Inside-out and standard vein grafts associated with platelet-rich plasma (PRP) in sciatic nerve repair. A histomorphometric study

Roque, José Sidney; Pomini, Karina Torres; Buchaim, Rogério Leone; Buchaim, Daniela Vieira; Andreo, Jesús Carlos; Roque, Domingos Donizeti; Rodrigues, Antônio de Castro; Júnior, Geraldo Marco Rosa; Moraes, Luís Henrique Rapucci; Viterbo, Fausto

doi:10.1590/s0102-865020170080000003

“…A meta-analysis of published papers determined that for nerve gaps up to 4 cm in length, vein conduits did not induce any significant improvement in sensory recovery outcome compared to conduits of other materials [170]. However, the axon regeneration-promoting efficacy of vein conduits is enhanced when they are filled with PRP [171][172][173], muscle [174], pre-degenerated muscle [175,176], muscle seeded with neural-transdifferentiated human mesenchymal stem cells [177], and minced peripheral nerves [178]. One study in sheep showed that using the median epineural sheath as a conduit can restore median nerve function across 6-cm-long nerve gaps [179].…”

Section: Conduit Compositionmentioning

confidence: 99%

Restoration of Neurological Function Following Peripheral Nerve Trauma

Kuffler

¹

,

Foy

²

2020

IJMS

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Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical “gold standard” technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2–3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.

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“…A meta-analysis of published papers determined that for nerve gaps up to 4 cm in length, vein conduits did not induce any significant improvement in sensory recovery outcome compared to conduits of other materials [170]. However, the axon regeneration-promoting efficacy of vein conduits is enhanced when they are filled with PRP [171][172][173], muscle [174], pre-degenerated muscle [175,176], muscle seeded with neural-transdifferentiated human mesenchymal stem cells [177], and minced peripheral nerves [178]. One study in sheep showed that using the median epineural sheath as a conduit can restore median nerve function across 6-cm-long nerve gaps [179].…”

Section: Conduit Compositionmentioning

confidence: 99%

Wound Repair and Regeneration

2020

0

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“…PRP is an autologous concentrate of platelets in a small volume of plasma containing growth factors released by these cells, which can serve as a matrix for enhancing collagen synthesis, stimulating angiogenesis, accelerating SC migration, and promoting nerve regeneration [13,14]. Once activated by thrombin, PRP filling inside the vein can provide good mechanical support, which does not easily leak out and exerts its effects for a long period [15]. Recent studies also reported that PRP had positive effects on nerve regeneration, in addition to its positive effects on the healing of many types of tissues [16,17].…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve defects repaired with autogenous vein grafts filled with platelet-rich plasma and active nerve microtissues and evaluated by novel multimodal ultrasound techniques

Zhu

¹

,

Peng

²

,

Wang

³

et al. 2022

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Background Developing biocompatible nerve conduits that accelerate peripheral nerve regeneration, lengthening and functional recovery remains a challenge. The combined application of nerve microtissues and platelet-rich plasma (PRP) provides abundant Schwann cells (SCs) and various natural growth factors and can compensate for the deficiency of SCs in the nerve bridge, as well as the limitations of applying a single type of growth factor. Multimodal ultrasound evaluation can provide additional information on the stiffness and microvascular flow perfusion of the tissue. This study was designed to investigate the effectiveness of a novel tissue-engineered nerve graft composed of an autogenous vein, nerve microtissues and PRP in reconstructing a 12-mm tibial nerve defect and to explore the value of multimodal ultrasound techniques in evaluating the prognosis of nerve repair. Methods In vitro, nerve microtissue activity was first investigated, and the effects on SC proliferation, migration, factor secretion, and axonal regeneration of dorsal root ganglia (DRG) were evaluated by coculture with nerve microtissues and PRP. In vivo, seventy-five rabbits were equally and randomly divided into Hollow, PRP, Micro-T (Microtissues), Micro-T + PRP and Autograft groups. By analysing the neurological function, electrophysiological recovery, and the comparative results of multimodal ultrasound and histological evaluation, we investigated the effect of these new nerve grafts in repairing tibial nerve defects. Results Our results showed that the combined application of nerve microtissues and PRP could significantly promote the proliferation, secretion and migration of SCs and the regeneration of axons in the early stage. The Micro-T + PRP group and Autograft groups exhibited the best nerve repair 12 weeks postoperatively. In addition, the changes in target tissue stiffness and microvascular perfusion on multimodal ultrasound (shear wave elastography; contrast-enhanced ultrasonography; Angio PlaneWave UltrasenSitive, AngioPLUS) were significantly correlated with the histological results, such as collagen area percentage and VEGF expression, respectively. Conclusion Our novel tissue-engineered nerve graft shows excellent efficacy in repairing 12-mm defects of the tibial nerve in rabbits. Moreover, multimodal ultrasound may provide a clinical reference for prognosis by quantitatively evaluating the stiffness and microvescular flow of nerve grafts and targeted muscles.

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Inside-out and standard vein grafts associated with platelet-rich plasma (PRP) in sciatic nerve repair. A histomorphometric study

Cited by 9 publications

References 24 publications

Restoration of Neurological Function Following Peripheral Nerve Trauma

Restoration of Neurological Function Following Peripheral Nerve Trauma

Wound Repair and Regeneration

Peripheral nerve defects repaired with autogenous vein grafts filled with platelet-rich plasma and active nerve microtissues and evaluated by novel multimodal ultrasound techniques

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