How to Measure Outcomes of Peripheral Nerve Surgery

Wang, Yirong; Malay, Sunitha; Chung, Kevin C.

doi:10.1016/j.hcl.2013.04.004

Cited by 67 publications

(71 citation statements)

References 77 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While defining these parameters can be slightly subjective, in general there is a consensus that short length defects are less than 30 mm . The most common metric used for these comparisons has been meaningful recovery based on the Medical Research Council (MRC) scale (Table ), set for sensory function at ≥S3 and motor function at ≥M4 . For digital nerves repaired with an autograft, the reported ranges of meaningful recovery are nearly 100% .…”

Section: Guidelines For Nerve Graft Repairsmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

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

show abstract

Section: Guidelines For Nerve Graft Repairsmentioning

confidence: 99%

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

2020

View full text Add to dashboard Cite

show abstract

“…Moreover, sensory assessments such as S2PD, M2PD, and SWM are vulnerable to subjective bias. 23 Without detailing the specific tool used to conduct the outcome assessment, one cannot easily compare the results obtained with even the same assessment method.…”

Section: Discussionmentioning

confidence: 99%

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

Deslivia

Lee

Adikrishna

2015

J reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…As detailed in Wang et al, patients were serially tested for motor and sensory function according to the Medical Research Council (MRC) grading scale. 43 Postoperative ultrasound studies were performed to assess continuity of the grafts.…”

Section: Postoperative Follow-upmentioning

confidence: 99%

First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Gersey

Burks

Anderson

et al. 2017

FOC

View full text Add to dashboard Cite

OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

show abstract

How to Measure Outcomes of Peripheral Nerve Surgery

Cited by 67 publications

References 77 publications

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

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

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

First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

Contact Info

Product

Resources

About