Failed peripheral nerve reconstruction with processed nerve allografts in three patients

Nietosvaara, Yrjänä; Grahn, Petra; Sommarhem, Antti

doi:10.1177/1753193418817968

Cited by 15 publications

(15 citation statements)

References 4 publications

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“…In our study, allografts with diameters of up to 5 mm were used and the poorest outcomes were seen in larger diameter grafts, with > 3 mm in diameter appearing to be inhibitory to axonal regeneration. Best et al (53) demonstrated that in large diameter nerve grafts, scar formation as a sequelae to central ischaemia develops; this is likely to be the case with our results and has recently been reported in three cases (54). However, in comparison to autologous nerve grafts, the allograft is perhaps more sensitive.…”

Section: A C C E P T E Dsupporting

confidence: 75%

A Retrospective Case Series Reporting the Outcomes of Avance Nerve Allografts in the Treatment of Peripheral Nerve Injuries

Leckenby

Furrer

Haug

et al. 2020

Plastic &Amp; Reconstructive Surgery

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Section: A C C E P T E Dsupporting

confidence: 75%

A Retrospective Case Series Reporting the Outcomes of Avance Nerve Allografts in the Treatment of Peripheral Nerve Injuries

Leckenby

Furrer

Haug

et al. 2020

Plastic &Amp; Reconstructive Surgery

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“…Nietosvaara et al presented three cases of PNAs ranging from 20 mm to 50 mm failing to facilitate any measurable axon regeneration across these PNAs. In fact, they document that the PNAs resorbed leaving behind scar tissue, and in one case, had thickened into a neuroma‐like stump . Overall, this evidence is perhaps the strongest reason to take a conservative approach to using alternatives in the clinic until these circumstances are better understood.…”

Section: Guidelines For Nerve Graft Repairsmentioning

confidence: 99%

Advances in the repair of segmental nerve injuries and trends in reconstruction

2020

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Despite advances in surgery, the reconstruction of segmental nerve injuries continues to pose challenges. In this review, current neurobiology regarding regeneration across a nerve defect is discussed in detail. Recent findings include the complex roles of nonneuronal cells in nerve defect regeneration, such as the role of the innate immune system in angiogenesis and how Schwann cells migrate within the defect. Clinically, the repair of nerve defects is still best served by using nerve autografts with the exception of small, noncritical sensory nerve defects, which can be repaired using autograft alternatives, such as processed or acellular nerve allografts. Given current clinical limits for when alternatives can be used, advanced solutions to repair nerve defects demonstrated in animals are highlighted. These highlights include alternatives designed with novel topology and materials, delivery of drugs specifically known to accelerate axon growth, and greater attention to the role of the immune system. K E Y W O R D S acellular nerve allograft, autograft, nerve gap, nerve guidance conduit, peripheral nerve 2 | BIOLOGY OF NERVE REGENERATION ACROSS A DEFECT Peripheral nerve is capable of robust regeneration following injury. The molecular and cellular mechanisms have primarily been studied in rodent models. Following injury, neurons and their axons and the nonneuronal cellular environment distal to the injury undergo immediate morphological and molecular changes. Within the axon, there is a rapid influx of ions, principally calcium, as well as a disruption of transport proteins signaling a disruption to homeostasis with its end-organ. This multifactorial injury response from axon damage is rapidly transported to the neuron cell Abbreviations: ANA, acellular nerve allograft; ECM, extracellular matrix; FDA, Food and Drug Administration; FK506, tacrolimus; GDNF, glial cell line-derived neurotrophic factor; GFRα1, glial cell line-derived neurotrophic factor family receptor alpha-1; MRC, Medical Research

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“…Recent clinical investigations suggest processed nerve allografts may provide an alternative to autograft for segmental defects of motor or mixed motor/ sensory nerves (Leckenby et al, 2020;Safa et al, 2019). Despite their increasing popularity, experience with allograft failure is limited and mainly based on animal experiments and case reports (Nietosvaara et al, 2019;Saheb-Al-Zamani et al, 2013). A common finding is central necrosis with intraneural fibrosis and insufficient axonal regeneration.…”

Section: Problem Statementmentioning

confidence: 99%

Basic science approaches to common hand surgery problems

Wong

Murphy

et al. 2021

J Hand Surg Eur Vol

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The field of hand surgery is constantly evolving to meet challenges of populations with increasing age and higher demands for active living. While our surgical care has improved over the last decades, it seems that future major improvement in outcomes of clinical treatment will come through advances in biologics and the translation of major discoveries in basic science. This article aims to provide an update on where basic science solutions may answer some of the most critical issues in hand surgery, with a focus on augmentation of tissue repair.

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Failed peripheral nerve reconstruction with processed nerve allografts in three patients

Abstract: References Laing T, Siddiqui A, Sood M. The management of neuropathic pain from neuromas in the upper limb: surgical techniques and future directions.

Cited by 15 publications

References 4 publications

A Retrospective Case Series Reporting the Outcomes of Avance Nerve Allografts in the Treatment of Peripheral Nerve Injuries

A Retrospective Case Series Reporting the Outcomes of Avance Nerve Allografts in the Treatment of Peripheral Nerve Injuries

Advances in the repair of segmental nerve injuries and trends in reconstruction

Basic science approaches to common hand surgery problems

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