Failed digital nerve reconstruction by foreign body reaction to Neurolac® nerve conduit

Hernández‐Cortés, Pedro; Garrido, Juan de Dios López-González; Cámara, M. A.; Ravassa, F OʼValle

doi:10.1002/micr.20730

Cited by 26 publications

(17 citation statements)

References 9 publications

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“…17,[19][20][21] Even the FDA approved PLCL conduit (the NeurolacV C conduit), [5][6][7]18 has been shown to exhibit significant swelling and breakage leading to compromised nerve growth. 14,19,22 Significant inflammatory responses to PCL or copolymers of PCL have also been reported, including infiltration with fibroblasts, inflammatory cells, and FBGCs. 16,17,19,20,23 In our study, micro-CT imaging with contrast allowed us to identify fragments of conduit detached from the walls and then use subsequent histology to confirm the inflammatory response to the fragments.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of peripheral nerve regeneration through biomaterial conduits via micro‐CT imaging

Pixley

Hopkins

Little

et al. 2016

Laryngoscope Investig Oto

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ObjectiveHollow nerve conduits made of natural or synthetic biomaterials are used clinically to aid regeneration of peripheral nerves damaged by trauma or disease. To support healing, conduit lumen patency must be maintained until recovery occurs. New methods to study conduit structural integrity would provide an important means to optimize conduits in preclinical studies. We explored a novel combined technique to examine structural integrity of two types of nerve conduits after in vivo healing.Study DesignMicro‐CT imaging with iodine contrast was combined with histological analysis to examine two different nerve conduits after in vivo nerve reconstruction in rats.Materials and MethodsSciatic nerve gaps in adult Lewis rats were reconstructed with poly(caprolactone) (PCL, 1.6 cm gap, 14‐week survival) or silicone (1 cm gap, 6‐week survival) conduits (N = 12 total). Conduits with regenerating tissues were imaged by micro‐CT with iodine contrast and compared to the histology (hematoxylin and eosin, immunostaining for axons) of regenerated tissues after iodine removal.ResultsPCL nerve conduits showed extensive breakage throughout their length, but all showed successful nerve growth through the conduits. The silicone conduits remained intact, although significant constriction was uniquely detected by micro‐CT, with 1 of 6 animals showing incomplete tissue regeneration.ConclusionsMicro‐CT with iodine contrast offers a unique and valuable means to determine 3D structural integrity of nerve conduits and nerve healing following reconstruction. Furthermore, this paper shows that even if conduit compression and degradation occur, nerve regeneration can still take place.

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Section: Discussionmentioning

confidence: 99%

Evaluation of peripheral nerve regeneration through biomaterial conduits via micro‐CT imaging

Pixley

Hopkins

Little

et al. 2016

Laryngoscope Investig Oto

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“…Also other investigators propose that a porous multilayer polycaprolactone wall could demonstrate fast material degradation and thus induce massive foreign body reaction due to its high surface to volume ratio [44, 45]. Furthermore, severe FBGC formation and failure of nerve regeneration due to swelling, fibrosis, ischemia, and thus necrosis of the neural tissues were reported experimentally and clinically [44, 46]. In the present study, the remarkably massive tissue reaction and the poor performance of the COM grafts with regard to nerve recovery could additionally be attributed to the polycaprolactone shell properties.…”

Section: Discussionmentioning

confidence: 99%

Outer Electrospun Polycaprolactone Shell Induces Massive Foreign Body Reaction and Impairs Axonal Regeneration through 3D Multichannel Chitosan Nerve Guides

Duda

Dreyer

Behrens

et al. 2014

BioMed Research International

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We report on the performance of composite nerve grafts with an inner 3D multichannel porous chitosan core and an outer electrospun polycaprolactone shell. The inner chitosan core provided multiple guidance channels for regrowing axons. To analyze the in vivo properties of the bare chitosan cores, we separately implanted them into an epineural sheath. The effects of both graft types on structural and functional regeneration across a 10 mm rat sciatic nerve gap were compared to autologous nerve transplantation (ANT). The mechanical biomaterial properties and the immunological impact of the grafts were assessed with histological techniques before and after transplantation in vivo. Furthermore during a 13-week examination period functional tests and electrophysiological recordings were performed and supplemented by nerve morphometry. The sheathing of the chitosan core with a polycaprolactone shell induced massive foreign body reaction and impairment of nerve regeneration. Although the isolated novel chitosan core did allow regeneration of axons in a similar size distribution as the ANT, the ANT was superior in terms of functional regeneration. We conclude that an outer polycaprolactone shell should not be used for the purpose of bioartificial nerve grafting, while 3D multichannel porous chitosan cores could be candidate scaffolds for structured nerve grafts.

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“…Also, Duda et al [153] reported a strong foreign body response in PCL conduits. Currently, Neurolac ® [154][155][156] is the only FDA-approved caprolactone conduit ( Table 2). Several reports have been made in the application of PCL conduits in sciatic rat nerve repair [157][158][159][160][161][162].…”

Section: Poly (D L Lactide-co-ε-caprolactone)mentioning

confidence: 99%

“…Bertleff et al [154] performed a randomized prospective multicentre study where PCL conduits were comparable to either primary end-to-end repair or nerve autograft. However, latter research showed no meaningful recovery in digital nerves repair [155,156]. Secer and colleagues [163] studied the use of PCL in the recovery of 455 patients with ulnar nerve injuries.…”

Section: Poly (D L Lactide-co-ε-caprolactone)mentioning

confidence: 99%

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

Pedrosa¹,

Caseiro²,

Santos³

et al. 2017

Scaffolds in Tissue Engineering - Materials, Technologies and Clinical Applications

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Human adult peripheral nerve injuries are a high incidence clinical problem that greatly affects patients' quality of life. Although peripheral nervous system has intrinsic regenerative capacity, this occurs in an incomplete or poorly functional manner. When a nerve fiber loses its continuity with consequent damage of the basal lamina tubes, axon spontaneous regeneration is disorganized and mismatched. These phenomena translate in an inadequate nerve functional recovery and consequent musculoskeletal incapacity. Nerve grafts still remain the gold standard in peripheral injuries treatment. However, this approach contains its disadvantages such as the necessity of primary surgery to harvest the autografts, loss of a functional nerve, donor site morbidity and longer surgery procedures. Therefore, biomaterials and tissue engineering can provide efficient resources and alternatives to nerve injury repair not only by the development of biocompatible structures but also, introducing neurotrophic factors and cellular systems to stimulate optimum clinical outcome. In this chapter, a comprehensive state-of-the art picture of tissue-engineered nerve grafts scaffolds, their application in nerve regeneration along with latest advances in peripheral nerve repair and future perspectives will be discussed, including our own large experience in this field of knowledge.

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Failed digital nerve reconstruction by foreign body reaction to Neurolac® nerve conduit

Cited by 26 publications

References 9 publications

Evaluation of peripheral nerve regeneration through biomaterial conduits via micro‐CT imaging

Evaluation of peripheral nerve regeneration through biomaterial conduits via micro‐CT imaging

Outer Electrospun Polycaprolactone Shell Induces Massive Foreign Body Reaction and Impairs Axonal Regeneration through 3D Multichannel Chitosan Nerve Guides

Scaffolds for Peripheral Nerve Regeneration, the Importance of In Vitro and In Vivo Studies for the Development of Cell-Based Therapies and Biomaterials: State of the Art

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