Bridging nerve defects with combined skeletal muscle and vein conduits

Abstract

The use of vein or muscle grafts to bridge nerve defects longer than 1-1.5 cm gives poor results. Veins collapse and in muscle grafts axons may regrow outside the graft. We used veins (to guide regeneration) filled with muscle (to avoid vein collapse). Nerve regeneration through 1 and 2 cm grafts made of vein plus muscle was compared with similarly long traditional nerve grafts, free fresh muscle grafts, and empty vein grafts. Regeneration was assessed clinically and histologically (qualitative and quantitative evaluation) in the graft and distal nerve stumps. Vein plus muscle grafts were superior to vein and fresh muscle grafts both functionally and histologically. Functional results were similar to those found in traditional nerve grafts, but axon number was superior in the veins filled with muscle. This suggests that vein filled with muscle might serve as a grafting conduit for the repair of peripheral nerve injuries and could give better results than traditional nerve grafting.

Reflex‐based grasping, skilled forelimb reaching, and electrodiagnostic evaluation for comprehensive analysis of functional recovery—The 7‐mm rat median nerve gap repair model revisited

“…Some earlier experimental (Brunelli et al., 1993) and recent clinical work (Manoli, Schulz, et al., 2014) did, however, not report any inferiority of MVGs in comparison to ANGs especially when shorter nerve defects have been bridged. Despite the fact, however, that MVGs also resulted in considerable recovery of fine and gross motor skills in our study, the multimodal analysis of functional recovery performed was comprehensive and therefore eventually more sensitive to otherwise undetectable variations between the graft types.…”

A nanofibrous PHBV tube with Schwann cell as artificial nerve graft contributing to Rat sciatic nerve regeneration across a 30-mm defect bridge

“…Common grafting in surgery was autograft or nerve removal from elsewhere of the body. Unfortunately, autografts had limitations such as body injury, repeated surgery and disproportion of grafted nerve tissue in terms of size and structure of nerve tissue (Evans, 2000;Heath & Rutkowski, 1998) also; transplantation of allograft or xenograft had similar problems such as stimulation of the immune system (Brunelli et al, 1993;Tong et al, 1994;Fansa et al, 2002;Barcelos et al, 2003;de Ruiter et al, 2009). The studies were conducted on the application of artifi cial neural tube to form neural cords (Archibald et al, 1995;Fields et al, 1989;Keeley et al, 1993).…”

Neuregulin 1 Role in Schwann Cell Regulation and Potential Applications to Promote Peripheral Nerve Regeneration

“…Autologous and autogenous blood vessels (Chiu et al, 1988) and muscle fibres (Glasby, Gschmeissner, Hitchcock, & Huang, 1986) have also been used as conduits for nerve regeneration with different success rates; however, they present the same disadvantages as auto and allografts (Doolabh, Hertl, & Mackinnon, 1996). In 1993, Brunelli et al described a new biological conduit represented by a vein segment filled with fresh skeletal muscle (Brunelli, Battiston, Vigasio, Brunelli, & Marocolo, 1993). Both the vein and the skeletal muscle of this autologous graft are withdrawn in the site of surgery and are sutured to bridge the two stumps of a severed nerve.…”