◽  
Content Type ◽  
Nerve Segment ◽  
Group I ◽  
Fine Print

Object. This study was conducted to evaluate peripheral nerve regeneration through a conduit composed of a bioresorbable material (LactoSorb). Methods. Sprague—Dawley rats weighing approximately 250 g were randomized into five groups. A 20-mm-long sciatic nerve gap was created, then it was bridged by a reverse nerve autograft (Group I), an empty silicone tube (Group II), a silicone tube containing a short (2-mm) interposed nerve segment (Group III), an empty LactoSorb conduit (Group IV), or a LactoSorb conduit containing a 2-mm interposed nerve segment (Group V). The intact sciatic nerve served as the control in each animal. At 16 weeks postoperatively, no nerve regeneration was observed through either the empty silicone tube or the empty LactoSorb conduit. There was regeneration in all animals receiving the reverse autograft as well as in all animals receiving the silicone or LactoSorb conduit containing the 2-mm interposed nerve segment. Effective regeneration was assessed based on histological, electrophysiological, and morphometric criteria. Conclusions. The results indicate that a conduit made of resorbable material will support sciatic nerve regeneration over a critical gap defect.

A New Type of “Bioartificial” Nerve Graft for Bridging Extended Defects in Nerves

1997 ◽  
Vol 22 (3) ◽  
pp. 299-303 ◽  
Author(s):  
G. LUNDBORG ◽  
L. DAHLIN ◽  
D. DOHI ◽  
M. KANJE ◽  
N. TERADA
Keyword(s):  
Sciatic Nerve ◽  
Nerve Graft ◽  
Reflex Response ◽  
Positive Staining ◽  
Extended Defects ◽  
Rat Sciatic Nerve ◽  
Nerve Segment ◽  
New Type ◽  
Distal Nerve ◽  
Tissue Matrix

In the rat sciatic nerve, a gap of around 10 mm in nerve continuity seems to be the maximal distance which can be successfully repaired by silicone tubes. In this study we tested if a new artificial nerve graft, composed of eight polyamide filaments (diameter 250 μm) placed inside silicone tubes (1.8 mm inner diameter), could be used to bridge an extended gap (15 mm) in rat sciatic nerve. Silicone tubes containing eight polyamide sutures were found to support regeneration across such a gap. After 4 weeks sensory fibres had bridged the gap and grown into the distal nerve segment as revealed by a positive pinch reflex test as well as positive staining for neurofilaments in the distal nerve segment. Myelinated axons could be observed in the tissue matrix formed in between and peripheral to the synthetic filaments along the whole length of the tube. In contrast, when silicone tubes without filaments were used to bridge the 15 mm gap, the tubes contained only fluid or in two cases a thin tissue strand. No positive pinch reflex response was elicited in the nerve segment distal to such a tube. We conclude that the new artificial nerve graft can be used to support regeneration across extended gaps in nerves.

Management and results of sciatic nerve injuries: a 24-year experience

1998 ◽  
Vol 89 (1) ◽  
pp. 13-23 ◽  
Author(s):  
David G. Kline ◽  
Daniel Kim ◽  
Rajiv Midha ◽  
Carter Harsh ◽  
Robert Tiel
Keyword(s):  
Sciatic Nerve ◽  
Spontaneous Recovery ◽  
Nerve Injuries ◽  
Management Guidelines ◽  
Content Type ◽  
Surgical Exploration ◽  
Excellent Outcome ◽  
Retrospective Clinical Study ◽  
Late Referral ◽  
Fine Print

Object. The purpose of this retrospective clinical study was to present results and provide management guidelines for various types of sciatic injuries. Methods. Over a 24-year period, 380 patients with sciatic nerve injuries were managed. In 230 patients (60%), the injury was at the buttock level, with injection injuries comprising more than half of these cases. Thigh-level sciatic injury was evaluated in 150 cases (40%) and was usually secondary to one of four main causes: 1) gunshot wound; 2) femur fracture; 3) laceration; or 4) contusion. Patients with partial deficits uncomplicated by severe pain or with significant spontaneous recovery or late referral were managed medically. Surgical exploration was not indicated in 23% of injuries at the thigh level and almost 50% of those at the buttock level. Most of these patients achieved partial but good spontaneous recovery, especially in the tibial division distribution. Surgical intervention was required for more complete and persistent deficits in either the tibial or peroneal distribution. Divisions of the sciatic nerve were split apart and evaluated independently. Management was guided by nerve action potential (NAP) recordings, which indicated whether neurolysis or resection of the lesion was required. Repair was then made by using sutures or more frequently by graft placement. In most cases in which neurolysis was performed because a positive NAP was recorded distal to the lesion, useful function was found in the peroneal distribution. Unfortunately, significant recovery occurred in only 36% of patients who received suture or graft repairs of the peroneal division. Good-to-excellent outcome was common for the tibial division, even in cases in which repair was proximal and required lengthy grafts. The relatively favorable recovery of tibial as opposed to peroneal divisions of the sciatic nerve occurred regardless of the level or mechanism of injury. Conclusions. Surgical exploration and, when necessary, repair of sciatic nerve injuries is worthwhile in selected cases.

Peripheral nerve grafts promoting central nervous system regeneration after spinal cord injury in the primate

2002 ◽  
Vol 96 (2) ◽  
pp. 197-205 ◽  
Author(s):  
Allan D. O. Levi ◽  
Hector Dancausse ◽  
Xiuming Li ◽  
Suzanne Duncan ◽  
Laura Horkey ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Spinal Cord Injury ◽  
Nervous System ◽  
Peripheral Nerve ◽  
Content Type ◽  
Nerve Grafts ◽  
Cord Injury ◽  
Peripheral Nerve Grafts ◽  
Fine Print

Object. Partial restoration of hindlimb function in adult rats following spinal cord injury (SCI) has been demonstrated using a variety of transplantation techniques. The purpose of the present study was twofold: 1) to determine whether strategies designed to promote regeneration in the rat can yield similar results in the primate; and 2) to establish whether central nervous system (CNS) regeneration will influence voluntary grasping and locomotor function in the nonhuman primate. Methods. Ten cynomologus monkeys underwent T-11 laminectomy and resection of a 1-cm length of hemispinal cord. Five monkeys received six intercostal nerve autografts and fibrin glue containing acidic fibroblast growth factor (2.1 µg/ml) whereas controls underwent the identical laminectomy procedure but did not receive the nerve grafts. At 4 months postgrafting, the spinal cord—graft site was sectioned and immunostained for peripheral myelin proteins, biotinylated dextran amine, and tyrosine hydroxylase, whereas the midpoint of the graft was analyzed histologically for the total number of myelinated axons within and around the grafts. The animals underwent pre- and postoperative testing for changes in voluntary hindlimb grasping and gait. Conclusions. 1) A reproducible model of SCI in the primate was developed. 2) Spontaneous recovery of the ipsilateral hindlimb function occurred in both graft- and nongraft—treated monkeys over time without evidence of recovering the ability for voluntary tasks. 3) Regeneration of the CNS from proximal spinal axons into the peripheral nerve grafts was observed; however, the grafts did not promote regeneration beyond the lesion site. 4) The grafts significantly enhanced (p < 0.0001) the regeneration of myelinated axons into the region of the hemisected spinal cord compared with the nongrafted animals.

Surgical treatment of lumbosacral plexus injuries

2004 ◽  
Vol 1 (1) ◽  
pp. 64-71 ◽  
Author(s):  
Eva Maria Lang ◽  
Jörg Borges ◽  
Thomas Carlstedt
Keyword(s):  
Cauda Equina ◽  
Femoral Nerve ◽  
Severe Trauma ◽  
Lumbosacral Plexus ◽  
Spinal Root ◽  
Content Type ◽  
Spinal Nerves ◽  
Nerve Grafts ◽  
Nerve Transfers ◽  
Fine Print

Object. The purpose of this study was to analyze therapeutic possibilities and clinical outcomes in patients with lumbosacral plexus injuries to develop surgical concepts of treatment. Methods. In a retrospective investigation 10 patients with injuries to the lumbosacral plexus were evaluated after surgery. The patients were assessed clinically, electrophysiologically, and based on the results of magnetic resonance imaging and computerized tomography myelography. In most patients a traction injury had occurred due to severe trauma that also caused pelvic fractures. In most cases the roots of the cauda equina of the lumbosacral plexus had ruptured. In cases of spinal root ruptures repair with nerve grafts were performed. In cases in which proximal stumps of the plexus could not be retrieved palliative nerve transfers by using lower intercostals nerves or fascicles from the femoral nerve were performed. Conclusions. Lesions of the proximal spinal nerves and cauda equina occur in the most serious lumbosacral plexus injuries. Patients with such injuries subjected to reconstruction of spinal nerves, repair of ventral roots in the cauda equina, and nerve transfers recovered basic lower-extremity functions such as unsupported standing and walking.

scholarly journals Decellularized peripheral nerve grafts by a modified protocol for repair of rat sciatic nerve injury

2021 ◽  
Vol 16 (6) ◽  
pp. 1086
Author(s):  
Arash Zaminy ◽  
Sara Sayad-Fathi ◽  
FarshadMoharrami Kasmaie ◽  
Zohreh Jahromi ◽  
Adib Zendedel
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Nerve Injury ◽  
Sciatic Nerve Injury ◽  
Nerve Grafts ◽  
Rat Sciatic Nerve ◽  
Peripheral Nerve Grafts

Centrocentral anastomosis in the prevention and treatment of painful terminal neuroma

1985 ◽  
Vol 63 (5) ◽  
pp. 754-758 ◽  
Author(s):  
José González-Darder ◽  
José Barberá ◽  
M. José Abellán ◽  
Antonio Mora
Keyword(s):  
Sciatic Nerve ◽  
Control Parameter ◽  
Histological Study ◽  
Nerve Graft ◽  
Nerve Section ◽  
Content Type ◽  
Proximal Stump ◽  
Neuroma Formation ◽  
Fine Print ◽  
Observation Period

✓ In this experimental study, microsurgical centrocentral anastomosis was applied to an experimental model of painful terminal neuroma resulting from left sciatic nerve section in the rat. The anastomosis consisted of end-to-end suturing of the sciatic nerve fascicles to the tibial branch, with the interposition of a nerve graft taken from the same anastomosed fascicle. As a control parameter for the experiment, the autotomy which follows sciatic nerve section in the rat was evaluated. Autotomy is considered an objective indication of abnormal sensations that are provoked by the formation of a terminal neuroma. Histological study of the proximal stump of the sciatic nerve was also performed. The observation period was 10 weeks. The study demonstrates that centrocentral anastomosis reduces the size of the neuroma formation and the incidence of autotomy.

Management and outcomes in 353 surgically treated sciatic nerve lesions

2004 ◽  
Vol 101 (1) ◽  
pp. 8-17 ◽  
Author(s):  
Daniel H. Kim ◽  
Judith A. Murovic ◽  
Robert Tiel ◽  
David G. Kline
Keyword(s):  
Sciatic Nerve ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Fracture Dislocation ◽  
Suture Repair ◽  
Nerve Lesions ◽  
Content Type ◽  
Injury Mechanisms ◽  
Grade 3 ◽  
Fine Print

Object. This is a retrospective analysis of 353 surgically treated sciatic nerve lesions in which injury mechanisms, location, time to surgical repair, surgical techniques, and functional outcomes are reported. Results are presented to provide guidelines for management of these injuries. Methods. One hundred seventy-five patients with buttock-level and 178 with thigh-level sciatic nerve injury were surgically treated at the Louisiana State University Health Sciences Center between 1968 and 1999. Buttock-level injury mechanisms included injection in 64 patients, hip fracture/dislocation in 26, contusion in 22, compression in 19, gunshot wound (GSW) in 17, hip arthroplasty in 15, and laceration in 12; at the thigh level, GSW was the cause in 62 patients, femoral fracture in 34, laceration in 32, contusion in 28, compression in 12, and iatrogenic injury in 10. Patients with sciatic nerve divisions in which positive intraoperative nerve action potentials (NAPs) were found underwent neurolysis and attained at least Grade 3 functional outcomes in 108 (87%) of 124 and in 91 (96%) of 95 buttock- and thigh-level tibial divisions, respectively, compared with 84 (71%) of 119 and 75 (79%) of 95, respectively, in the peroneal divisions. For suture repair, recovery to at least Grade 3 occurred in eight (73%) of 11 buttock-level and in 27 (93%) of 29 thigh-level tibial division injuries, and in three (30%) of 10 buttock-level and 20 (69%) of 29 thigh-level peroneal division lesions. For graft repair, good recovery occurred in 21 (62%) of 34 and in 43 (80%) of 54 buttock- and thigh-level tibial divisions, respectively, even in proximal repairs requiring long grafts, and in only nine (24%) of 37 and 22 (45%) of 49 buttock- and thigh-level peroneal division lesions, respectively. Conclusions. Surgical exploration and neurolysis after positive NAP readings, or repair with sutures or grafts after negative NAP results are worthwhile in selected cases.

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