Transection of peripheral nerves, bridging strategies and effect evaluation

Disruption of peripheral nerves due to trauma is a frequently occurring clinical problem. Gaps in the nerve are bridged by guiding the regenerating nerves along autologous grafts or artificial guides. This review gives an overview on the different methods of nerve repair techniques. Conventional sut...

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Bibliographic Details
Published in:Biomaterials 2004-04, Vol.25 (9), p.1583-1592
Main Authors: IJkema-Paassen, J., Jansen, K., Gramsbergen, A., Meek, M.F.
Format: Article
Language:English
Subjects:
Absorbable Implants
Animals
Biodegradable nerve guide
Disease Models, Animal
Humans
Nerve Regeneration - physiology
Nerve transection
Peripheral Nerve Injuries
Peripheral Nerves - growth & development
Peripheral Nerves - surgery
Peripheral Nerves - transplantation
Prognosis
Rat
Reinnervation
Sciatic nerve
Transplants
Treatment Outcome
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Summary:Disruption of peripheral nerves due to trauma is a frequently occurring clinical problem. Gaps in the nerve are bridged by guiding the regenerating nerves along autologous grafts or artificial guides. This review gives an overview on the different methods of nerve repair techniques. Conventional suturing techniques are discussed as well as the use of e.g. biological, synthetic, non-degradable or degradable nerve guides. Functional assessment showed that repair of a gap with a bio-degradable guide is superior to that with autologous grafts. But still, long lasting changes were observed in the Sciatic Function Index (SFI), abnormal walking patterns, disturbed Electro Myo Graphic (EMG) patterns, next to shifts in the histochemical properties of the muscles and longlasting abnormalities in neuromuscular contacts. These phenomena are explained by an at-random reinnervation. When transecting the nerve at young ages, this did not lead to enhanced recovery. Rearing rats operated at adult age in an enriched environment, also had no beneficial effect. Future research should aim at developing longer guides, possibly lined with Schwann cells, or additives, improving specific reinnervation of the former target areas.
ISSN:0142-9612
1878-5905
DOI:10.1016/S0142-9612(03)00504-0