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Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascic...

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Autores principales: Gordon, Tessa, Eva, Placheta, Borschel, Gregory H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660729/
https://www.ncbi.nlm.nih.gov/pubmed/26692833
http://dx.doi.org/10.4103/1673-5374.167747
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author Gordon, Tessa
Eva, Placheta
Borschel, Gregory H.
author_facet Gordon, Tessa
Eva, Placheta
Borschel, Gregory H.
author_sort Gordon, Tessa
collection PubMed
description Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges) into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ‘protect’ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.
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spelling pubmed-46607292015-12-11 Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration Gordon, Tessa Eva, Placheta Borschel, Gregory H. Neural Regen Res Invited Review Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges) into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ‘protect’ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries. Medknow Publications & Media Pvt Ltd 2015-10 /pmc/articles/PMC4660729/ /pubmed/26692833 http://dx.doi.org/10.4103/1673-5374.167747 Text en Copyright: © Neural Regeneration Research http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Invited Review
Gordon, Tessa
Eva, Placheta
Borschel, Gregory H.
Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title_full Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title_fullStr Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title_full_unstemmed Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title_short Delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
title_sort delayed peripheral nerve repair: methods, including surgical ‘cross-bridging’ to promote nerve regeneration
topic Invited Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4660729/
https://www.ncbi.nlm.nih.gov/pubmed/26692833
http://dx.doi.org/10.4103/1673-5374.167747
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