Update on nerve repair by biological tubulization

Geuna, Stefano; Tos, Pierluigi; Titolo, Paolo; Ciclamini, Davide; Beningo, Teresa; Battiston, Bruno

doi:10.1186/1749-7221-9-3

Cited by 33 publications

(30 citation statements)

References 84 publications

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“…Several authors defend the use of venous grafts in the repair of peripheral nerve gaps, justified by the ease of access without damage to the patient, abundance of calibers and donor sites, besides not presenting a financial cost [11][12][13] .…”

Section: ■ Introductionmentioning

confidence: 99%

“…Although this technique has a favorable result, it presents as main negative factors: the limitation of calibers, lengths and areas of donor nerves and secondary morbidity [6][7][8] . In this sense, the tubulization technique has been shown to be an appropriate and alternative method in clinical practice, which consists of the fixation of a tubular segment, which may be of biological or synthetic origin, between the stumps of the injured nerve, providing direction and favorable environment to regeneration 9,10 .Several authors defend the use of venous grafts in the repair of peripheral nerve gaps, justified by the ease of access without damage to the patient, abundance of calibers and donor sites, besides not presenting a financial cost [11][12][13] .Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis Bueno CRS et al Acta Cir Bras.…”

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Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis

et al. 2017

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Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis 1 4-Experimental SurgeryActa Cir Bras. 2017;32(3):287-296 Abstract Purpose: To compare the functional result of standart vein grafts and inside-out vein graft technique on sciatic nerve repair. Methods: We used 24 male Wistar rats divided into 4 groups: control group (CG), standard vein graft group (SVG), Inside-out vein graft group (IOVG) and denervated Group (DG). SVG, IOVG and DG underwent total section of the sciatic nerve, SVG and IOVG however underwent nerve repair surgery using a graft with normal jugular vein and inside-out jugular vein, respectively. Histological analysis of the soleus and Extensor Digitorum Longus (EDL), and Sciatic Functional Index were used to compare the results after 6 weeks. Results: Both grafts acted favorably in muscle recovery and improved functionality; They were similar in all parameters, however, in more points SVG achieved similar to the CG, in the other hand IOVG more times was similar to DG. Fact that makes the graft with normal vein the most viable option between the two options. Conclusion: Both types of grafts acted beneficially wherein the graft normal vein has proved to be the best option 287Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis Bueno CRS et al. Acta Cir Bras. 2017;32(3):287-296 288 For this purpose, the adhesion of the rat as an animal model was based on the fact that its physiological profile, its morphological structure and the biological processes involved in the nerve regeneration are quite similar to that of the human being, being a suitable model for this investigation 14 . The purpose of this study was to compare the muscular and functional results after sciatic nerve repair with the tubulization technique using the normal vein graft and the reverse vein graft, in order to determine the most favorable surgical option. ■ MethodsThe study was approved under the protocol 032/2011 by the Ethics Committee, Faculty of Dentistry of Bauru, Universidade de São Paulo.Were used twenty-four male Wistar rats with 60 days of life in collective storage, with no restrictions on movement, respecting cycles of 12 hours of light / dark and average ambient temperature of 24°C. The animals were divided into four groups (n=6 each). Control Group (CG) and three experimental groups: Denervate Group (DG), Inside-Out Vein Graft (IOVG) and Standart Vein Graft (SVG). In all groups the right pelvic limb was used for the experimental study. The IOVG and SVG groups received autologous venous graft from the left jugular vein, but for the IOVG group, the jugular vein was inverted. Surgical proceduresThe animals were anesthetized with a combination of Ketamine Hydrochloride (Dopalen ® ) and Xilazine Hydrochloride (Anasedan ® ), administered intramuscularly at a dose of 0.10 ml/100g body weight in the dorsolateral region of the left hind paw. Subsequen...

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Section: ■ Introductionmentioning

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Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis

et al. 2017

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“…The muscle auto-grafts are abundant in individuals and display a longitudinally oriented basal lamina similar to peripheral nerves (13,17). However, fresh muscle is not suitable for immediate grafting because it contains muscle fibres that direct the nerve fibres to grow in different directions (7,8).…”

Section: Discussionmentioning

confidence: 99%

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

et al. 2017

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Background:Autologous nerve grafts are used to bridge peripheral nerve defects. Limited sources and donor site morbidity are the major problems with peripheral nerve grafts. Although various types of autologous grafts such as arteries, veins and muscles have been recommended, an ideal conduit has not yet been described.Aims:To investigate the effectiveness of a small intestinal conduit for peripheral nerve defects.Study Design:Animal experimentation.Methods:Twenty-one rats were divided into three groups (n=7). Following anaesthesia, sciatic nerve exploration was performed in the Sham group. The 10 mm nerve gap was bridged with a 15 mm ileal segment in the small intestinal conduit group and the defect was replaced with orthotopic nerve in autologous nerve graft group. The functional recovery was tested monthly by walking-track analysis and the sciatic functional index. Histological evaluation was performed on the 12th week.Results:Sciatic functional index tests are better in autologous nerve graft group (-55.09±6.35); however, during follow-up, progress in sciatic functional index was demonstrated, along with axonal regeneration and innervation of target muscles in the small intestinal conduit group (-76.36±12.08) (p<0.05). In histologic sections, distinctive sciatic nerve regeneration was examined in the small intestinal conduit group. The expression of S-100 and neurofilament was observed in small intestinal conduit group but was less organised than in the autologous nerve graft group. Although the counted number (7459.79±1833.50 vs. 4226.51±1063.06 mm2), measured diameter [2.19 (2.15-2.88) vs. 1.74 (1.50-2.09) µm] and myelin sheath thickness [1.18 (1.09-1.44) vs. 0.66 (0.40-1.07) µm] of axons is significantly high in the middle sections of autologous nerve graft compared to the small intestinal conduit group, respectively (p<0.05), the peripheral nerve regeneration was also observed in the small intestinal conduit group.Conclusion:Small intestinal conduit should not be considered as an alternative to autologous nerve grafts in its current form; however, the results are promising. Even though the results are no better than autologous nerve grafts, with additional procedures, it might be a good alternative due to harvesting abundant sources without donor site morbidity.

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“…Peripheral nerves, composed of motor and sensory neurons, are considered as complex organs and are present in nearly all parts of the human body [2]. Motor neurons transmit processed information from the central nervous systems (CNS) to skeletal muscles via efferent pathways, whereas collected information from periphery travels to the brain via afferent pathways, after they are translated into nerve signals [3].…”

Section: Introductionmentioning

confidence: 99%

The Role of Pharmacological Agents in Nerve Regeneration after Peripheral Nerve Repair

Mekaj¹

2017

Peripheral Nerve Regeneration - From Surgery to New Therapeutic Approaches Including Biomaterials and Cell-Based Therapies Deve

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Peripheral nerve injuries are frequent and represent a significant pathology of the peripheral nervous system because, despite operative techniques and successful microsurgical repair, in most cases, the nerve repair is followed by scar formation. Numerous investigations have been carried out with the aim of finding pharmacological substances that can prevent scar formation and speed up the regeneration of repaired nerves. This chapter is dedicated to the efforts of many researchers to find different pharmacological agents with local effects on the improvement of nerve regeneration. Numerous experiments have been carried out in mice and rabbits using hyaluronic acid, tacrolimus, cyclosporin A, melatonin, vitamin B12, methylprednisolone, riluzole and potassium and calcium channel blockers. In the experimental animal studies, topical pharmacological agents were used at the site of peripheral nerve repair. The effect of these substances is most commonly studied in sciatic nerve injury in experimental animals. Their effects were evaluated using a variety of methods, such as morphological, biomechanical, electrophysiological and functional evaluation, and the above-mentioned substances, have been shown to have neuroprotective and neuroregenerative properties though different mechanisms.

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Update on nerve repair by biological tubulization

Cited by 33 publications

References 84 publications

Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis

Comparative study between standard and inside-out vein graft techniques on sciatic nerve repair of rats. Muscular and functional analysis

Can a Small Intestine Segment Be an Alternative Biological Conduit for Peripheral Nerve Regeneration?

The Role of Pharmacological Agents in Nerve Regeneration after Peripheral Nerve Repair

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