Peripheral nerve conduits: technology update

Arslantunali, Damla; Dursun, T.; Yücel, Deniz; Hasırcı, Nesrin; Hasırcı, Vasıf

doi:10.2147/mder.s59124

Cited by 136 publications

(86 citation statements)

References 146 publications

(142 reference statements)

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“…Examples of alternate techniques include conduits made of collagen, porous or smooth- walled poly-L-lactic acid, poly(glycerol sebacate), and polylactic-co-glycolic acid. Other examples would include vein grafts, small intestinal submucosa seeded with Schwann cells, cytokines, other trophic substances and/or cells such as mesenchymal stem cells (for reviews, see Arslantunali et al, 2014; Aikeremujiang and Ao, 2015). Although results of morphometric and electrophysiological analyses of repairs made using these appliances may approach or exceed those reported for cable autografts, functional tests when performed produce uniformly poor results, even when compared to autografts.…”

Section: Discussionmentioning

confidence: 99%

Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats

Mikesh

Ghergherehchi

Rahesh

et al. 2018

J of Neuroscience Research

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Many publications report that ablations of segments of peripheral nerves produce the following unfortunate results: (1) Immediate loss of sensory signaling and motor control; (2) rapid Wallerian degeneration of severed distal axons within days; (3) muscle atrophy within weeks; (4) poor behavioral (functional) recovery after many months, if ever, by slowly-regenerating (∼1mm/d) axon outgrowths from surviving proximal nerve stumps; and (5) Nerve allografts to repair gap injuries are rejected, often even if tissue matched and immunosuppressed. In contrast, using a female rat sciatic nerve model system, we report that neurorrhaphy of allografts plus a well-specified-sequence of solutions (one containing polyethylene glycol: PEG) successfully addresses each of these problems by: (a) Reestablishing axonal continuity/signaling within minutes by nonspecific ally PEG-fusing (connecting) severed motor and sensory axons across each anastomosis; (b) preventing Wallerian degeneration by maintaining many distal segments of inappropriately-reconnected, PEG-fused axons that continuously activate nerve-muscle junctions; (c) maintaining innervation of muscle fibers that undergo much less atrophy than otherwise-denervated muscle fibers; (d) inducing remarkable behavioral recovery to near-unoperated levels within days to weeks, almost certainly by CNS and PNS plasticities well-beyond what most neuroscientists currently imagine; and (e) preventing rejection of PEG-fused donor nerve allografts with no tissue matching or immunosuppression. Similar behavioral results are produced by PEG-fused autografts. All results for Negative Control allografts agree with current neuroscience data 1-5 given above. Hence, PEG-fusion of allografts for repair of ablated peripheral nerve segments expand on previous observations in single-cut injuries, provoke reconsideration of some current neuroscience dogma, and further extend the potential of PEG-fusion in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats

Mikesh

Ghergherehchi

Rahesh

et al. 2018

J of Neuroscience Research

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“…Mechanical properties such as flexibility and kink resistance, are important parameters while considering the design specifications of a synthetic conduit [2]. In addition, the porosity and permeability of a nerve conduit are also important [3]. The conduit walls can either be fabricated as non-porous or porous.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have investigated conduit porosity in the context of peripheral nerve regeneration and reported contradictory results [9–11]. Increased porosity in the conduit walls may enhance permeability to nutrients, and this may potentially augment nerve regeneration [3]. However, larger pores (>30 µm) can also permit fibrous tissue infiltration and outward diffusion of growth factors from within the conduit lumen that can potentially suppress nerve regeneration [10, 12–15].…”

Section: Introductionmentioning

confidence: 99%

Fibrin glue as a stabilization strategy in peripheral nerve repair when using porous nerve guidance conduits

Bhatnagar

Bushman

Murthy

et al. 2017

J Mater Sci: Mater Med

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Porous conduits provide a protected pathway for nerve regeneration, while still allowing exchange of nutrients and wastes. However, pore sizes >30 µm may permit fibrous tissue infiltration into the conduit, which may impede axonal regeneration. Coating the conduit with Fibrin Glue (FG) is one option for controlling the conduit’s porosity. FG is extensively used in clinical peripheral nerve repair, as a tissue sealant, filler and drug-delivery matrix. Here, we compared the performance of FG to an alternative, hyaluronic acid (HA) as a coating for porous conduits, using uncoated porous conduits and reverse autografts as control groups. The uncoated conduit walls had pores with a diameter of 60 to 70 µm that were uniformly covered by either FG or HA coatings. In vitro, FG coatings degraded twice as fast as HA coatings. In vivo studies in a 1 cm rat sciatic nerve model showed FG coating resulted in poor axonal density (993 ± 854 #/mm2), negligible fascicular area (0.03 ± 0.04 mm2), minimal percent wet muscle mass recovery (16 ± 1 in gastrocnemius and 15 ± 5 in tibialis anterior) and G-ratio (0.73 ± 0.01). Histology of FG-coated conduits showed excessive fibrous tissue infiltration inside the lumen, and fibrin capsule formation around the conduit. Although FG has been shown to promote nerve regeneration in non-porous conduits, we found that as a coating for porous conduits in vivo, FG encourages scar tissue infiltration that impedes nerve regeneration. This is a significant finding considering the widespread use of FG in peripheral nerve repair.Graphical Abstract

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“…It may be accompanied by neurological deficits. These injuries may lead to irreversible disabilities in patients, such as sensory loss, deficient motor function, pain problems in terms of cold intolerance and hyperesthesia that can ultimately impair hand function, and affect quality of life at work and in society (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Cervical and Upper Limb Peripheral Nerve Injuries in Adults: Electrodiagnostic Studies and Symptoms

Eftekharsadat¹,

Babaei-Ghazani²,

Samadirad³

et al. 2017

Trauma Mon

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Background: Peripheral nerve injury (PNI), due to upper extremity and cervical trauma could impair hand function, as well as affect quality of life at work and in society. Diagnosis and treatment of these patients is important Objectives: In this study we aim to evaluate clinical symptoms and electrodiagnostic findings in traumatic upper extremity PNI. Methods: A total of 106 traumatic patients with any clinical doubt of upper extremity peripheral nerve injuries were recruited and completed a physical examination. In addition, an electrodiagnostic study was performed to investigate detailed pattern of nerve lesions.

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Peripheral nerve conduits: technology update

Cited by 136 publications

References 146 publications

Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats

Polyethylene glycol treated allografts not tissue matched nor immunosuppressed rapidly repair sciatic nerve gaps, maintain neuromuscular functions, and restore voluntary behaviors in female rats

Fibrin glue as a stabilization strategy in peripheral nerve repair when using porous nerve guidance conduits

Cervical and Upper Limb Peripheral Nerve Injuries in Adults: Electrodiagnostic Studies and Symptoms

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