Decellularized Nerves for Upper Limb Nerve Reconstruction: A Systematic Review of Functional Outcomes

Deslivia, Maria Florencia; Lee, Hyun-Joo; Adikrishna, Arnold

doi:10.1055/s-0035-1558463

Cited by 12 publications

(5 citation statements)

References 24 publications

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“…90 Another interesting example of cell-free tissue's recent clinical application is the use of decellurized nerve. Deslivia et al 176 prepared a review for evaluating the evidence for functional outcomes after decellularized allogeneic nerve scaffold use in clinical setting. The analyzed group of 131 upper-limb nerve reconstructions (in patients age 18 to 86 years) allowed to conclude that decellularized nerves have been used with satisfactory outcomes in static and moving two-point discriminations to bridge nerve gaps ranging from 5 to 100 mm.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…The analyzed group of 131 upper-limb nerve reconstructions (in patients age 18 to 86 years) allowed to conclude that decellularized nerves have been used with satisfactory outcomes in static and moving two-point discriminations to bridge nerve gaps ranging from 5 to 100 mm. 176 To summarize, there should be no doubt that the use of bioengineered cell-free scaffolds optionally revitalized with autologous cells is a promising method for regenerative medicine. However, it must be strongly emphasized that the clinical application of a fully functional bioengineered organ or even tissue requires a lot of research and further improvements.…”

Section: Future Perspectivesmentioning

confidence: 99%

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A review of decellurization methods caused by an urgent need for quality control of cell‐free extracellular matrix' scaffolds and their role in regenerative medicine

et al. 2017

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The natural extracellular matrix (ECM),thanks to its specific properties (e.g., collagenous lattice, a reservoir of growth factors, ECM-cell anchoring areas, an optimal pH and CO ),ensures an optimal microenvironment for homeostatic and regenerative cell development. In the context of regenerative medicine, ECM is a lair for residual and infiltrative cells. The aim of the clinical usage of cell-free ECM scaffolds is the enhancement of tissue regeneration with possible minimization of an adverse host reaction on allogeneic or xenogeneic biomaterial. Thus, the objective of decellularization is to obtain acellular grafts characterized by optimal biological properties, such as a lack of remaining cellular elements (e.g., cell membrane phospholipids and proteins, nucleic acids, mitochondria), lack of immunogenicity, lack of calcification promotion and lack of cytotoxicity (e.g., in unrinsed detergents). Furthermore, cell-free ECM scaffolds should present the optimal mechanical and structural properties that may ensure the biocompatibility of the graft. The maintenance of the ultrastructure composition of the ECM is one of the most important goals of decellularization. All physical, chemical, and biological methods proposed (used separately or in combination to extract cells from tissues/organs) are not 100% effective in cell removal and always cause a disruption of the ECM texture, as well as a probable loss of important structure components. Although cell-free ECM scaffolds are generally classified as medical devices, there are no widely accepted or legally defined criteria for quality control/evaluation methods of obtained matrices. Such criteria must be provided. Some of them have been proposed in this manuscript. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 909-923, 2018.

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Section: Future Perspectivesmentioning

confidence: 99%

Section: Future Perspectivesmentioning

confidence: 99%

A review of decellurization methods caused by an urgent need for quality control of cell‐free extracellular matrix' scaffolds and their role in regenerative medicine

et al. 2017

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“…73 In a systematic review of peripheral nerve reconstruction functional outcomes, the most commonly used test was the static 2-point discrimination (S2PD) assessment for sensory assessment. 62 Given its limitations, results of 2PD should be corroborated by other tests and/or clinical findings, especially when subjective recovery does not align with 2PD findings.…”

Section: Improvementsmentioning

confidence: 99%

“…28,45,59,60 Additionally, time between stimulus applications (from first to second point of 2PD) has been shown to affect the ability to discriminate between stimuli. 61 While some have supported the 2PD test for its high level of consistency, 62 others have consider it to be inherently inconsistent, largely due to the lack of control of application force, even within a single tester. 60,[63][64][65][66] Despite its widespread use, the 2PD has been shown to have low validity in assessing the tactile spatial acuity of hands.…”

Section: Disadvantages/criticismsmentioning

confidence: 99%

Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature

et al. 2022

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Peripheral nerve injuries (PNIs) often present with variable symptoms, making them difficult to diagnose, treat, and monitor. When neurologic compromise is inadequately assessed, suboptimal treatment decisions can result in lasting functional deficits. There are many available tools for evaluating pain and functional status of peripheral nerves. However, the literature lacks a detailed, comprehensive view of the data comparing the clinical utility of these modalities, and there is no consensus on the optimal algorithm for sensory and pain assessment in PNIs. We performed a systematic review of the literature focused on clinical data, evaluating pain and sensory assessment methods in peripheral nerves. We searched through multiple databases, including PubMed/Medline, Embase, and Google Scholar, to identify studies that assessed assessment tools and explored their advantages and disadvantages. A total of 66 studies were selected that assessed various tools used to assess patient's pain and sensory recovery after a PNI. This review may serve as a guide to select the most appropriate assessment tools for monitoring nerve pain and/or sensory function both pre- and postoperatively. As the surgeons work to improve treatments for PNI and dysfunction, identifying the most appropriate existing measures of success and future directions for improved algorithms could lead to improved patient outcomes.

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“…At minimum there should be an analysis of the gap sizes in the Weber paper (poor data interpretation and grouping of larger and medium gaps with small numbers). A recent systematic review on conduits and gap management by DeSlivia et al, 2015 4 is better to discuss. Particularly as there is recruitment of the 5-20mm gap range a more extensive introductory comment and literature review is warranted.…”

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confidence: 99%

Protocol for a phase I trial of a novel synthetic polymer nerve conduit 'Polynerve' in participants with sensory digital nerve injury (UMANC)

et al. 2019

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Background: Peripheral nerve injuries are common, with approximately 9,000 cases in the UK annually. Young working individuals are predominantly affected, leading to significant health and social implications. Functional recovery is often poor with impaired hand sensation, reduced motor function and pain and cold intolerance. Where a nerve gap exists, nerve grafting remains the gold-standard treatment but creates a second surgical site, sensory deficit at the donor site, possible neuroma formation and has limited availability. Current commercially available synthetic and resorbable nerve conduit alternatives are reported to be rigid and inflexible. This study will set out to examine the first-in-man use of a new nerve conduit device ‘Polynerve’ to repair small nerve gaps in digital sensory nerves of the hand. Polynerve is a degradable co-polymer of poly-ε-caprolactone and poly-l-lactic acid, which is shaped as a cylinder that has greater tensile strength, flexibility and less acidic degradation compared with current commercially available synthetic nerve conduits. In addition, it has a novel micro-grooved internal lumen that aids Schwann cell ingress and alignment to improve nerve regeneration. Methods: In total, 17 eligible participants will be recruited to undergo repair of a transected sensory nerve of the hand using the Polynerve device. All participants that receive the nerve conduit device will be followed for a period of 12 months post-surgery. The primary endpoint is safety of the device and the secondary endpoint is degree of sensory nerve regeneration through the conduit assessed using standard sensory testing (2-PD, WEST monofilament testing and locognosia). Discussion: The ‘UMANC’ trial is a single-centre UK-based, prospective, unblinded, phase I clinical trial of a novel nerve conduit device. We aim to demonstrate the safety of Polynerve as a synthetic, biodegradable nerve conduit and improve the treatment options available to patients with significant nerve injuries. Registration: Clinicaltrials.gov: NCT02970864; EudraCT: 2016-001667-37.

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Decellularized Nerves for Upper Limb Nerve Reconstruction: A Systematic Review of Functional Outcomes

Abstract: Our study is the first to summarize the clinical results of decellularized nerves. Decellularized nerves have been used to bridge nerve gaps ranging from 5 to 100 mm with associated satisfactory outcomes in static and moving two-point discriminations.

Cited by 12 publications

References 24 publications

A review of decellurization methods caused by an urgent need for quality control of cell‐free extracellular matrix' scaffolds and their role in regenerative medicine

A review of decellurization methods caused by an urgent need for quality control of cell‐free extracellular matrix' scaffolds and their role in regenerative medicine

Clinical Assessment of Pain and Sensory Function in Peripheral Nerve Injury and Recovery: A Systematic Review of Literature

Protocol for a phase I trial of a novel synthetic polymer nerve conduit 'Polynerve' in participants with sensory digital nerve injury (UMANC)

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