Nerve Grafting

Millesi, H.

doi:10.1016/s0094-1298(20)31826-5

Cited by 130 publications

(8 citation statements)

References 29 publications

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“…The treatment of segmental nerve loss in upper extremity trauma remains a challenge. Nerve autograft remains the most common strategy for repairing segmental nerve defects; however, the use of nerve autograft has several disadvantages, including donor site morbidity, increased operative time, and limited harvest sites [23,24,26,28]. The use of decellularized nerve allograft may provide an effective means of repairing segmental nerve defects while sparing the patient the secondary morbidity of nerve autograft harvest.…”

Section: Discussionmentioning

confidence: 99%

“…The reconstruction of injured peripheral nerves remains as a formidable challenge in reconstructive surgery. Nerve grafting is indicated for nerve repair when tension-free direct repair is not possible or when there is segmental nerve loss [15,23]. The most common material used to bridging segmental nerve defects is autogenous nerve grafts [16].…”

Section: Introductionmentioning

confidence: 99%

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Early Clinical Outcomes with the Use of Decellularized Nerve Allograft for Repair of Sensory Defects within the Hand

Karabekmez

Duymaz

Moran

2009

Hand (New York, N,Y.)

226

146

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Nerve conduits have become an established option for repair of sensory deficits of up to 2 cm. More recently, decellularized nerve allograft has also been advocated as an option for nerve repair; however, no clinical studies have examined its efficacy for the treatment of sensory nerve defects. The aim of this study was to examine our early experience with the use of decellularized nerve allograft for repair of segmental nerve defects within the hand and fingers. From July 2007 to March 2008, seven patients who had ten nerve gaps were treated surgically using decellularized nerve allograft. Eight digital and two dorsal sensory nerves were repaired. The etiologies of the nerve defects were traumatic nerve transection in eight defects and neuroma resection and reconstruction in two defects. All of the affected nerves were pure sensory fibers. Functional recovery was evaluated by blinded hand therapist using moving and static two point discrimination tests. Implantation sites were also evaluated for any signs of infection, rejection, or graft extrusion. There were five men and two women with a mean age of 44 years (range 23-65). Mean nerve graft length was 2.23 cm with a range of 0.5-3 cm. Mean follow up time was 9 months (range 5-12). Average two point discrimination was 4.4 mm moving and 5.5 mm static at last recorded follow-up. There were no wound infections observed around the graft material and sensory improvement was observed in all of the patients despite this short-term follow-up. Re-exploration of two fingers was required for flexor tendon rupture in one and flexor tendon tenolysis in the other. In both cases, the nerve allograft was visualized and appeared well incorporated in the repair site. Decellularized nerve allografts were capable of returning adequate sensation in nerve defects ranging from 0.5 to 3 cm. There were no cases of infection or rejection. Decellularized nerve allograft may provide an option for segmental nerve gaps beyond 2 cm. Randomized comparative studies will be required to determine efficacy in comparison to collagen conduits or nerve autograft.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Clinical Outcomes with the Use of Decellularized Nerve Allograft for Repair of Sensory Defects within the Hand

Karabekmez

Duymaz

Moran

2009

Hand (New York, N,Y.)

226

146

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“…2 ). The gold standard is still to use autologous nerve grafts, 32 although other strategies, such as nerve allografts and different synthetic nerve conduits have been introduced (see below).…”

Section: Treatment Of Nerve Injuriesmentioning

confidence: 99%

Nerve injuries of the upper extremity and hand

Dahlin

Wiberg

2017

EFORT Open Reviews

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A nerve injury has a profound impact on the patient’s daily life due to the impaired sensory and motor function, impaired dexterity, sensitivity to cold as well as eventual pain problems.To perform an appropriate treatment of nerve injuries, a correct diagnosis must be made, where the injury is properly classified, leading to an optimal surgical approach and technique, where timing of surgery is also important for the outcome.Knowledge about the nerve regeneration process, where delicate processes occur in neurons, non-neuronal cells (i.e. Schwann cells) and other cells in the peripheral as well as the central nervous systems, is crucial for the treating surgeon.The surgical decision to perform nerve repair and/or reconstruction depends on the type of injury, the condition of the wound as well as the vascularity of the wound.To reconnect injured nerve ends, various techniques can be used, which include both epineurial and fascicular nerve repair, and if a nerve defect is caused by the injury, a nerve reconstruction procedure has to be performed, including bridging the defect using nerve-grafts or nerve transfer techniques.The patients must be evaluated properly and regularly after the surgical procedure and appropriate rehabilitation programmes are useful to improve the final outcome.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160071. Originally published online at www.efortopenreviews.org

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“…Gap sizes larger than 10 mm have to be assumed as critical, as peripheral nerve reconstruction is needed. Tension after coaptation leads to poor results, as Schwann-cell activation and axon regeneration are impaired, meaning decreases in fiber count and nerve density (Mackinnon, 1989;Millesi, 1984;Sunderland et al, 2004). The nerve regeneration rate is about 1-3 mm per day, depending on the location along the axon (proximal lesion sites tend to regenerate faster than at distal locations; Menorca et al, 2013).…”

Section: Introductionmentioning

confidence: 99%