RESUMO
INTRODUCTION: Isolated musculocutaneous nerve injuries occur rarely due to their anatomical location. We present our patient with a musculocutaneous nerve injury in a motorcyclist. CASE: The patient was initially treated for a motorcycle accident. Further examination of the patient revealed impaired elbow flexion and numbness of the lateral forearm. Electromyography confirmed impaired function of the musculocutaneous nerve. After 3 months, the patient's condition did not show any improvement, neither electromyography confirmed recovery of the nerve activity, so surgical treatment was planned. In the surgical revision, neuroma-in-continuity was discovered and resected. The resulting nerve defect was 6â cm long. We provided nerve grafting using sural nerve from the right lower limb. After surgery, the patient began physical therapy and electrical stimulation. Two years later, the patient reached complete recovery of muscle strength. CONCLUSION: Due to the lack of improvement after a 3-month period, we proceeded with a surgical revision, which demonstrated a complete lesion of the nerve that could not heal spontaneously. Therefore, we opted for the nerve graft method and the patient regained full function of elbow flexors.
Assuntos
Acidentes de Trânsito , Motocicletas , Nervo Musculocutâneo , Humanos , Nervo Musculocutâneo/lesões , Nervo Musculocutâneo/cirurgia , Masculino , Adulto , Traumatismos dos Nervos Periféricos/cirurgia , Nervo Sural/transplanteRESUMO
Background: The hamstring autograft can be harvested using various skin incisions, such as vertical, transverse, and oblique incisions, and from different localizations, including anteromedial and posteromedial harvest sites. The aim of this study was to compare studies on the anteromedial and posteromedial approaches for hamstring autograft harvest in terms of clinical outcomes, saphenous nerve injury, infection, operative time, graft length, incision length, range of motion, and patient satisfaction. Methods: Following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a search was conducted in PubMed and Scopus, focusing on studies comparing anteromedial and posterior approaches for hamstring harvest. This study was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42023450249). Methodological quality was evaluated using the Modified Coleman Methodology Score. Odds ratios (ORs) and mean differences (MDs) quantified dichotomous and continuous outcomes, respectively. Results: Five articles, involving 405 knees, underwent analysis. Four studies were level 3 evidence, while 1 was level 1. The anteromedial hamstring harvest showed higher rates of saphenous nerve injury (OR, 9.77; 95% confidence interval [CI], 2.19-43.65; p = 0.003) and longer operative times, with an MD of about 13 minutes (MD, 13.33; 95% CI, 0.68-25.97; p = 0.04), compared to the posteromedial approach. The anteromedial method yielded a longer semitendinosus graft, with an MD of about 17 mm (MD, 17.57; 95% CI, 7.17-27.98; p = 0.0009). However, no significant differences existed in range of motion, flexion contracture, unintentional graft harvest, infection rates, and patient-reported outcomes. Notably, the posteromedial group reported higher cosmetic satisfaction, with 92% being very satisfied, compared to the anteromedial group with 80% (p = 0.005). However, overall satisfaction levels were similar between the 2 groups (p = 0.35), with a very satisfied rate of 72% for the anteromedial group and 78% for the posteromedial group. Conclusions: The anteromedial hamstring harvest showed greater saphenous nerve injury and longer operative times compared to the posteromedial approach, along with a longer graft. However, no significant differences were observed in the range of motion, flexion contracture, graft harvest, infection, or patient outcomes.
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Autoenxertos , Músculos Isquiossurais , Humanos , Coleta de Tecidos e Órgãos/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Transplante AutólogoRESUMO
Peripheral nerve injuries are common and remain a significant health challenge. Outcome measurements are used to evaluate injury, monitor recovery after nerve repair, and compare scientific advances. Clinical judgement is required to determine which available tools are most applicable, which requires a vast understanding of the available outcome measurements. In this article we discuss the highest yield tools available for clinical application.
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Traumatismos dos Nervos Periféricos , Humanos , Traumatismos dos Nervos Periféricos/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Avaliação da Deficiência , Recuperação de Função FisiológicaRESUMO
BACKGROUND: Traumatic peripheral nerve injury, with an annual incidence reported to be approximately 13-23 per 100,000 people, is a serious clinical condition that can often lead to significant functional impairment and permanent disability. Although nerve transfer has become increasingly popular in the treatment of brachial plexus injuries, satisfactory results cannot be obtained even with total nerve root transfer, especially after serious injuries. To overcome this problem, we hypothesize that the application of stem cells in conjunction with nerve transfer procedures may be a viable alternative to more aggressive treatments that do not result in adequate improvement. Similarly, some preliminary studies have shown that adipose stem cells combined with acellular nerve allograft provide promising results in the repair of brachial plexus injury. The purpose of this study was to assess the efficacy of combining adipose-derived stem cells with nerve transfer procedure in a rat brachial plexus injury model. METHODS: Twenty female Wistar rats weighing 300-350 g and aged 8-10 weeks were randomly divided into two groups: a nerve transfer group (NT group) and a nerve transfer combined adipose stem cell group (NT and ASC group). The upper brachial plexus injury model was established by gently avulsing the C5-C6 roots from the spinal cord with microforceps. A nerve transfer from the ulnar nerve to the musculocutaneous nerve (Oberlin procedure) was performed with or without seeded allogeneic adipose tissue-derived stem cells. Adipose tissue-derived stem cells at a rate of 2 × 106 cells were injected locally to the surface of the nerve transfer area with a 23-gauge needle. Immunohistochemistry (S100 and PGP 9.5 antibodies) and electrophysiological data were used to evaluate the effect of nerve repair 12 weeks after surgery. RESULTS: The mean latency was significantly longer in the NT group (2.0 ± 0.0 ms, 95% CI: 1.96-2.06) than in the NT and ASC group (1.7 ± 0.0 ms, 95% CI: 1.7-1.7) (p < .001). The mean peak value was higher in the NT group (1.7 ± 0.0 mV, 95% CI: 1.7-1.7) than in the NT and ASC group (1.7 ± 0.3 mV, 95% CI: 1.6-1.9) with no significant difference (p = .61). Although S100 and PGP 9.5 positive areas were observed in higher amounts in the NT and ASC group compared to the NT group, the differences were not statistically significant (p = .26 and .08, respectively). CONCLUSIONS: This study conducted on rats provides preliminary evidence that adipose-derived stem cells may have a positive effect on nerve transfer for the treatment of brachial plexus injury. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
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Tecido Adiposo , Plexo Braquial , Modelos Animais de Doenças , Nervo Musculocutâneo , Regeneração Nervosa , Transferência de Nervo , Ratos Wistar , Nervo Ulnar , Animais , Ratos , Transferência de Nervo/métodos , Feminino , Regeneração Nervosa/fisiologia , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Nervo Musculocutâneo/cirurgia , Tecido Adiposo/citologia , Tecido Adiposo/transplante , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Nervo Ulnar/transplante , Transplante de Células-Tronco/métodos , Distribuição Aleatória , Neuropatias do Plexo Braquial/cirurgia , Traumatismos dos Nervos Periféricos/cirurgiaRESUMO
Processed nerve allograft is a widely accepted tool for reconstructing peripheral nerve defects. Repair parameters that need to be considered include gap length, nerve diameter, nerve type (motor, sensory, or mixed), and the soft tissue envelope. Although the use of processed nerve allograft must be considered based on each unique clinical scenario, a rough algorithm can be formed based on the available animal and clinical literature. This article critically reviews the current surgical algorithm, defines the role of processed nerve allograft compared with nerve autograft, and discusses how this role may change in the future.
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Aloenxertos , Nervos Periféricos , Humanos , Nervos Periféricos/transplante , Traumatismos dos Nervos Periféricos/cirurgia , Algoritmos , Transplante Homólogo , Regeneração NervosaRESUMO
Modern end-to-side (ETS) nerve transfers have undergone several permutations since the early 1990's. Preclinical data have revealed important mechanisms and patterns of donor axon outgrowth into the recipient nerves and target reinnervation. The versatility of ETS nerve transfers can also potentially address several processes that limit functional recovery after nerve injury by babysitting motor end-plates and/or supporting the regenerative environment within the denervated nerve. Further clinical and basic science work is required to clarify the ideal clinical indications, contraindications, and mechanisms of action for these techniques in order to maximize their potential as reconstructive options.
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Regeneração Nervosa , Transferência de Nervo , Humanos , Transferência de Nervo/métodos , Regeneração Nervosa/fisiologia , Traumatismos dos Nervos Periféricos/cirurgiaRESUMO
Axons successfully repaired with polyethylene glycol (PEG) fusion tecnology restored axonal continuity thereby preventing their Wallerian degeneration and minimizing muscle atrophy. PEG fusion studies in animal models and preliminary clinical trials involving patients with digital nerve repair have shown promise for this therapeutic approach. PEG fusion is safe to perform, and given the enormous potential benefits, there is no reason not to explore its therapeutic potential.
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Traumatismos dos Nervos Periféricos , Polietilenoglicóis , Humanos , Polietilenoglicóis/uso terapêutico , Polietilenoglicóis/administração & dosagem , Traumatismos dos Nervos Periféricos/cirurgia , Animais , Regeneração NervosaRESUMO
Functional recovery after peripheral nerve injuries is disappointing despite surgical advances in nerve repair. This review summarizes the relatively short window of opportunity for successful nerve regeneration due to the decline in the expression of growth-associated genes and in turn, the decline in regenerative capacity of the injured neurons and the support provided by the denervated Schwann cells, and the atrophy of denervated muscles. Brief, low-frequency electrical stimulation and post-injury exercise regimes ameliorate these deficits in animal models and patients, but the misdirection of regenerating nerve fibers compromises functional recovery and remains an important area of future research.
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Regeneração Nervosa , Traumatismos dos Nervos Periféricos , Regeneração Nervosa/fisiologia , Humanos , Traumatismos dos Nervos Periféricos/fisiopatologia , Traumatismos dos Nervos Periféricos/cirurgia , Animais , Células de Schwann/fisiologia , Recuperação de Função FisiológicaRESUMO
Nerve autografts involve the transplantation of a segment of the patient's own nerve to bridge a nerve gap. Autografts provide biological compatibility, support for axonal regeneration, and the ability to provide an anatomic scaffold for regrowth that other modalities may not match. Disadvantages of the autograft include donor site morbidity and the extra operative time needed to harvest the graft. Nevertheless, nerve autografts such as the sural nerve remain the gold standard in reconstructing nerve gaps, but a multitude of factors need to be favorable in order to garner reliable, consistent outcomes.
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Autoenxertos , Regeneração Nervosa , Nervo Sural , Humanos , Nervo Sural/transplante , Transplante Autólogo , Traumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/transplanteRESUMO
Electrical stimulation (ES) enhances peripheral nerve inherent regeneration capacity by promoting accelerated axonal outgrowth and selectivity toward appropriate motor and sensory targets. These effects lead to significantly improved functional outcomes and shorter recovery time. Electrical stimulation can be applied intra-operatively or immediately post-operatively. Active clinical trials are looking into additional areas of application, length of stimulation, and functional outcomes.
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Terapia por Estimulação Elétrica , Humanos , Regeneração Nervosa/fisiologia , Nervos Periféricos , Traumatismos dos Nervos Periféricos/cirurgia , Traumatismos dos Nervos Periféricos/terapiaRESUMO
Peripheral nerve injuries are prevalent and their treatments present significant challenges. Among the various reconstructive options, nerve conduits and wraps are popular choices. Advances in bioengineering and regenerative medicine have led to the development of new biocompatible materials and implant designs that offer the potential for enhanced neural recovery. Cost, nerve injury type, and implant size must be considered when deciding on the ideal reconstructive option.
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Materiais Biocompatíveis , Regeneração Nervosa , Traumatismos dos Nervos Periféricos , Humanos , Traumatismos dos Nervos Periféricos/cirurgia , Alicerces Teciduais , Bioengenharia , Regeneração Tecidual Guiada , Engenharia Tecidual , Próteses e ImplantesRESUMO
This article highlights the use of rodents as preclinical models to evaluate the management of nerve injuries, describing the pitfalls and value from rodent nerve injury and regeneration outcomes, as well as treatments derived from these rodent models. The anatomic structure, size, and cellular and molecular differences and similarities between rodent and human nerves are summarized. Specific examples of success and failure when assessing outcome metrics are presented for context. Evidence for translation to clinical practice includes the topics of electrical stimulation, Tacrolimus (FK506), and acellular nerve allografts.
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Modelos Animais de Doenças , Regeneração Nervosa , Traumatismos dos Nervos Periféricos , Animais , Traumatismos dos Nervos Periféricos/cirurgia , Traumatismos dos Nervos Periféricos/terapia , Regeneração Nervosa/fisiologia , Ratos , Pesquisa Translacional Biomédica , Humanos , Tacrolimo , Roedores , Terapia por Estimulação Elétrica , Imunossupressores , CamundongosRESUMO
Following nerve injury, growth factors (GFs) are transiently upregulated in injured neurons, proliferating Schwann cells, and denervated muscle and skin. They act on these same cells and tissues to promote nerve regeneration and end-organ reinnervation. Consequently, much attention has been focused on developing GF-based therapeutics. A major barrier to clinical translation of GFs is their short half-life. To provide sustained GF treatment to the affected nerve, muscle, and skin in a safe and practical manner, engineered drug delivery systems are needed. This review highlights recent advancements in GF-based therapeutics and discusses the remaining hurdles for clinical translation.
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Peptídeos e Proteínas de Sinalização Intercelular , Regeneração Nervosa , Regeneração Nervosa/fisiologia , Regeneração Nervosa/efeitos dos fármacos , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Traumatismos dos Nervos Periféricos/cirurgia , Traumatismos dos Nervos Periféricos/tratamento farmacológico , Traumatismos dos Nervos Periféricos/fisiopatologia , Animais , Sistemas de Liberação de MedicamentosRESUMO
PURPOSE: To evaluate the effects on peripheral neural regeneration of the end-to-side embracing repair technique compared to the autograft repair technique in Wistar rats. METHODS: Fifteen male Wistar rats were divided into three groups with five animals each: denervated group (GD), autograft group (GA), and embracing group (EG). For the evaluation, the grasping test, electroneuromyography (ENMG), and muscle weight assessment were used. RESULTS: Muscle weight assessment and ENMG did not show significant neural regeneration at the end of 12 weeks in the DG and GE groups, but only in GA. The grasping test showed an increase in strength between the surgery and the fourth week in all groups, and only the GA maintained this trend until the 12th week. CONCLUSIONS: The present study indicates that the neural regeneration observed in the end-to-side embracing neurorrhaphy technique, in the repair of segmental neural loss, is inferior to autograft repair in Wistar rats.
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Regeneração Nervosa , Ratos Wistar , Animais , Masculino , Regeneração Nervosa/fisiologia , Eletromiografia , Ratos , Procedimentos Neurocirúrgicos/métodos , Músculo Esquelético/inervação , Traumatismos dos Nervos Periféricos/cirurgia , Transplante Autólogo/métodos , Fatores de Tempo , Reprodutibilidade dos Testes , Nervo Isquiático/cirurgia , Nervo Isquiático/lesões , Nervo Isquiático/fisiologiaRESUMO
Complicated peripheral nerve injuries or defects, especially at branching sites, remain a prominent clinical challenge after the application of different treatment strategies. Current nerve grafts fail to match the expected shape and size for delicate and precise branched nerve repair on a case-by-case basis, and there is a lack of geometrical and microscale regenerative navigation. In this study, we develop a sugar painting-inspired individualized multilevel epi-/peri-/endoneurium-mimetic device (SpinMed) to customize natural cues, featuring a selectively protective outer sheath and an instructive core, to support rapid vascular reconstruction and consequent efficient neurite extension along the defect area. The biomimetic perineurium dictates host-guest crosslinking in which new vessels secrete multimerin 1 binding to the fibroin filler surface as an anchor, contributing to the biological endoneurium that promotes Schwann cell homing and remyelination. SpinMed implantation into rat sciatic nerve defects yields a satisfactory outcome in terms of structural reconstruction, with sensory and locomotive function restoration. We further customize SpinMed grafts based on anatomy and digital imaging, achieving rapid repair of the nerve trunk and branches superior to that achieved by autografts and decellularized grafts in a specific beagle nerve defect model, with reliable biosafety. Overall, this intelligent art-inspired biomimetic design offers a facile way to customize sophisticated high-performance nerve grafts and holds great potential for application in translational regenerative medicine.
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Regeneração Nervosa , Células de Schwann , Nervo Isquiático , Animais , Regeneração Nervosa/efeitos dos fármacos , Ratos , Nervo Isquiático/lesões , Nervo Isquiático/fisiologia , Células de Schwann/metabolismo , Cães , Traumatismos dos Nervos Periféricos/terapia , Traumatismos dos Nervos Periféricos/cirurgia , Ratos Sprague-Dawley , Masculino , Alicerces Teciduais/química , Materiais Biomiméticos/química , Materiais Biomiméticos/farmacologia , Biomimética/métodos , Fibroínas/química , Fibroínas/farmacologia , Engenharia Tecidual/métodosRESUMO
INTRODUCTION: The main objective of the current study is to investigate variations in postoperative outcomes that follow digital nerve repair in Zone 1 and Zone 2, respectively. We hope that by carrying out this investigation, we will be able to identify which zone has better sensation recovery and patient-reported outcomes, allowing us to identify the best way of conducting surgery for specific types of injuries. MATERIALS AND METHODS: A retrospective cohort study was conducted in patients with digital nerve injuries treated in a designated hand surgery clinic between January 2021 and December 2023. The study was guided by ethical consideration, where all participants gave their informed consent. Surgical interventions involved primary repair, autograft/allograft nerve grafting, nonsurgical approaches, as well as conduit repair in which results were determined using objective measures and patient feedback. RESULTS: Direct repair emerged superior among injuries of Zone 1 and Zone 2 with high success rates and good patient-reported outcomes. In general, injuries in Zone 1 had better sensory recovery than injuries in Zone 2 and this was associated with higher levels of satisfaction. Comparisons using statistical methods confirmed that direct repair outperformed other modalities. CONCLUSION: More importantly, the comparison of this study shows that repairs in Zone 1 are more successful than those in Zone 2 revealing direct repair as a superior method for digital nerve injuries. The difference is crucial because it suggests that surgical efficiency may depend on where the injury is. This means that direct repair should be given priority over the two zones, although surgeons will need to watch out for challenges related to Zone 2 injuries and adjust their strategies accordingly to obtain the best patient outcomes possible.
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Traumatismos dos Dedos , Traumatismos dos Nervos Periféricos , Humanos , Estudos Retrospectivos , Masculino , Traumatismos dos Nervos Periféricos/cirurgia , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Estudos de Coortes , Adulto Jovem , Procedimentos Neurocirúrgicos/métodos , Recuperação de Função Fisiológica , Satisfação do Paciente , Resultado do Tratamento , Idoso , AdolescenteRESUMO
BACKGROUND: High ulnar nerve injuries is known to have unfavorable motor outcomes compared to other peripheral nerve injuries in the upper extremity. Functional muscle recovery after peripheral nerve injury depends on the time to motor end plate reinnervation and the number of motor axons that successfully reach the target muscle. The purpose of this study is to assess the functional recovery, and complications following performing supercharge end-to-side (SETS) anastomosis for proximal ulnar nerve injuries. Our study focuses on the role of SETS in the recovery process of high ulnar nerve injury. PATIENT AND METHODS: This study is a prospective, single-arm, open-label, case series. The original proximal nerve pathology was dealt with according to the cause of injury, then SETS was performed distally. The follow-up period was 18 months. We compared the neurological findings before and after the procedure. A new test was used to show the effect of SETS on recovery by performing a Lidocaine proximal ulnar nerve block test. RESULTS: Recovery of the motor function of the ulnar nerve was evident in 33 (86.8%) patients. The mean time to intrinsic muscle recovery was 6.85 months ± 1.3, only 11.14% of patients restored protective sensation to the palm and finger and 86.8% showed sensory level at the wrist level at the end of the follow-up period. Lidocaine block test was performed on 35 recovered patients and showed no change in intrinsic hand function in 31 patients. CONCLUSION: SETS exhibit a remarkable role in the treatment of high ulnar nerve damage. SETS transfer can act as a nerve transfer that can supply intrinsic muscles by its fibers and allows for proximal nerve regeneration. We believe that this technique improves recovery of hand motor function and allows recovery of sensory fibers when combined with treating the proximal lesion. TRIAL REGISTRATION: Approved by Research Ethics Committee of Faculty of Medicine- Cairo University on 01/09/2021 with code number: MD-215-2021.
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Transferência de Nervo , Recuperação de Função Fisiológica , Nervo Ulnar , Humanos , Estudos Prospectivos , Nervo Ulnar/lesões , Nervo Ulnar/cirurgia , Adulto , Masculino , Feminino , Transferência de Nervo/métodos , Pessoa de Meia-Idade , Adulto Jovem , Traumatismos dos Nervos Periféricos/cirurgia , Traumatismos dos Nervos Periféricos/etiologia , Traumatismos dos Nervos Periféricos/fisiopatologia , Resultado do Tratamento , Seguimentos , Regeneração Nervosa/fisiologia , AdolescenteRESUMO
BACKGROUND: Entrapment or injury of the lateral femoral cutaneous nerve (LFCN) is being recognized with increasing frequency, often requiring a surgical approach to relieve symptoms. The presence of anatomic variations can lead to errors in diagnosis and intraoperative decision-making. METHODS: This study presents the experience of a single surgeon (T.W.T.) in managing 184 patients referred with clinical issues related to the LFCN. A comprehensive review of these cases was conducted to develop a prospective surgical management algorithm. Data on the LFCN's anatomic course, pain relief outcomes, comorbidities, body mass index, and sex were extracted from patients' medical charts and operative notes. Pain relief was assessed subjectively, categorized into "excellent relief" for complete pain resolution, "good" for substantial pain reduction with some residual discomfort, and "failure" for cases with no pain relief necessitating reoperation. RESULTS: The decision tree is dichotomized based on the mechanism of LFCN pathology: compression (requiring neurolysis) versus history of trauma, surgery, and/or obesity (requiring resection). Forty-seven percent of the patients in this series had an anatomic variation. It was found that failure to relieve symptoms of compression often indicated the presence of anatomic variation of the LFCN or intraneural changes consistent with a neuroma, even if adequate decompression was achieved. With respect to pain relief as the outcome measure, recognition of LFCN anatomic variability and use of this algorithm resulted in 75% excellent results, 10% good results, and 15% failures. Twenty-seven of the 36 failures originally had neurolysis as the surgical approach. Twelve of those failures had a second surgery, an LFCN neurectomy, resulting in 10 excellent, 1 good, and 1 persistent failure. CONCLUSION: This article establishes an algorithm for the surgical treatment of MP, incorporating clinical experience and anatomical insights to guide treatment decisions. Criteria for considering neurectomy may include a history of trauma, prior local surgery, anatomical LFCN variations, and severe nerve damage due to chronic compression.
Assuntos
Nervo Femoral , Síndromes de Compressão Nervosa , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Síndromes de Compressão Nervosa/cirurgia , Nervo Femoral/cirurgia , Nervo Femoral/lesões , Algoritmos , Neuropatia Femoral/cirurgia , Resultado do Tratamento , Idoso , Descompressão Cirúrgica/métodos , Estudos Retrospectivos , Árvores de Decisões , Traumatismos dos Nervos Periféricos/cirurgia , Medição da Dor , Procedimentos Neurocirúrgicos/métodosRESUMO
As one of the common traumatic diseases in clinical practice, peripheral nerve injury (PIN) often causes nerve pain, abnormal reflexes, autonomic disorders, and even sensorimotor disorders due to the slow regeneration rate after injury, which seriously affects body function. Even as the gold standard of treatment, autologous nerve transplantation has limitations such as limited donor area and donor injury, which greatly limits its clinical application effect. Therefore, the preparation of artificial nerve grafts suitable for clinical practice has become the future development trend of peripheral nerve injury treatment, and the repair of injury defects and the promotion of nerve regeneration have also become research hotspots in tissue engineering and regenerative medicine. In recent years, extensive research has been carried out on nerve guidance conduits (NGCs) in the field of nerve regeneration and repair, in which scaffold materials and internal fillers have also become the focus of research as the core elements of neural catheters, and a series of achievements have been made in the application of new materials, embedding stem cells/precursor cells, and developing trophic factors and drug-loaded sustained-release systems. Therefore, this paper focuses on the application progress of hydrogel and its related derivative materials in the field of peripheral nerve injury repair, and provides new ideas for promoting the related research of tissue engineering and clinical medicine.
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Hidrogéis , Regeneração Nervosa , Traumatismos dos Nervos Periféricos , Traumatismos dos Nervos Periféricos/terapia , Traumatismos dos Nervos Periféricos/cirurgia , Humanos , Regeneração Nervosa/efeitos dos fármacos , Animais , Engenharia Tecidual/métodosRESUMO
Optimal recovery of muscle function after proximal nerve injuries remains a complex and challenging problem. After a nerve injury, alterations in the affected muscles lead to atrophy, and later degeneration and replacement by fat-fibrous tissues. At present, several different strategies for the preservation of skeletal muscle have been reported, including various sets of physical exercises, muscle massage, physical methods (e.g. electrical stimulation, magnetic field and laser stimulation, low-intensity pulsed ultrasound), medicines (e.g. nutrients, natural and chemical agents, anti-inflammatory and antioxidants, hormones, enzymes and enzyme inhibitors), regenerative medicine (e.g. growth factors, stem cells and microbiota) and surgical procedures (e.g. supercharge end-to-side neurotization). The present review will focus on methods that aimed to minimize the damage to muscles after denervation based on our present knowledge.