Defining the relative impact of muscle versus Schwann cell denervation on functional recovery after delayed nerve repair

Sarhane, Karim A.; Slavin, Benjamin R.; Hricz, Nicholas; Malapati, Harsha; Guo, Yuanhao; Grzelak, Michael; Chang, Irene; Shappell, Heather; Guionneau, Nicholas von; Wong, Alison; Mi, Ruifa; Höke, Ahmet; Tuffaha, Sami H.

doi:10.1016/j.expneurol.2021.113650

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…Although sensory nerve grafts are the clinical "gold standard" technique for repairing nerve gaps, 1,2 recovery is often disappointing. 17,23,24 This is attributed to the negative influence of the increasing values of gap length, time between trauma and repair, and patient age. 12 Thus, reliable good-to-excellent recovery is only across gaps less than 3-5 cm, [2][3][4][5][6][7] repairs performed less than 3-5 months posttrauma, 4,5 and patients aged less than 20-25 years.…”

Section: Discussionmentioning

confidence: 99%

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Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma

Foy

Micheo

Kuffler

2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Sensory nerve grafts are the clinical “gold standard” for repairing peripheral nerve gaps. However, reliable good-to-excellent recovery develops only for gaps less than 3–5 cm, repairs performed less than 3–5 months posttrauma, and patients aged less than 20–25 years. As the value of any variable increases, the extent of recovery decreases precipitously, and if the values of any two or all increase, there is little to no recovery. One 9-cm-long and two 11-cm-long nerve gaps in a 56-year-old patient were repaired 2.6 years posttrauma. They were bridged with two sensory nerve grafts within an autologous platelet-rich plasma-filled collagen tube. Both were connected to the proximal ulnar nerve stump, with one graft end to the distal motor and the other to the sensory nerve branches. Although presurgery the patient suffered chronic level 10 excruciating neuropathic pain, it was reduced to 6 within 2 months, and did not increase for more than 2 years. Motor axons regenerated across the 9-cm gap and innervated the appropriate two measured muscles, with limited muscle fiber recruitment. Sensory axons regenerated across both 11-cm gaps and restored normal topographically correct sensitivity to stimuli of all sensory modalities, including static two-point discrimination of 5 mm, and pressure of 2.83 g to all regions innervated by both sensory nerves. This novel technique induced a significant long-term reduction in chronic excruciating neuropathic pain while promoting muscle reinnervation and complete sensory recovery, despite the values of all three variables that reduce or prevent axon regeneration and recovery being simultaneously large.

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Section: Discussionmentioning

confidence: 99%

“…[3][4][5] As the value of any variable increases, the extent of recovery decreases. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] As any two variables increase, there is a precipitous decrease in recovery. 20 If all three increase simultaneously, there is very limited to no recovery.…”

Section: Introductionmentioning

confidence: 99%

Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma

Foy

Micheo

Kuffler

2021

Plastic and Reconstructive Surgery - Global Open

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“…Postsurgical neuroma formation is a significant risk of intervention following nerve injury, and can lead to a recurring cycle of aberrant neuronal recovery. Risk of neuroma formation can be minimized by avoiding iatrogenic nerve injury, early primary repair where possible and precise coaptation of the epineurium intraprocedurally [61 ▪▪ ,62,63]. Nonsurgical strategies for neuroma management include aggressive management with adjuvant analgesics, and neuromodulation using peripheral or spinal repetitive electrical stimulation or transcutaneous magnetic stimulation, techniques which may also stimulate axonal regeneration [64].…”

Section: Managementmentioning

confidence: 99%

Traumatic peripheral nerve injuries: diagnosis and management

Barnes

Miller²,

Simon

2022

Current Opinion in Neurology

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Purpose of reviewTo review advances in the diagnostic evaluation and management of traumatic peripheral nerve injuries.Recent findingsSerial multimodal assessment of peripheral nerve injuries facilitates assessment of spontaneous axonal regeneration and selection of appropriate patients for early surgical intervention. Novel surgical and rehabilitative approaches have been developed to complement established strategies, particularly in the area of nerve grafting, targeted rehabilitation strategies and interventions to promote nerve regeneration. However, several management challenges remain, including incomplete reinnervation, traumatic neuroma development, maladaptive central remodeling and management of fatigue, which compromise functional recovery.SummaryInnovative approaches to the assessment and treatment of peripheral nerve injuries hold promise in improving the degree of functional recovery; however, this remains a complex and evolving area.

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“…A second approach is to develop new diagnosis tools based on the monitoring of alternative physiological parameters also altered by a denervation event. In this sense, alterations in muscle function induced by peripheral nerve injury could be associated with changes in muscle temperature due, at least in part, to alterations in mass [7], in blood flow and in muscle metabolism [8][9][10][11][12]. Consequently, intramuscular thermal dynamics could be potentially used as a diagnosis indicator of muscle atrophy.…”

Section: Introductionmentioning

confidence: 99%

Early in vivo detection of denervation‐induced atrophy by luminescence transient nanothermometry

Lifante,

Moreno‐Rupérez,

Ximendes

et al. 2023

Journal of Biophotonics

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Denervation induces skeletal muscle atrophy due to the loss of control and feedback with the nervous system. Unfortunately, muscle atrophy only becomes evident days after the denervation event when it could be irreversible. Alternative diagnosis tools for early detection of denervation‐induced muscle atrophy are, thus, required. In this work, we demonstrate how the combination of transient thermometry, a technique already used for early diagnosis of tumors, and infrared‐emitting nanothermometers makes possible the in vivo detection of the onset of muscle atrophy at short (<1 day) times after a denervation event. The physiological reasons behind these experimental results have been explored by performing three dimensional numerical simulations based on the Pennes' bioheat equation. It is concluded that the alterations in muscle thermal dynamics at the onset of muscle atrophy are consequence of the skin perfusion increment caused by the alteration of peripheral nervous autonomous system. This work demonstrates the potential of infrared luminescence thermometry for early detection of diseases of the nervous system opening the venue toward the development of new diagnosis tools.

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Defining the relative impact of muscle versus Schwann cell denervation on functional recovery after delayed nerve repair

Cited by 13 publications

References 27 publications

Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma

Functional Recovery following Repair of Long Nerve Gaps in Senior Patient 2.6 Years Posttrauma

Traumatic peripheral nerve injuries: diagnosis and management

Early in vivo detection of denervation‐induced atrophy by luminescence transient nanothermometry

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