Peripheral nerve regeneration in human hand transplantation (original) (raw)
Related papers
Neurosurgical Focus, 2012
Object Despite the development of various nerve coaptation materials and techniques, achievement of desired functional peripheral nerve regeneration is still inadequate, and repair of peripheral nerve injuries is still one of the most challenging tasks and concerns in neurosurgery. The effect of an FK506-loaded vein graft as an in situ delivery system for FK506 in bridging the defects was studied using a rat sciatic nerve regeneration model. Methods A 10-mm sciatic nerve defect was bridged using an inside-out vein graft (IOVG) filled with 10 μl of a carrier-drug dilution (10 ng/ml FK506) in the IOVG/FK506 group. In the IOVG control group, the vein was filled with the same volume of carrier dilution alone. The regenerated fibers were studied 4, 8, and 12 weeks after surgery. Results Functional study confirmed faster recovery of the regenerated axons in the IOVG/FK506 group than in the IOVG group (p < 0.05). There was a statistically significant difference between the mean gastrocn...
Peripheral Nerve Injury: Principles for Repair and Regeneration
The Open Orthopaedics Journal, 2014
Peripheral Nerve Injuries are one of the most common causes of hand dysfunction caused by upper limb trauma but still current management has remained suboptimal. This review aims to explain the traditional view of pathophysiology of nerve repair and also describe why surgical management is still inadequate in using the new biological research that has documented the changes that occur after the nerve injury, which, could cause suboptimal clinical outcomes. Subsequently presentation and diagnosis will be described for peripheral nerve injuries. When traditional surgical repair using end-to-end anastomosis is not adequate nerve conduits are required with the gold standard being the autologous nerve. Due to associated donor site morbidity and poor functional outcome documented with autologous nerve repair several new advancements for alternatives to bridge the gap are being investigated. We will summarise the new and future advancements of non-biological and biological replacements as well as gene therapy, which are being considered as the alternatives for peripheral nerve repair.
Anatomy, 2016
Objectives: FK506 is an effective immunosuppressive drug for treating graft rejection in transplants patients. However, the neuroregenerative effect of FK506 has been well described in the literature. The aim of this study was to investigate the effects of FK506 in alpha motor neurons after primary and delayed repair of sciatic nerve. Methods: Rats (n=72) were divided into 6 groups. Control, sham-operated, primary repair FK506 (-), primary repair FK506 (+), delayed repair FK506 (-), and delayed repair FK506 (+) groups. Results: After injury, the normal structure of the motor neuron perikarya was maintained by primary repair in the FK506 (+) group. In the delayed repair group, beneficial effect of FK506 was found to be less effective. The SFI value reached-50 recovery level in the FK506-treated group earlier than those of not FK506-treated groups. Conclusion: Beneficial effect of FK506 has been approved by functional and ultrastructural data in both of primary and delayed repair groups.
Introduction: Thematic Papers Issue on Peripheral Nerve Regeneration and Repair
Anatomical record (Hoboken, N.J. : 2007), 2018
Injuries to the peripheral nerves result in loss of motor, sensory and autonomic functions in the denervated segments of the body, thus having strong impact in the quality of life of affected patients. Neurons are able to regenerate their injured axons in the peripheral nerves; however, the endogenous repair mechanisms usually do not allow for a satisfactory functional recovery, especially after severe nerve injuries. The interest on regeneration after peripheral nerve injuries has increased in the recent years due to the numerous advances derived from studies of neurobiology, cell therapy, and tissue engineering. This Thematic Papers Issue brings together a number of papers, authored by researchers in the field, which cover a wide spectrum of topics related to regeneration and repair of peripheral nerve injuries. The Issue proposal originated from the recent 4th International Symposium on Peripheral Nerve Regeneration (ISPNR2017) which was hosted by Xavier Navarro and the European ...
British Journal of Plastic Surgery, 2002
Clinical experience and experimental work in sheep have shown that a two-stage approach to restoring muscle function with a long nerve graft and free muscle grafting seems to be more beneficial than a one-stage approach. Based on a standardised experimental protocol, one-stage and two-stage nerve grafting approaches in rabbits were compared, and the actual differences in muscle force, together with morphological data, were calculated. In 20 rabbits the saphenous nerve was used as a 7 cm nerve graft. Animals were separated into two groups. In group 1, 10 rabbits underwent a one-stage approach to reinnervate the rectus femoris muscle. In the left hindlimb, the proximal end of the graft was coapted to the cut motor nerve branch of the vastus medialis muscle, and the distal end was coapted to the nerve branch of the rectus femofis muscle. In group 2, 10 rabbits underwent a two-stage approach, leaving the distal end of the nerve graft unconnected to the rectus femofis muscle in the first stage. In the second stage, this end was coapted to the freshly cut motor nerve branch of the rectus femofis muscle. After 15 months, the maximum tetanic tensions in the reinnervated rectus femoris muscle and the contrallateral unoperated muscle were determined. The graft and the motor branch distal to the graft were biopsied in order to count the number of regenerated myelinated nerve fibres. The mean_ s.d. maximum tetanic tensions in the reinnervated rectus femoris muscles were 10.6 +4.9 N in group 1 and 21.4__+ 1.1 N in group 2. Compared with the unoperated side, the muscle force following denervation and reinnervation was 38.3% in group 1 and 58.9% in group 2 (P=0.01). The mean_ s.d. numbers of regenerated myelinated nerve fibres distal to the graft in the rectus femofis muscle branch were 737 _+ 340 in group 1 and 1487 + 1004 in group 2 (P = 0.05). These results show that the neurotrophic effect of an immediately connected target organ is far outweighed by the adverse effect of the longer period of muscle denervation. Therefore, nerve grafting and muscle transplantation should not be performed in the same operation. 9
Peripheral nerve regeneration, repair, and grafting
Journal of Hand Therapy, 1998
P eripheral nerve injuries are a major source of chronic disability. The poor long-term results of nerve repairs during World War II led clinicians to have a pessimistic view of the outcome of nerve repair. J The principles of microsurgery and our improved understanding of nerve biology have greatly advanced our clinical results. 2 Although far from perfect, our results today give patients hope as well as function. The technical aspects of nerve repair are well established; the next step will be to manipulate the biologic features of the nerve in order to improve our outcomes.
Regeneration of critical injuries of the peripheral nerve with growth factors
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2013
Introduction: This project aims to study the regeneration of non-repairable lesions of peripheral nerve by muscle grafts enhanced with growth factors. Material and methods: The experiment was carried out in two phases. The first one compared direct suture of a critical defect in the sciatic nerve of ten rats, with the interposition of autologous muscle graft, denatured by heat, in another ten. The second phase compared ten rats with nerve repair using an acellular muscle graft, with injection of 2 cc of IGF-1 (10 mg/ml mecasermin, injectable solution) into the acellular graft of another ten. A clinical and functional follow-up was carried out including, ambulation, footprint measurement, and ''Grasping Test''. The animals were sacrificed at 90-100 days, and samples obtained for macro-and microscopic studies with toluidine blue, hematoxylin-eosin and Masson's trichrome staining. Results: The first experiment showed the characteristic findings of nerve tissue in muscle graft level sections. The second was an enhancement of the results: post-surgical clinical improvement, early ambulation, decrease in the rate of pressure ulcers in toes, recovery of the footprint, and increasing the percentage of nerve endings in distal sciatic regeneration (from 47 to 62%). Conclusions: In this study the experimental and clinical possibilities of nerve defect repair by denatured muscle are demonstrated, confirming the suitability of the technique. Furthermore, it confirms our hypothesis with clinical and cellular determinations enriched by the addition of growth factors that promote nerve regeneration.
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