Nerve Conduits

Abstract

Tendon injuries continue to be a vexing clinical problem faced by the upper extremity surgeon. These injuries often lead to disability and dissatisfaction for both the patient and treating physician. Advances throughout the century have focused largely on improvements in surgical techniques and therapy protocols. Recently, attention has been turned to the biologic pathways by which tendons heal and the growth factors involved in this process have been identified. There is great hope that these growth factors may one day be used to treat tendon injuries. This article provides a summary of the use of growth factors on tendon injuries including contemporary research, delivery methods, and future directions in this field.

Limitations of Conduits in Peripheral Nerve Repairs

“…Neurotropism is the concept that the distal nerve stump releases substances (neurotrophic factors, nutrients, etc.) that attract the proximal regenerative front [11,21]. The gradient and availability of diffusible substances released by proximal and distal injured nerves is likely affected by the volume of the conduit, such that, as Figure 6 Large-diameter nerves.…”

“…Biodegradable nerve conduits avoid donor site morbidity and immunosuppression associated with nerve allografting and have been found to reduce operative time [16,21].…”

The role of aligned polymer fiber-based constructs in the bridging of long peripheral nerve gaps

“…Polymeric tubular nerve constructs have been used clinically for repairing peripheral nerve injury [6]. These nerve constructs, made of either non-porous silicone or porous natural/ synthetic polymers, bridge the injured nerve stumps when the gaps are <10-12mm in rats by enabling the formation of a fibrin cable that provides a substrate for the migration of Schwann cells.…”

Tissue‐Engineered Peripheral Nerve

“…Nerve autografts are, however, associated with several disadvantages: sensory loss as well as possible scarring and painful neuroma formation at the donor site, potential mismatches in diameter or length to the injured nerve, and the required multiple surgeries (4,5). Nerve allografts transplanted from other individuals are one potential alternative to autografts, but they require the use of immunosuppressants to reduce the patient's response to transplant tissue antigens (6).…”