Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the progno...Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, including a novel internal fixator device that enables rapid and distal reconnection of proximal and distal nerve stumps.展开更多
A(very)brief history of tension in nerve repair:Successful nerve repair is achieved by conveying as many axons successfully to their targets as possible.Typically,this is best achieved through a direct end-to-end repa...A(very)brief history of tension in nerve repair:Successful nerve repair is achieved by conveying as many axons successfully to their targets as possible.Typically,this is best achieved through a direct end-to-end repair under minimal tension(Millesi,1986).However,this is not feasible in most cases of trauma,where a segment of tissue damage must be excised and overcome.This has most commonly been addressed with the use of nerve grafts to bridge the gap.Autologous nerve grafts are considered the gold standard,with allograft or synthetic substitutes demonstrating some success over shorter distances.Despite their utility,autologous grafts pose challenges of their own.These include functional deficit in the donor distribution(typically sensory),extended operative duration,additional scarring,and a lack of intrinsic blood supply.They are also a poor anatomical match for the stumps being bridged,both internally(disparate neuronal size and composition)as well as externally(often requiring cabled bundles to approximate the caliber of the nerve being repaired).Finally,unlike end-to-end repairs,autologous grafts also require axons to traverse a second repair interface,where a large proportion of axons are lost across the anatomical discontinuity.展开更多
基金supported by a grant from Department of Defense(W81XWH-10-1-0773)National Science Foundation(CBET1042522)a grant from the National Skeletal Muscle Research Center at UCSD
文摘Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, including a novel internal fixator device that enables rapid and distal reconnection of proximal and distal nerve stumps.
基金supported by Department of Defense/CDMRP Award#W81XWH2010510(to SBS)。
文摘A(very)brief history of tension in nerve repair:Successful nerve repair is achieved by conveying as many axons successfully to their targets as possible.Typically,this is best achieved through a direct end-to-end repair under minimal tension(Millesi,1986).However,this is not feasible in most cases of trauma,where a segment of tissue damage must be excised and overcome.This has most commonly been addressed with the use of nerve grafts to bridge the gap.Autologous nerve grafts are considered the gold standard,with allograft or synthetic substitutes demonstrating some success over shorter distances.Despite their utility,autologous grafts pose challenges of their own.These include functional deficit in the donor distribution(typically sensory),extended operative duration,additional scarring,and a lack of intrinsic blood supply.They are also a poor anatomical match for the stumps being bridged,both internally(disparate neuronal size and composition)as well as externally(often requiring cabled bundles to approximate the caliber of the nerve being repaired).Finally,unlike end-to-end repairs,autologous grafts also require axons to traverse a second repair interface,where a large proportion of axons are lost across the anatomical discontinuity.
