Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Korus, Lisa; Ross, Douglas C.; Doherty, Christopher; Miller, Thomas A.

doi:10.1136/jnnp-2015-310420

Cited by 33 publications

(58 citation statements)

References 75 publications

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“…3 In instances of severe injury to the brachial plexus or nerve roots, successful nerve regeneration may not be possible without surgical brachial plexus reconstruction. 4,5 Even patients in whom regenerating nerve fibres reach the target muscles, there are substantial barriers to a good functional outcome. The process of axonal regeneration is inefficient and sprouting fibres may not reconnect with the appropriate fascicle beyond the injured segment.…”

Section: Recovery From Bptmentioning

confidence: 99%

Central Adaptation following Brachial Plexus Injury

et al. 2016

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Brachial plexus trauma (BPT) often affects young patients and may result in lasting functional deficits. Standard care following BPT involves monitoring for clinical and electrophysiological evidence of muscle reinnervation, with surgical treatment decisions based on the presence or absence of spontaneous recovery. Data are emerging to suggest that central and peripheral adaptation may play a role in recovery following BPT. The present review highlights adaptive and maladaptive mechanisms of central and peripheral nervous system changes following BPT that may contribute to functional outcomes. Rehabilitation and other treatment strategies that harness or modulate these intrinsic adaptive mechanisms may improve functional outcomes following BPT.

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Section: Recovery From Bptmentioning

confidence: 99%

Central Adaptation following Brachial Plexus Injury

et al. 2016

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“…At the same time, it is now considered to be the gold standard for the recovery of nerves with a post-traumatic extended defect. This technique is successfully used to reinnervate the diaphragm, the biceps brachii, and other muscles [13].…”

Section: Autotransplantation Of Nerve Sitesmentioning

confidence: 99%

The role of peripheral nerve surgery in a tissue reinnervation

Tuturov

2019

Chin Neurosurg Jl

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In modern neuroscience, the most relevant is the study of the problem of reinnervation of tissues after severe injuries. Complete restoration of lost physiological functions is still impossible with lesions of peripheral nerves with the formation of extensive diastasis between their proximal and distal sites. In this case, the standard neurorrhaphy cannot be carried out because of the eruption of the filaments during tension and convergence of the ends. To solve this problem, a technique was developed for autotransplantation of the nerve sections, which is still the gold standard for the reconstruction of extensive nerve defects. However, the presence of significant shortcomings led to the development of the doctrine of the direction of regeneration with the help of conduits. Currently, the use of nerve channels is the most promising technology for peripheral nerve repair after trauma. The most actively developing now is the direction of reinnervation, such as neurotization. Neurotization, in some way, combined all the methods of restoring nerves. The overall goal of all these methods-the restoration of extensive nerve defects-allows them to be combined into a new industry: reinnervating neurosurgery.

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“…Moreover, the distance to cover by the regenerating axons from the SC avulsion site to the muscular end plates is so long that by the time the axons reach their destination, the muscles are atrophic and fibrotic [20,128]. To avoid and delay this muscle atrophy as much as possible, several strategies have been attempted: manipulating the molecular pathways involved in muscle atrophy [129][130][131], nerve transfers from neighboring functioning nerves [132][133][134][135][136], direct electrical stimulation of the affected muscles [137][138][139] and neuronal transplantation inside the denervated muscle [20,[140][141][142]. In rats, the combination of GDNF at the SC-NR injury site and embryonic spinal foetal neuron transplant inside the target muscles provided the best possible functional result [20].…”

Section: Pharmacological Aids To Enhance Regeneration After Nerve Roomentioning

confidence: 99%

Nerve Root Reimplantation in Brachial Plexus Injuries

Vanaclocha‐Vanaclocha¹,

Saiz-Sapena²,

Ortiz-Criado³

et al. 2019

Treatment of Brachial Plexus Injuries

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Nerve root avulsion is the most severe form of brachial or lumbosacral plexus injury. Spontaneous recovery is extremely rare, and when all the nerve roots of the affected plexus are avulsed, the therapeutic options are very limited. Nerve root reimplantation has been attempted since the 1990s, first in experimental animal models and afterwards in human beings. Currently, only partial recovery of the proximal limb muscles has been achieved. New therapeutic strategies have been developed to improve motor neuron survival and axonal regeneration, with promising results. Neurotrophic factors and some drugs have been used successfully to improve the regenerating ability, but long-term studies in humans are needed to develop complete recovery of the affected limb.

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Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation

Cited by 33 publications

References 75 publications

Central Adaptation following Brachial Plexus Injury

Central Adaptation following Brachial Plexus Injury

The role of peripheral nerve surgery in a tissue reinnervation

Nerve Root Reimplantation in Brachial Plexus Injuries

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