|
1
|
Ueno M, Tanaka K, Murakami K, Ishida N. The Great Auricular Nerve as a Nerve Graft Donor: An Anatomical and Clinical Study of the Maximum Harvestable Length and Branches. Microsurgery 2025; 45:e70078. [PMID: 40481754 PMCID: PMC12144926 DOI: 10.1002/micr.70078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Revised: 03/23/2025] [Accepted: 05/29/2025] [Indexed: 06/11/2025]
Abstract
BACKGROUND For immediate facial nerve reconstruction during head and neck tumor resection, a great auricular nerve (GAN) graft can be potentially harvested in the same surgical field during tumor resection. However, it is often avoided because a GAN graft is only approximately 5 cm long without any branches, and a sural nerve graft is recommended for larger defects. We investigated the length of the GAN that can be harvested in 18 patients, along with the evaluation of postoperative facial nerve palsy. METHODS We retrospectively analyzed 18 cases of immediate facial nerve reconstruction using the GAN from 2018 to 2023 at our hospital. In most cases, we traced the GAN to the back surface of the sternocleidomastoid and harvested the nerve graft immediately before the loops of the cervical nerve plexus or bifurcation into the phrenic nerve. This tracing method allowed the collection of a longer nerve graft with more branches. RESULTS The mean length of the harvested GAN was 8.16 cm (95% confidence interval 7.42-8.89 cm), with the longest graft being 10.5 cm. The GAN grafts had an average of 1.83 branches and were 1.76-2.23 mm in diameter. Three patients had two peripheral transected edges of the facial nerve, each of which was sutured with a branch of the GAN graft. Three patients had five-six peripheral edges and required additional nerve grafts, such as the sural nerve. Postoperative facial nerve palsy was grade III or IV by House-Brackmann and FNGS 2.0 in all cases. CONCLUSIONS For immediate facial nerve reconstruction, the GAN can be harvested in a length of at least 8 cm and few branches by sufficient dissection of the back surface of the sternocleidomastoid muscle, including its branches and other sensory nerves, with few complications.
Collapse
Affiliation(s)
- Mayu Ueno
- Reconstructive Plastic SurgeryInstitute of Science TokyoTokyoJapan
| | - Kentaro Tanaka
- Reconstructive Plastic SurgeryInstitute of Science TokyoTokyoJapan
| | - Kyoichi Murakami
- Reconstructive Plastic SurgeryInstitute of Science TokyoTokyoJapan
| | - Naoya Ishida
- Reconstructive Plastic SurgeryInstitute of Science TokyoTokyoJapan
| |
Collapse
|
|
2
|
Airapetian A, Bachmetjev B, Suchomlinov A. Anatomical Variations in the Formation of the Sural Nerve: A Pilot Study in a Sample of Lithuanian Cadavers. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:671. [PMID: 40282962 PMCID: PMC12029134 DOI: 10.3390/medicina61040671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Revised: 03/27/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: The sural nerve (SN) is a pure sensory nerve that supplies the lateral aspect of the ankle and foot. Its anatomical variability has been extensively documented, with multiple classifications describing its different formation patterns. The SN is commonly used for nerve grafting and is a critical structure in lower-limb surgeries. Due to its superficial course, it is vulnerable to iatrogenic injuries, particularly in procedures involving the Achilles tendon. The presence of anatomical variations in SN formation and trajectory has significant implications for surgical planning, diagnostics, and nerve conduction studies. Understanding these formation variations is essential to minimize surgical complications and optimize clinical outcomes. Materials and Methods: A pilot cross-sectional cadaveric study was conducted on nine formalin-fixed adult cadavers at the Department of Anatomy, Histology, and Anthropology, Vilnius University Faculty of Medicine, Lithuania. Standard dissection techniques were employed to examine the formation and trajectory of the SN. Morphometric parameters, including nerve diameter and length, were measured using an RS PTO Digital Caliper with 0.01 mm precision. Variations in SN formation were classified according to the system proposed by P.K. Ramakrishnan et al. Statistical analyses were performed using SPSS 26.0 and RStudio, with a significance threshold set at p ≤ 0.05. Results: The most prevalent SN formation variation observed in the Lithuanian cadaveric sample was Type 3, which was found in 8 out of 18 limbs (44.4%), while Type 6 was not identified. Additionally, a symmetric formation was observed bilaterally in 5 out of the 9 cadavers (55.6%). The SN was significantly thicker in two-contributor formations (3.17 mm) compared to single-contributor formations (1.93 mm, p = 0.001). The SN was also significantly longer in two-contributor formations (25.80 cm) than in single-contributor formations (18.96 cm, p = 0.016). No significant differences in SN morphology were found between left and right lower limbs. Conclusions: This study highlights the substantial anatomical variability of the SN in the Lithuanian population. The findings suggest a correlation between SN diameter and formation type, which may have clinical implications for nerve grafting and surgical planning. The predominance of Type 3 formation and the observed symmetry rate provide valuable anatomical insights for lower limb surgeries. Further large-scale studies are necessary to establish population-specific SN variations and their relevance in clinical practice.
Collapse
Affiliation(s)
- Artur Airapetian
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, LT-03101 Vilnius, Lithuania;
| | - Benedikt Bachmetjev
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, LT-03101 Vilnius, Lithuania;
| | - Andrej Suchomlinov
- Department of Anatomy, Histology and Anthropology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
- Division of Anatomy, Department of Surgery, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
| |
Collapse
|
|
3
|
Napiontek W, Oliva XM, Cárcamo-Aguilar F, Belling DA, Zárate Leal MF, Diaz Sanchez T. Sural nerve injury risk during endoscopic gastrocnemius recession: Comparison of two approaches. Foot Ankle Surg 2025:S1268-7731(25)00082-7. [PMID: 40169320 DOI: 10.1016/j.fas.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 02/20/2025] [Accepted: 03/24/2025] [Indexed: 04/03/2025]
Abstract
BACKGROUNDS The gastrocnemius recession was originally introduced as a method of treating isolated gastrocnemius contractures among pediatric population, however currently this procedure allows to treat various foot pathologies. Different modifications of open technique has been developed over the years and recently endoscopic approach become a widespread technique among many surgeons. It provides smaller incision and shorter operative time, however might be associated with the higher risk of sural nerve damage as a result of poor visualization. The aim of this study was to evaluate two different endoscopic approaches, introduced by Stryer and Lui, in terms of sural nerve injury. METHOD In 14 dissected legs the following measurements were assessed: 1) Distance between the sural nerve and cannula. 2) Distance to the sural nerve from the lateral portal and the medial portal when performing the Strayer technique. 3) Distance to the sural nerve from the lateral portal and the medial portal when performing the Lui technique. RESULT In both techniques the sural nerve was located dorsally to the cannula and no nerve damage was observed. In Lui technique the distance between cannula and the nerve was noticeably deeper than in Strayer method. CONCLUSION Both method of endoscopic gastrocnemius recession have similar risk of intraoperative sural nerve injury. Open method should always be considered as an alternative, especially for surgeons who lack experience in endoscopic procedures. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Wojciech Napiontek
- Department of Orthopaedics and Traumatology, S.T. Dąbrowski District Hospital, Puszczykowo, Poland.
| | - Xavier Martin Oliva
- Department of Anatomy and Human Embryology, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
| | - Felipe Cárcamo-Aguilar
- Traumatologo y Ortopedista, Universidad Católica de la Santísima Concepción, Alonso de Ribera 2850, Concepción 4090541, Chile
| | - Diego A Belling
- Hospital Nacional Daniel Alcides Carrión, Av. Guardia Chalaca 2176, Bellavista, Lima 07016, Peru
| | - Milán F Zárate Leal
- Fundación Valle del Lili, Departamento de Ortopedia y Traumatología, Cali, Colombia
| | - Tania Diaz Sanchez
- Molecular Oncology and Embriology Laboratory, Human Anatomy Unit, Faculty of Medicine and Health Sciences, University of Barcelona, Spain.
| |
Collapse
|
|
4
|
Hirtler L, Bussek V, Kleinberger M, Willegger M. Anterolateral and accessory anterolateral portals are safe to avoid subcutaneous nerve injury during subtalar arthroscopy-Definition of safe zones for standard lateral portals. Knee Surg Sports Traumatol Arthrosc 2025; 33:1147-1155. [PMID: 39342497 PMCID: PMC11848959 DOI: 10.1002/ksa.12463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 08/19/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE Injury to the superficial peroneal nerve (SPN) or the sural nerve (SN) is a common complication in subtalar arthroscopy. The purpose of this anatomical study was to evaluate the distance to surrounding subcutaneous nerves in the vicinity of three standard arthroscopic portals for subtalar joint arthroscopy and through actual portal placement for arthroscopic procedures, in order to define anatomical safe zones. METHODS Forty paired fresh-frozen foot-and-ankle specimens were used. Subtalar arthroscopy using a three-portal technique (anterolateral [AL], posterolateral [PL] and accessory anterolateral [AAL] portals) was performed. After completion of subtalar arthroscopy, the portals were marked, and all surrounding subcutaneous nerves, that is, the branches of the SPN and SN, were dissected. The distance of the nearest nerve at the level of the respective portal was measured and potential injury was recorded. RESULTS The nearest nerve at the level of the AL portal was the intermediate dorsal cutaneous nerve at a mean of 15.4 ± 5.1 mm medial to the portal. The nearest nerve at the level of the AAL portal was the lateral dorsal cutaneous nerve at a mean of 17.7 ± 4.8 mm, being lateral to the portal. The nearest nerve at the level of the PL portal was the SN at a mean of 6.7 ± 4.7 mm anterior to the portal. Based on the measurements, safe zones were defined. CONCLUSIONS Placement of the AL and AAL portals in subtalar arthroscopy is saved using standard anatomical landmarks and a thorough surgical technique. At the level of the PL portal, the SN is the most endangered structure in subtalar arthroscopy. Surgeons should be aware of the proximity of the SN to the PL portal and take the utmost care during portal placement and instrument insertion to avoid iatrogenic injury. The risk of nerve damage during portal placement may be reduced when positioning the portals in the defined safe zones. LEVEL OF EVIDENCE Not applicable.
Collapse
Affiliation(s)
- Lena Hirtler
- Division of Anatomy, Center for Anatomy and Cell BiologyMedical University of ViennaViennaAustria
| | - Vinzenz Bussek
- Division of Anatomy, Center for Anatomy and Cell BiologyMedical University of ViennaViennaAustria
| | - Markus Kleinberger
- Division of Anatomy, Center for Anatomy and Cell BiologyMedical University of ViennaViennaAustria
| | - Madeleine Willegger
- Department of Orthopedics and Trauma SurgeryMedical University of ViennaViennaAustria
| |
Collapse
|
|
5
|
Costa NN, dos Santos JF, Aranha MFDAC, Coelho EWF, Paes VLS, de Oliveira RDCS. Repair methods in peripheral nerves after traumatic injuries: a systematic literature review. Acta Cir Bras 2025; 40:e401225. [PMID: 40008718 PMCID: PMC11849802 DOI: 10.1590/acb401225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 11/14/2024] [Indexed: 02/27/2025] Open
Abstract
PURPOSE To identify and describe the most used surgical repair methods for traumatic injuries to peripheral nerves, as well as highlight the causes of trauma to peripheral nerves and the most prevalent traumatized nerves. METHODS This is a systematic literature review using the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The searches were carried out in PubMED, in the time window from January 2018 to December 2022. RESULTS In total, 3,687 articles were collected, of which, after applying the inclusion and exclusion filters and analyzing the risk of bias, 34 articles remained. It was observed that the age of the injury and type of nerve repair strongly influence the recovery of patients. The most identified trauma repair procedures were neurolysis, direct suturing, grafting, and nerve transfer. Among these four procedures, direct suturing is currently preferred. CONCLUSION Several repair methods can be used in peripheral nerve injuries, with emphasis on direct suturing. However, nerve transfer proves to be a differential in those cases in which repair is delayed or the first treatment options have failed, which shows that each method will be used according to the indication for each case.
Collapse
Affiliation(s)
- Naely Nobre Costa
- Universidade do Estado do Pará – Medical School – Belém (PA) – Brazil
| | | | | | | | | | | |
Collapse
|
|
6
|
Obeng E, Shen B, Wang W, Xie Z, Zhang W, Li Z, Yao Q, Wu W. Engineered bio-functional material-based nerve guide conduits for optic nerve regeneration: a view from the cellular perspective, challenges and the future outlook. Regen Biomater 2024; 12:rbae133. [PMID: 39776856 PMCID: PMC11703557 DOI: 10.1093/rb/rbae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 10/16/2024] [Accepted: 11/03/2024] [Indexed: 01/11/2025] Open
Abstract
Nerve injuries can be tantamount to severe impairment, standard treatment such as the use of autograft or surgery comes with complications and confers a shortened relief. The mechanism relevant to the regeneration of the optic nerve seems yet to be fully uncovered. The prevailing rate of vision loss as a result of direct or indirect insult on the optic nerve is alarming. Currently, the use of nerve guide conduits (NGC) to some extent has proven reliable especially in rodents and among the peripheral nervous system, a promising ground for regeneration and functional recovery, however in the optic nerve, this NGC function seems quite unfamous. The insufficient NGC application and the unabridged regeneration of the optic nerve could be a result of the limited information on cellular and molecular activities. This review seeks to tackle two major factors (i) the cellular and molecular activity involved in traumatic optic neuropathy and (ii) the NGC application for the optic nerve regeneration. The understanding of cellular and molecular concepts encompassed, ocular inflammation, extrinsic signaling and intrinsic signaling for axon growth, mobile zinc role, Ca2+ factor associated with the optic nerve, alternative therapies from nanotechnology based on the molecular information and finally the nanotechnological outlook encompassing applicable biomaterials and the use of NGC for regeneration. The challenges and future outlook regarding optic nerve regenerations are also discussed. Upon the many approaches used, the comprehensive role of the cellular and molecular mechanism may set grounds for the efficient application of the NGC for optic nerve regeneration.
Collapse
Affiliation(s)
- Enoch Obeng
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Baoguo Shen
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Zhenyuan Xie
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Wenyi Zhang
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Zhixing Li
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Qinqin Yao
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
| | - Wencan Wu
- State Key Laboratory of Ophthalmology, Optometry and Vision Science, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Eye Hospital, School of Ophthalmology & Optometry, Wenzhou Medical University, Wenzhou 325027, China
- Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vision, and Brain Health), Wenzhou, Zhejiang 325000, China
| |
Collapse
|
|
7
|
Tusnim J, Budharaju K, Grasman JM. Fabrication of ECM protein coated hollow collagen channels to study peripheral nerve regeneration. Sci Rep 2024; 14:16096. [PMID: 38997331 PMCID: PMC11245515 DOI: 10.1038/s41598-024-67046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/08/2024] [Indexed: 07/14/2024] Open
Abstract
Peripheral nerve injury is a prevalent clinical problem that often leads to lifelong disability and reduced quality of life. Although peripheral nerves can regenerate, recovery after severe injury is slow and incomplete. The current gold standard treatment, autologous nerve transplantation, has limitations including donor site morbidity and poor functional outcomes, highlighting the need for improved repair strategies. We developed a reproducible in vitro hollow channel collagen gel construct to investigate peripheral nerve regeneration (PNR) by exploring the influence of key extracellular matrix (ECM) proteins on axonal growth and regeneration. Channels were coated with ECM proteins: collagen IV, laminin, or fibronectin and seeded with dorsal root ganglia (DRG) collected from E16 rat embryos to compare the ability of the ECM proteins to enhance axonal growth. Robust axonal extension and Schwann cell (SC) infiltration were observed in fibronectin-coated channels, suggesting its superiority over other ECM proteins. Differential effects of ECM proteins on axons and SCs indicated direct growth stimulation beyond SC-mediated guidance. In vitro laceration injury modeling further confirmed fibronectin's superior pro-regenerative effects, showcasing its potential in enhancing axonal regrowth post-injury. Advancing in vitro modeling that closely replicates native microenvironments will accelerate progress in overcoming the limitations of current nerve repair approaches.
Collapse
Affiliation(s)
- Jarin Tusnim
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Karthik Budharaju
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA
| | - Jonathan M Grasman
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, 07102, USA.
| |
Collapse
|
|
8
|
Raveendran S, Thomas BP. Multiple Mini Incision Technique for Sural Nerve Harvest: When to Add a Fibular Incision Based on a New Surgical Classification. J Hand Microsurg 2024; 16:100047. [PMID: 38855519 PMCID: PMC11144649 DOI: 10.1055/s-0043-1771397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
Sural nerve is the most common nerve used as a source for nerve grafting. Open harvest with longitudinal incisions produces unsightly scars, and this have led to development of less invasive techniques using endoscopes, nerve stripper, and mini-incisions. Several anatomical classifications have also been proposed due to the variations in the anatomy of the sural nerve. A simple and practical surgicoanatomical classification of the sural nerve based on which we have refined our minimal access technique, the multiple mini-incision technique for sural nerve harvest is proposed. In this technique, the incisions required for harvest of the sural nerve are standardized and predictable. A fibular incision is required when the sural nerve has major contribution from the common peroneal nerve. We have found this a simpler and reliable technique of harvest of sural nerve in nerve reconstructive surgery.
Collapse
Affiliation(s)
- Sreekanth Raveendran
- Department of Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binu Prathap Thomas
- Department of Hand Surgery, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
|
9
|
Umansky D, Elzinga K, Midha R. Surgery for mononeuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:227-249. [PMID: 38697743 DOI: 10.1016/b978-0-323-90108-6.00012-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Advancement in microsurgical techniques and innovative approaches including greater use of nerve and tendon transfers have resulted in better peripheral nerve injury (PNI) surgical outcomes. Clinical evaluation of the patient and their injury factors along with a shift toward earlier time frame for intervention remain key. A better understanding of the pathophysiology and biology involved in PNI and specifically mononeuropathies along with advances in ultrasound and magnetic resonance imaging allow us, nowadays, to provide our patients with a logical and sophisticated approach. While functional outcomes are constantly being refined through different surgical techniques, basic scientific concepts are being advanced and translated to clinical practice on a continuous basis. Finally, a combination of nerve transfers and technological advances in nerve/brain and machine interfaces are expanding the scope of nerve surgery to help patients with amputations, spinal cord, and brain lesions.
Collapse
Affiliation(s)
- Daniel Umansky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, United States
| | - Kate Elzinga
- Division of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Rajiv Midha
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
|
10
|
Kannan R, Khajuria A, Davies DC, Rymer B, Nduka C, Koshima I. Sural communicating nerve for application as a vascularized nerve graft: A microneurovascular anatomic study in cadavers. Microsurgery 2023; 43:818-822. [PMID: 37226423 DOI: 10.1002/micr.31068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/23/2023] [Accepted: 05/17/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Sural nerve harvest causes paraesthesia to the lateral heel of the foot, which can debilitate those with already compromised proprioception. To circumvent this, we investigated an alternative donor nerve, branch of the lateral sural nerve complex called the sural communicating nerve (SCoNe), for its harvest and use as a vascularized nerve graft, in cadaver. METHODS The SCoNe was visualized by dissection in 15 legs from 8 human cadavers and the relationship of the SCoNe to the overall sural nerve complex was documented. The surface markings, dimensions, and the micro-neurovascular anatomy in the super-microsurgery range (up to 0.30 mm) of the SCoNe was recorded and analyzed. RESULTS SCoNe graft surface marking was confined within a triangle drawn between the fibular head laterally, the popliteal vertical midline medially and the tip of the lateral malleolus inferiorly. The proximal end of the SCoNe was situated at a mean intersection distance of 5 cm from both the fibular head and popliteal midline respectively. The mean length of the SCoNe was 226 ± 43 mm with a mean proximal diameter of 0.82 mm and mean distal diameter of 0.93 mm. In 53% of the cadavers, an arterial input was present in the proximal third of the SCoNe and veins were predominantly (87%) present in the distal third. In 46% and 20% of the 15 legs respectively, there was a nutrient artery and vein perfusing the SCoNe in its central segment. The external mean diameter of this artery was 0.60 ± 0.30 mm, while the vein was slightly larger with a mean diameter of 0.90 ± 0.50 mm. DISCUSSION SCoNe graft may preserve lateral heel sensation, compared to sural nerve harvest, pending clinical studies. It may have wide applications as a vascularized nerve graft, including being ideal as a vascularized cross-facial nerve graft because its nerve diameter is similar to the distal facial nerve branches. The accompanying artery is a good anastomotic match to the superior labial artery.
Collapse
Affiliation(s)
- Ruben Kannan
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Ankur Khajuria
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
- Kellogg College, University of Oxford, Oxford, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - D Ceri Davies
- Human Anatomy Unit, Imperial College London, London, UK
| | - Ben Rymer
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Charles Nduka
- Facial Palsy Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Isao Koshima
- Department of Plastic Surgery, Hiroshima University Hospital, Hiroshima, Japan
| |
Collapse
|
|
11
|
Xing WB, Wu ST, Wang XX, Li FY, Wang RX, He JH, Fu J, He Y. Potential of dental pulp stem cells and their products in promoting peripheral nerve regeneration and their future applications. World J Stem Cells 2023; 15:960-978. [PMID: 37970238 PMCID: PMC10631371 DOI: 10.4252/wjsc.v15.i10.960] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/07/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023] Open
Abstract
Peripheral nerve injury (PNI) seriously affects people's quality of life. Stem cell therapy is considered a promising new option for the clinical treatment of PNI. Dental stem cells, particularly dental pulp stem cells (DPSCs), are adult pluripotent stem cells derived from the neuroectoderm. DPSCs have significant potential in the field of neural tissue engineering due to their numerous advantages, such as easy isolation, multidifferentiation potential, low immunogenicity, and low transplant rejection rate. DPSCs are extensively used in tissue engineering and regenerative medicine, including for the treatment of sciatic nerve injury, facial nerve injury, spinal cord injury, and other neurodegenerative diseases. This article reviews research related to DPSCs and their advantages in treating PNI, aiming to summarize the therapeutic potential of DPSCs for PNI and the underlying mechanisms and providing valuable guidance and a foundation for future research.
Collapse
Affiliation(s)
- Wen-Bo Xing
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Shu-Ting Wu
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Xin-Xin Wang
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Fen-Yao Li
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Ruo-Xuan Wang
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Ji-Hui He
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Jiao Fu
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Yan He
- Institute of Regenerative and Translational Medicine, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- First Clinical College, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- Department of Stomatology, Tianyou Hospital, Wuhan University of Science and Technology, Wuhan 430000, Hubei Province, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, Wuhan 430022, Hubei Province, China.
| |
Collapse
|
|
12
|
Kehrer A, Hollmann KS, Klein SM, Anker AM, Tamm ER, Prantl L, Engelmann S, Knoedler S, Knoedler L, Ruewe M. Histomorphometry of the Sural Nerve for Use as a CFNG in Facial Reanimation Procedures. J Clin Med 2023; 12:4627. [PMID: 37510742 PMCID: PMC10380239 DOI: 10.3390/jcm12144627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Facial palsy (FP) is a debilitating nerve pathology. Cross Face Nerve Grafting (CFNG) describes a surgical technique that uses nerve grafts to reanimate the paralyzed face. The sural nerve has been shown to be a reliable nerve graft with little donor side morbidity. Therefore, we aimed to investigate the microanatomy of the sural nerve. Biopsies were obtained from 15 FP patients who underwent CFNG using sural nerve grafts. Histological cross-sections were fixated, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. The median age of the operated patients was 37 years (5-62 years). There was a significant difference in axonal capacity decrease towards the periphery when comparing proximal vs. distal biopsies (p = 0.047), while the side of nerve harvest showed no significant differences in nerve caliber (proximal p = 0.253, distal p = 0.506) and axonal capacity for proximal and distal biopsies (proximal p = 0.414, distal p = 0.922). Age did not correlate with axonal capacity (proximal: R = -0.201, p = 0.603; distal: R = 0.317, p = 0.292). These novel insights into the microanatomy of the sural nerve may help refine CFNG techniques and individualize FP patient treatment plans, ultimately improving overall patient outcomes.
Collapse
Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Division of Plastic and Facial Palsy Surgery, Hospital Ingolstadt, 85049 Ingolstadt, Germany
| | - Katharina S Hollmann
- Department of Molecular Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Silvan M Klein
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Ernst R Tamm
- Department of Human Anatomy and Embryology, University of Regensburg, 93053 Regensburg, Germany
| | - Lukas Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Simon Engelmann
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Samuel Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, 93053 Regensburg, Germany
| |
Collapse
|
|
13
|
Gallo Pellitero AJ, Formigo Couceiro J, Otero Villaverde S. [Ultrasound-guided radiofrequency ablation of the sural nerve for chronic ankle pain: A case report]. Rehabilitacion (Madr) 2023; 57:100806. [PMID: 37352600 DOI: 10.1016/j.rh.2023.100806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 06/25/2023]
Abstract
Chronic lateral ankle pain related to sural neuralgia is a rare pathology. The sural nerve innervates the sensitivity of the posterolateral border of the leg, as well as the dorsolateral border of the foot. On occasions, sural neuralgia is resistant to conservative treatment and can affect the patient's psycho-emotional and social sphere. We describe the case of a 54-year-old patient with neuropathic pain in the sural territory and a history of several ankle surgeries. After unsuccessful conservative treatment, ultrasound-guided ablative radiofrequency is performed in the sural nerve with subsequent complete cessation of pain without side effects. We propose to give importance to ecopalpation in the consultation of a rehabilitation physician, as well as to describe ultrasound-guided ablative radiofrequency as a safe and effective technique for sural neuralgia that does not respond to conservative treatment. However, more quality studies are needed to corroborate these results.
Collapse
|
|
14
|
Wang Z, Chen W, Jia H, Hu F, Wang B, Yang Y, Liu F. Application of Preoperative Ultrasonography in the Percutaneous Minimally Invasive Repair of Acute Closed Achilles Tendon Rupture. BIOMED RESEARCH INTERNATIONAL 2023; 2023:8956803. [PMID: 36654870 PMCID: PMC9842412 DOI: 10.1155/2023/8956803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Percutaneous minimally invasive surgery involving Achilles tendon (AT) repair has the advantages of a low rerupture rate and fewer postoperative complications. However, due to the inability to operate under direct vision, the injury of the small saphenous vein (SSV) and sural nerve (SN) remains largely a high risk involving many challenges. We propose to introduce the preoperative application and advantages of ultrasonography in percutaneous minimally invasive surgery for acute AT rupture. Our results indicated that ultrasonography could locate the position of the SN more accurately and reduce the risk of iatrogenic nerve injury. Compared with the traditional surface markers, the preoperative localization and marking of AT, SSV, and SN in ultrasonography significantly reduced the risk of intraoperative accidental injury to blood vessels and nerves, which could reduce postoperative complications and promote early rehabilitation of patients. We ultimately exploit the properties of ultrasonography in percutaneous minimally invasive surgery to treat Achilles tendon rupture.
Collapse
Affiliation(s)
- Zhuang Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Weiwei Chen
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Honglei Jia
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Fangning Hu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Bomin Wang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Yongliang Yang
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| |
Collapse
|
|
15
|
Novel implantable devices delivering electrical cues for tissue regeneration and functional restoration. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
|
|
16
|
Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening. J Pediatr Orthop 2022; 42:e201-e205. [PMID: 34995262 DOI: 10.1097/bpo.0000000000002020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI). METHODS Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut. RESULTS Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury. CONCLUSIONS The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy. LEVEL OF EVIDENCE Level III.
Collapse
|
|
17
|
Erdim I, Gurbuz V, Sapmaz E, Cetin S, Gevrek F. Microanatomic analyses of extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. Braz J Otorhinolaryngol 2021; 89:14-21. [PMID: 34348859 PMCID: PMC9874283 DOI: 10.1016/j.bjorl.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/12/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To investigate microanatomic organizations of the extratemporal facial nerve and its branches, hypoglossal nerve, sural nerve, and great auricular nerve. METHODS Nerve samples were dissected in 12 postmortem autopsies, and histomorphometric analyses were conducted. RESULTS There was no significant difference between the right and left sides of the nerve samples for the nerve area, fascicle area, number of fascicles and average number of axons. The lowest mean fascicle number was found in the hypoglossal nerve (4.9 ± 1.4) while the highest was in great auricular nerve (11.4 ± 6.8). The highest nerve area (3,182,788 ± 838,430 μm2), fascicle area (1,573,181 ± 457,331 μm2) and axon number (14,772 ± 4402) were in hypoglossal nerve (p < 0.05). The number of axons per unit nerve area was higher in the facial nerve, truncus temporofacialis, truncus cervicofacialis and hypoglossal nerve, which are motor nerves, compared to the sural nerve and great auricular nerve, which are sensory nerves (p < 0.05). The number of axons per unit fascicle area was also higher in motor nerves than in sensory nerves (p < 0.05). CONCLUSION In the present study, it was observed that each nerve contained a different number of fascicles and these fascicles were different both in size and in the number of axons they contained. All these variables could be the reason why the desired outcomes cannot always be achieved in nerve reconstruction.
Collapse
Affiliation(s)
- Ibrahim Erdim
- Tokat Gaziosmanpasa University, Health Education and Training Hospital, Otorhinolaryngology Department, Tokat, Turkey.
| | - Veysel Gurbuz
- Turkey Republic the Ministry of Justice, Tokat Forensic Medicine Department, Tokat, Turkey
| | - Emrah Sapmaz
- Tokat Gaziosmanpasa University, Health Education and Training Hospital, Otorhinolaryngology Department, Tokat, Turkey
| | - Selcuk Cetin
- Tokat Gaziosmanpasa University, Health Education and Training Hospital, Forensic Medicine Department, Tokat, Turkey
| | - Fikret Gevrek
- Tokat Gaziosmanpasa University, Medical Faculty, Histology Deparment, Tokat, Turkey
| |
Collapse
|
|
18
|
BÜYÜKMUMCU M, AYDIN KABAKÇI AD, AKIN SAYGIN D, YILMAZ MT, ŞEKER M. Sural nerve harvest for infants: integrated with information based on anatomical dissections. Turk J Med Sci 2021; 51:473-482. [PMID: 32718120 PMCID: PMC8203145 DOI: 10.3906/sag-2005-225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/21/2020] [Indexed: 11/03/2022] Open
Abstract
Background/aim The aim of the present study was to determine the course and possible variations of the sural nerve with all anatomical details in human fetal cadavers. Materials and methods This study was performed on 60 fetal cadavers. Formation type and level of the sural nerve was detected. Results According to trimesters, it was determined that the mean transverse and vertical distance between the lowest point of the LM and the SN varied between 1.1 and 2.9 mm and 1.54 and 3.58 mm, respectively. Type 2 was the most common seen type of sural nerve (35.83%). It was determined that the sural nerve was mostly formed at the middle third of the leg (42.5%). Conclusion Sural nerve graft with the knowledge of the anatomical details may be used for peripheral nerve reconstruction is required in congenital lesions, such as facial paralysis, obstetric brachial paralysis, and posttraumatic lesions in infants and children.
Collapse
Affiliation(s)
- Mustafa BÜYÜKMUMCU
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | | | - Duygu AKIN SAYGIN
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | - Mehmet Tuğrul YILMAZ
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| | - Muzaffer ŞEKER
- Department of Anatomy, Faculty of Meram Medicine, University of Necmettin Erbakan, KonyaTurkey
| |
Collapse
|
|
19
|
Anatomy of the sural nerve complex: Unaccounted anatomic variations and morphometric data. Ann Anat 2021; 238:151742. [PMID: 33932499 DOI: 10.1016/j.aanat.2021.151742] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 03/19/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The sural nerve (SN) is a cutaneous sensory nerve innervating the posterolateral leg. The SN is formed from a highly variable set of contributing nerves called the sural nerve complex (SNC). The SNC is made up of the lateral sural cutaneous nerve, medial sural cutaneous nerve, sural communicating branch, and SN. The SN is frequently cited as the most common donor nerve graft and is commonly injured in procedures of the lower extremity. Recent meta-analysis standardized six morphologies of the SNC and established a required reporting criterion for the group of nerves forming the SN. Due to the inconsistencies in previous literature, this study will group observed SNC's by one of these six SNC morphologies to assess and validate the meta-analysis grouping criteria. This study will also collect the same morphometric data previously outlined in order to grow the number of samples that are reported in a standardized fashion. METHODS 100 formalin and 4 Theil preserved cadavers (n = 208) lower limbs were bilaterally dissected at Kansas City University and Creighton University School of Dentistry to observe the SNC in its entirety on the posterolateral leg. Anatomic data was captured utilizing the standardized morphologies types 1-6 with two sub-typing. Nerves that were found to be outside of this categorization were placed in an unassigned grouping. RESULTS The most prevalent SNCs were type 1 at 41.35% (n = 86) and type 3 nerves at 34.62% (n = 72). Type 2 was found 8.65% (n = 18), type 4 and 5 were found each at 0.48% (n = 1). Type 6 was not observed. When comparing the present studies frequency of nerve types 1-6 to the meta-analysis a sub-grouping of "North American" cadaveric studies a X2 = .903 p = .030 was found. Two distinct and previously unassigned formations of the SNC were 10.58% (n = 20) and 3.85% (n = 8) of data. These two SNC are termed type 7 & 8, these represent two formations of SN that are outside of what was previously reported. 15.87% (n = 33) did not match visual descriptions based on nerve origin of a type 1 SNC but met written definitions. These were termed type 1A1 and type 1A2. The SNC was asymmetrical in 57.69% (n = 120). The pooled mean length of the SN was 32.97 ± 14.12 cm (31.05-34.88), mean diameter was 2.31 ± 0.83 mm (2.20-2.42, and the distance of the posterior border of the lateral malleolus to the SN was found to be 1.72 ± 0.70 cm (1.63-1.80). CONCLUSION Anatomic variation in the SNC is highly variable, yet is consistent with previously observed literature. This study demonstrates two unaccounted formations of the SNC as well as two additional subcategories of SNC that were not included in the previous meta-analysis. These four variants warrant inclusion as standard formations of the SNC due to the high prevalence observed in this study as well as historical consistency observed in previous literature and case reports. These two SNC formations increase the risk of iatrogenic injury during surgical interventions of the lower extremity. Morphometric data describing the spatial relationship of this nerve complex on the posterolateral leg is consistent with previously reported data and aids in generating a large data set for future studies to characterize spatial properties of this nerve complex.
Collapse
|
|
20
|
The determination of safe zones for arthroscopic portal placement into the posterior knee by mapping the courses of neurovascular structures in relation to bony landmarks. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1087-1095. [PMID: 33389054 DOI: 10.1007/s00590-020-02847-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Minimally invasive surgery in the posterior knee is high risk for iatrogenic injury to popliteal neurovascular neurovasculature structures. This study aimed to use reliable landmarks to define safe zones for arthroscopic portal placement into the posterior knee. METHODS Distances were measured between bony landmarks and neurovascular structures within the popliteal fossa using 45 formalin-embalmed cadavers: small saphenous vein (SSV), medial (MCSN) and lateral (LCSN) cutaneous sural nerves, tibial nerve (TN), common fibular nerve (CFN), popliteal vein (PV) and artery (PA). The structures were measured in relation to medial (MEF) and lateral (LEF) femoral epicondyle, medial (MCT) and lateral (LCT) tibial condyle and the midpoint between the landmarks. RESULTS The mean distance (mm) between MEF and structures was, male and female, respectively: SSV 37.6 + 12.5, 37.9 + 8.2; MCSN 39.2 + 14, 38.8 + 10.1; TN 39.4 + 10.2, 38.0 + 8.1; PV 38.4 + 12.9, 32.8 + 5.6; PA 38.4 + 12.1, 34.6 + 4.9. At midpoint and MCT all structures medialized between 5 and 28%. The mean distance between LEF and structures was, male and female, respectively: CFN 13.4 + 8.2, 8.4 + 9.1; LCSN 24.9 + 7.3, 18.4 + 10.4. At midpoint and LCT the CFN lateralized by 37-42% and the LCSN medialized by 8-9%. CONCLUSIONS Results suggest posteromedial portal placement can be safely established < 20 mm from the medial femoral epicondyle, tibial condyle or the midpoint between the two landmarks. Posterolateral portal placement is of higher risk, and entry point is 18 mm from the lateral femoral epicondyle, tibial condyle or the midpoint between the two landmarks in males and 12 mm in females. These landmarks will allow safe portal placement in 99% of cases.
Collapse
|
|
21
|
Zhang L, Han Q, Chen S, Suo D, Zhang L, Li G, Zhao X, Yang Y. Soft hydrogel promotes dorsal root ganglion by upregulating gene expression of Ntn4 and Unc5B. Colloids Surf B Biointerfaces 2020; 199:111503. [PMID: 33338883 DOI: 10.1016/j.colsurfb.2020.111503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/24/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
Mechanical property is an important factor of cellular microenvironment for neural tissue regeneration. In this study, polyacrylamide (PAM) hydrogels with systematically varying elastic modulus were prepared using in situ radical polymerization. We found that the hydrogel was biocompatible, and the length of dorsal root ganglion (DRG)'s axon and cell density were optimal on the hydrogels with elastic modulus of 5.1 kPa (among hydrogels with elastic modulus between 3.6 kPa and 16.5 kPa). These DRGs also exhibited highest gene and protein expression of proliferation marker Epha4, Ntn4, Sema3D and differentiation marker Unc5B. Our study revealed the mechanism of how material stiffness affects DRG proliferation and differentiation. It will also provide theoretical basis and evidence for the design and development of nerve graft with better repair performance.
Collapse
Affiliation(s)
- Liling Zhang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China
| | - Qi Han
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China
| | - Shiyu Chen
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China
| | - Di Suo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region
| | - Luzhong Zhang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China
| | - Guicai Li
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China; Key Laboratory of Organ Regeneration & Transplantation of the Ministry of Education, Jilin University, 130061, Changchun, PR China.
| | - Xin Zhao
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong Special Administrative Region.
| | - Yumin Yang
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education, Nantong University, 226001, Nantong, PR China; Co-Innovation Center of Neuroregeneration, Nantong University, 226001, Nantong, PR China.
| |
Collapse
|
|
22
|
Wang L, Lu C, Yang S, Sun P, Wang Y, Guan Y, Liu S, Cheng D, Meng H, Wang Q, He J, Hou H, Li H, Lu W, Zhao Y, Wang J, Zhu Y, Li Y, Luo D, Li T, Chen H, Wang S, Sheng X, Xiong W, Wang X, Peng J, Yin L. A fully biodegradable and self-electrified device for neuroregenerative medicine. SCIENCE ADVANCES 2020; 6:eabc6686. [PMID: 33310851 PMCID: PMC7732202 DOI: 10.1126/sciadv.abc6686] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/26/2020] [Indexed: 05/08/2023]
Abstract
Peripheral nerve regeneration remains one of the greatest challenges in regenerative medicine. Deprivation of sensory and/or motor functions often occurs with severe injuries even treated by the most advanced microsurgical intervention. Although electrical stimulation represents an essential nonpharmacological therapy that proved to be beneficial for nerve regeneration, the postoperative delivery at surgical sites remains daunting. Here, a fully biodegradable, self-electrified, and miniaturized device composed of dissolvable galvanic cells on a biodegradable scaffold is achieved, which can offer both structural guidance and electrical cues for peripheral nerve regeneration. The electroactive device can provide sustained electrical stimuli beyond intraoperative window, which can promote calcium activity, repopulation of Schwann cells, and neurotrophic factors. Successful motor functional recovery is accomplished with the electroactive device in behaving rodent models. The presented materials options and device schemes provide important insights into self-powered electronic medicine that can be critical for various types of tissue regeneration and functional restoration.
Collapse
Affiliation(s)
- Liu Wang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Changfeng Lu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Shuhui Yang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Pengcheng Sun
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Yu Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China.
| | - Yanjun Guan
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Shuang Liu
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing 100084, P. R. China
| | - Dali Cheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, and Beijing Innovation Center for Future Chips, Tsinghua University, Beijing 100084, P. R. China
| | - Haoye Meng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Qiang Wang
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, and Beijing Innovation Center for Future Chips, Tsinghua University, Beijing 100084, P. R. China
| | - Jianguo He
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Hanqing Hou
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing 100084, P. R. China
| | - Huo Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Wei Lu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Yanxu Zhao
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Jing Wang
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Yaqiong Zhu
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Yunxuan Li
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Dong Luo
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Tong Li
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China
| | - Hao Chen
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Shirong Wang
- Beijing Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing 100081, P. R. China
| | - Xing Sheng
- Department of Electronic Engineering, Beijing National Research Center for Information Science and Technology, and Beijing Innovation Center for Future Chips, Tsinghua University, Beijing 100084, P. R. China
| | - Wei Xiong
- School of Life Sciences, IDG/McGovern Institute for Brain Research at Tsinghua University, Tsinghua University, Beijing 100084, P. R. China
| | - Xiumei Wang
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China
| | - Jiang Peng
- Institute of Orthopedics, Chinese PLA General Hospital, Beijing 100853, P. R. China.
| | - Lan Yin
- School of Materials Science and Engineering, The Key Laboratory of Advanced Materials of Ministry of Education, State Key Laboratory of New Ceramics and Fine Processing, Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, P. R. China.
| |
Collapse
|
|
23
|
Watabe LT, Santos PVBD, Mendes FDA, Lima CRD, Acioly MA. Fibular Nerve Repair by Lateral Sural Cutaneous Nerve Graft: Anatomic Feasibility Study and Clinical Results. World Neurosurg 2020; 146:e537-e543. [PMID: 33130134 DOI: 10.1016/j.wneu.2020.10.127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The common fibular nerve (CFN) is the most frequently injured nerve in the lower limbs. Surgical management is necessary in approximately two thirds of patients and includes neurolysis, suture, graft repair, or nerve transfer. The distal sural nerve is the preferred donor for grafting, but it is not without complications and requires a second incision. We sought to study the surgical anatomy of the lateral sural cutaneous nerve (LSCN) with the aim of repairing CFN injuries through the same incision and as a potential source for grafting in other nerve injuries. METHODS The popliteal fossa was dissected in 11 lower limbs of embalmed cadavers to study LSCN variations. Four patients with CFN injuries then underwent surgical repair by LSCN grafting using the same surgical approach. RESULTS At the medial margin of the biceps femoris, the LSCN emerged from the CFN approximately 8.15 cm above the fibular head. The LSCN ran longitudinally to the long axis of the popliteal fossa, with an average of 3.2 cm medial to the fibular head. The mean LSCN length and diameter were 9.61 cm and 3.6 mm, respectively. The LSCN could be harvested in all patients for grafting. The mean graft length was 4.4 cm. Motor function was consistently recovered for foot eversion but was recovered to a lesser extent for dorsiflexion and toe extension. All patients recovered sensitive function (75% of S3). Hypoesthesia was recognized at the calf. CONCLUSIONS LSCN harvest is a viable alternative for nerve grafting, especially for repairing short CFN injuries, thereby avoiding the need for a second incision.
Collapse
Affiliation(s)
- Larissa Thiene Watabe
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | | | - Fábio de Almeida Mendes
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Roberto de Lima
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Marcus André Acioly
- Division of Neurosurgery, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; Division of Neurosurgery, Fluminense Federal University, Niterói-Rio de Janeiro, Brazil.
| |
Collapse
|
|
24
|
Johnson L, Liette MD, Green C, Rodriguez P, Masadeh S. The Reverse Sural Artery Flap: A Reliable and Versatile Flap for Wound Coverage of the Distal Lower Extremity and Hindfoot. Clin Podiatr Med Surg 2020; 37:699-726. [PMID: 32919599 DOI: 10.1016/j.cpm.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The reverse sural artery flap is a distally based fasciocutaneous or adipofascial flap used for wound coverage of the distal one-third of the lower extremity, ankle, and posterior heel. The flap harvest can be performed without sacrificing major arteries of the lower extremity. It can be elevated and mobilized with relative ease and a short operative time. It provides a good alternative to free tissue transfer in complex lower-extremity wounds with exposed bone, tendon, or hardware. The surgeon must be familiar with the management of venous congestion to improve the success of the flap.
Collapse
Affiliation(s)
- Lance Johnson
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Michael D Liette
- University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA
| | - Chris Green
- American College of Foot and Ankle Surgeons, Integris Limb Salvage Center, Oklahoma City, OK, USA
| | - Pedro Rodriguez
- Plastic and Reconstructive Surgery, OSF Saint Anthony Medical Center, University of Illinois, 698 Featherstone Road, Rockford, IL 61107, USA
| | - Suhail Masadeh
- University of Cincinnati Medical Center, Cincinnati Veteran Affairs Medical Center, 231 Albert Sabin Way, ML 0513, Cincinnati, OH 45276, USA.
| |
Collapse
|
|
25
|
Singh KP, Gupta K, Kataria N, Arora V, Nagpal N. High-resolution ultrasonography of the sural nerve in diabetic peripheral neuropathy. J Ultrason 2020; 20:e83-e89. [PMID: 32609965 PMCID: PMC7409546 DOI: 10.15557/jou.2020.0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/06/2020] [Indexed: 12/25/2022] Open
Abstract
Aim of the study: To study the cross-sectional area, the maximum thickness of the nerve fascicle and the thickness/width ratio of the sural nerve in patients with diabetes mellitus and non-diabetic subjects using high-resolution ultrasonography and to correlate the results with nerve conduction studies. Material and methods: This prospective study was conducted among 60 patients divided into two groups: A and B. Group A consisted of 30 patients >18 years of age with a history of type 2 diabetes mellitus, and Group B consisted of 30 non-diabetic patients >18 years of age. High-resolution ultrasonography was performed using a linear transducer with the frequency of 5-18 MHz in all the patients in the prone position with the transducer placed in a transverse position at the junction of the middle and lower thirds of the calf. Nerve conduction studies were performed using Aleron 201 (RMS) in all the patients. Results: As compared to the control group, the sural nerve in the diabetic group showed increased cross-sectional area, maximum thickness of the nerve fascicle and thickness/width ratio (p <0.05). Nerve conduction studies showed decreased amplitude, increased latency and decreased velocity in the cases as compared to controls (p <0.05). The cross-sectional area, maximum thickness of the nerve fascicle and thickness/width ratio showed statistical significance when compared with amplitude, latency and velocity in the cases as well as controls (p <0.001). Conclusion: This study suggests that high-frequency ultrasound of the sural nerve is a useful tool for evaluating changes typical of peripheral neuropathy in patients with diabetes mellitus. Aim of the study: To study the cross-sectional area, the maximum thickness of the nerve fascicle and the thickness/width ratio of the sural nerve in patients with diabetes mellitus and non-diabetic subjects using high-resolution ultrasonography and to correlate the results with nerve conduction studies. Material and methods: This prospective study was conducted among 60 patients divided into two groups: A and B. Group A consisted of 30 patients >18 years of age with a history of type 2 diabetes mellitus, and Group B consisted of 30 non-diabetic patients >18 years of age. High-resolution ultrasonography was performed using a linear transducer with the frequency of 5–18 MHz in all the patients in the prone position with the transducer placed in a transverse position at the junction of the middle and lower thirds of the calf. Nerve conduction studies were performed using Aleron 201 (RMS) in all the patients. Results: As compared to the control group, the sural nerve in the diabetic group showed increased cross-sectional area, maximum thickness of the nerve fascicle and thickness/width ratio (p <0.05). Nerve conduction studies showed decreased amplitude, increased latency and decreased velocity in the cases as compared to controls (p <0.05). The cross-sectional area, maximum thickness of the nerve fascicle and thickness/width ratio showed statistical significance when compared with amplitude, latency and velocity in the cases as well as controls (p <0.001). Conclusion: This study suggests that high-frequency ultrasound of the sural nerve is a useful tool for evaluating changes typical of peripheral neuropathy in patients with diabetes mellitus.
Collapse
Affiliation(s)
- Kunwar Pal Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Sri Amritsar, Punjab , India
| | - Kamlesh Gupta
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Sri Amritsar, Punjab , India
| | - Nilanshu Kataria
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Sri Amritsar, Punjab , India
| | - Vijinder Arora
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Sri Amritsar, Punjab , India
| | - Nimisha Nagpal
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Sri Amritsar, Punjab , India
| |
Collapse
|
|
26
|
Ducic I, Yoon J, Buncke G. Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy. Microsurgery 2020; 40:710-716. [PMID: 32277511 PMCID: PMC7540447 DOI: 10.1002/micr.30588] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/01/2020] [Accepted: 03/27/2020] [Indexed: 01/24/2023]
Abstract
Background The sural nerve is the most frequently harvested nerve autograft and is most often biopsied in the workup of peripheral neuropathy. While the complication types associated with these two procedures are well known, their clinical significance is poorly understood and there is a paucity of data regarding the complication rates. Methods Pubmed search identified studies regarding complications after sural nerve harvest and biopsy. The data was grouped into sensory deficits, chronic pain, sensory symptoms, wound infections, wound complications, other postoperative complications, and complications impacting daily life. The incidence of each complication was calculated, and a chi‐square analysis was performed to determine if there were any differences between nerve biopsies and graft harvest with respect to each complication. Results Twelve studies yielded 478 sural nerve procedures. Sensory deficits occurred at a rate of 92.9%, chronic pain at 19.7%, sensory symptoms at 41.1%, wound infections at 5.7%, noninfectious wound complications at 7.8%, and impact on daily life at 5.0%. The differences in wound infections, sensory symptoms, and impact on daily life between biopsies versus graft excisions were found to reach statistical significance (p < .05). Conclusions Sural nerve excisions can cause chronic postoperative donor‐site complications. Given these complications, alternative available mediums for nerve reconstruction should be explored and utilized wherever appropriate. If an alternative medium is unavailable and nerve autograft must be harvested for nerve reconstruction, then patients should be counseled about risks for developing donor site complications that may negatively affect quality of life.
Collapse
Affiliation(s)
- Ivica Ducic
- Washington Nerve Institute, McLean, Virginia, USA.,Department of Surgery, The George Washington University, Washington, District of Columbia, USA
| | - Joshua Yoon
- Department of Surgery, The George Washington University, Washington, District of Columbia, USA
| | | |
Collapse
|
|
27
|
Surgical anatomy of the ovine sural nerve for facial nerve regeneration and reconstruction research. Sci Rep 2019; 9:10564. [PMID: 31332199 PMCID: PMC6646377 DOI: 10.1038/s41598-019-46661-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/02/2019] [Indexed: 01/30/2023] Open
Abstract
The lack of a clinically relevant animal models for research in facial nerve reconstruction is challenging. In this study, we investigated the surgical anatomy of the ovine sural nerve as a potential candidate for facial nerve reconstruction, and performed its histological quantitative analysis in comparison to the buccal branch (BB) of the facial nerve using cadaver and anesthetized sheep. The ovine sural nerve descended to the lower leg along the short saphenous vein. The length of the sural nerve was 14.3 ± 0.5 cm. The distance from the posterior edge of the lateral malleolus to the sural nerve was 7.8 ± 1.8 mm. The mean number of myelinated fibers in the sural nerve was significantly lower than that of the BB (2,311 ± 381vs. 5,022 ± 433, respectively. p = 0.003). The number of fascicles in the sural nerve was also significantly lower than in the BB (10.5 ± 1.7 vs. 21.3 ± 2.7, respectively. p = 0.007). The sural nerve was grafted to the BB with end-to-end neurorrhaphy under surgical microscopy in cadaver sheep. The surgical anatomy and the number of fascicles of the ovine sural nerve were similar of those reported in humans. The results suggest that the sural nerve can be successfully used for facial nerve reconstruction research in a clinically relevant ovine model.
Collapse
|
|
28
|
Vidoni A, McLoughlin E, James SL, Botchu R. Intra-neural ganglion cyst of the lateral dorsal cutaneous nerve: an uncommon cause of lateral ankle pain. J Ultrasound 2019; 23:81-86. [PMID: 31161399 DOI: 10.1007/s40477-019-00387-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION An intra-neural ganglion cyst of the lateral dorsal cutaneous branch of the sural nerve is rare, with only a few cases reported in the literature. MATERIALS AND METHODS We carried out a retrospective investigation of patients with an intraneural ganglion cyst of the lateral dorsal cutaneous nerve. RESULTS We present a case series of four patients with intra-neural ganglion cysts of the lateral dorsal cutaneous nerve, the distal continuation of the sural nerve at the lateral aspect of the foot. CONCLUSION Intra-neural ganglion cysts of the lateral dorsal cutaneous nerve are rare. They represent a relatively uncommon source of lateral ankle pain, which can easily be diagnosed with ultrasound (US) and magnetic resonance imaging and managed effectively with US-guided aspiration or surgical excision.
Collapse
Affiliation(s)
- A Vidoni
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.,Royal National Orthopedic Hospital, Stanmore, UK
| | - E McLoughlin
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - S L James
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK
| | - R Botchu
- Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
| |
Collapse
|
|
29
|
Wang ZZ, Sakiyama-Elbert SE. Matrices, scaffolds & carriers for cell delivery in nerve regeneration. Exp Neurol 2018; 319:112837. [PMID: 30291854 DOI: 10.1016/j.expneurol.2018.09.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/13/2018] [Accepted: 09/28/2018] [Indexed: 12/22/2022]
Abstract
Nerve injuries can be life-long debilitating traumas that severely impact patients' quality of life. While many acellular neural scaffolds have been developed to aid the process of nerve regeneration, complete functional recovery is still very difficult to achieve, especially for long-gap peripheral nerve injury and most cases of spinal cord injury. Cell-based therapies have shown many promising results for improving nerve regeneration. With recent advances in neural tissue engineering, the integration of biomaterial scaffolds and cell transplantation are emerging as a more promising approach to enhance nerve regeneration. This review provides an overview of important considerations for designing cell-carrier biomaterial scaffolds. It also discusses current biomaterials used for scaffolds that provide permissive and instructive microenvironments for improved cell transplantation.
Collapse
Affiliation(s)
- Ze Zhong Wang
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA; Department of Biomedical Engineering, University of Austin at Texas, Austin, TX, USA
| | | |
Collapse
|
|
30
|
Sun X, Wang Y, Guo Z, Xiao B, Sun Z, Yin H, Meng H, Sui X, Zhao Q, Guo Q, Wang A, Xu W, Liu S, Li Y, Lu S, Peng J. Acellular Cauda Equina Allograft as Main Material Combined with Biodegradable Chitin Conduit for Regeneration of Long-Distance Sciatic Nerve Defect in Rats. Adv Healthc Mater 2018; 7:e1800276. [PMID: 30044554 DOI: 10.1002/adhm.201800276] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/18/2018] [Indexed: 11/10/2022]
Abstract
Autologous nerve grafting (ANG), the gold standard treatment for peripheral nerve defects, still has many restrictions. In this study, the acellular cauda equina allograft (ACEA), which consists of biodegradable chitin conduit and acellular cauda equina, is developed. The cauda equina is able to complete decellularization more quickly and efficiently than sciatic nerves under the same conditions, and it is able to reserve more basal lamina tube. In vitro, ACEA shows superior guidance capacity for the regeneration of axons and migration of Schwann cells compared to acellular sciatic nerve allograft (ASNA) in dorsal root ganglion culture. In vivo, ACEA is used to bridge 15 mm long-distance defects in rat sciatic nerves. On day 21 after transplantation, the regenerative distance of neurofilaments in the grafting segment is not significantly different between the ACEA and ANG groups. At week 12, ACEA group shows better sciatic nerve repair than chitin conduit only and ASNA groups, and the effect is similar to that in the ANG group as determined by gait analysis, neural electrophysiological, and histological analyses. The above results suggest that the ACEA has the potential to become a new biological material as a replacement for autografting in the treatment of long-distance nerve defects.
Collapse
Affiliation(s)
- Xun Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- School of Medicine; Nankai University; No. 94 Weijin Road Tianjin 300071 P. R. China
| | - Yu Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Zhiyuan Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Bo Xiao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Zhen Sun
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Heyong Yin
- Department of Surgery; Ludwig-Maximilians-University (LMU); Nussbaumstr. 20 Munich 80336 Germany
| | - Haoye Meng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Xiang Sui
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Qing Zhao
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| | - Quanyi Guo
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Aiyuan Wang
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Wenjing Xu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Shuyun Liu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Yaojun Li
- Department of Otolaryngology; First Teaching Hospital of Tianjin University of Traditional Chinese Medicine; No. 314 An Shan Xi Road Tianjin 300192 P. R. China
| | - Shibi Lu
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
| | - Jiang Peng
- Institute of Orthopedics; Chinese PLA General Hospital; Beijing Key Lab of Regenerative Medicine in Orthopedics; Key Lab of Musculoskeletal Trauma & War Injuries, PLA; No. 28 Fuxing Road Beijing 100853 P. R. China
- Co-innovation Center of Neuroregeneration; Nantong University; Nantong Jiangsu Province 226007 P. R. China
| |
Collapse
|
|
31
|
Anatomical variations of the formation of human sural nerve in stillborns. J ANAT SOC INDIA 2018. [DOI: 10.1016/j.jasi.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
32
|
|
|
33
|
Desdicioglu K, Malas MA, Bahceci S, Simsek F, Polat AG. Anatomical and histological morphometry of the sural nerve in human fetuses. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
|
34
|
Jeon SK, Paik DJ, Hwang YI. Variations in sural nerve formation pattern and distribution on the dorsum of the foot. Clin Anat 2017; 30:525-532. [DOI: 10.1002/ca.22873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 02/28/2017] [Accepted: 02/28/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Su Kyoung Jeon
- Department of Anatomy & Cell Biology; Seoul National University College of Medicine; Seoul Korea
| | - Doo-Jin Paik
- Department of Anatomy & Cell Biology; College of Medicine, Hanyang University; Seoul Korea
| | - Young-Il Hwang
- Department of Anatomy & Cell Biology; Seoul National University College of Medicine; Seoul Korea
| |
Collapse
|
|
35
|
Chitosan/graphene and poly(D, L-lactic-co-glycolic acid)/graphene nano-composites for nerve tissue engineering. Tissue Eng Regen Med 2016; 13:684-690. [PMID: 30603449 DOI: 10.1007/s13770-016-9130-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/04/2016] [Accepted: 03/14/2016] [Indexed: 10/20/2022] Open
Abstract
This study aimed at examining and comparing the fabrication process, electrical conductivity, and biological properties of Chitosan/Graphene membranes and poly(D, L-lactic-co-glycolic acid) (PLGA)/Graphene membranes. Nano-composite membranes were made using chitosan or PLGA matrix, and 0.5-1.5 wt.% graphene nano-sheets as the reinforcement material; all the membranes were fabricated through solution casting method. Fourier transform infrared spectroscopy and X-ray diffraction results indicated that the graphene had been uniformly dispersed in polymeric matrix. The membranes with 1.5 wt.% graphene appeared to have the highest value of electrical conductivity among all the examined the membranes and this growth was about 106 in comparison with neat polymers. Since the Chitosan 1.5% graphene membrane was found to have the highest proliferation after 72 hours by MTT [3-(4, 5-di-methylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide] assay of PC12 cell line (p<0.05), it is promising to consider nano-composite membrane for nerve tissue engineering applications.
Collapse
|
|
36
|
Ribak S, da Silva Filho PRF, Tietzmann A, Hirata HH, de Mattos CA, da Gama SAM. Use of superficial peroneal nerve graft for treating peripheral nerve injuries. Rev Bras Ortop 2016; 51:63-9. [PMID: 26962502 PMCID: PMC4767825 DOI: 10.1016/j.rboe.2015.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/06/2015] [Indexed: 11/07/2022] Open
Abstract
Objective To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. Methods This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. Results The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. Conclusions Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.
Collapse
Affiliation(s)
- Samuel Ribak
- Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil; Hospital Nossa Senhora do Pari, São Paulo, SP, Brazil
| | | | | | - Helton Hiroshi Hirata
- Pontifícia Universidade Católica de Campinas, Campinas, SP, Brazil; Hospital Nossa Senhora do Pari, São Paulo, SP, Brazil
| | | | | |
Collapse
|
|
37
|
Ribak S, da Silva Filho PRF, Tietzmann A, Hirata HH, Mattos CAD, Gama SAMD. Emprego do enxerto do nervo fibular superficial para tratamento de lesões de nervos periféricos. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
|
38
|
Anatomical variations of the formation and course of the sural nerve: A systematic review and meta-analysis. Ann Anat 2015; 202:36-44. [DOI: 10.1016/j.aanat.2015.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/07/2015] [Indexed: 02/03/2023]
|
|
39
|
Sahin C, Karagoz H, Kulahci Y, Sever C, Akakin D, Kolbasi B, Ulkur E, Peker F. Minced nerve tissue in vein grafts used as conduits in rat tibial nerves. Ann Plast Surg 2015; 73:540-6. [PMID: 24691343 DOI: 10.1097/sap.0000000000000060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Peripheral nerve injuries are encountered frequently in clinical practice. In nerve repair, an end-to-end suture is the preferable choice of treatment. However, where primary closure is not possible, the defect is to be repaired with a nerve graft. METHODS A total of 21 female Wistar rats weighing 230 to 290 g were used in the study. They were classified into the following 3 groups: (I) nerve graft, (II) vein graft, and (III) minced nerve graft. In group I, after exposure of the tibial nerve, a 1-cm-long nerve gap was created on the tibial nerve, and the defect was repaired epineurally by using the autogenous nerve. In group II, the 1-cm tibial nerve defect was repaired by using an autogenous vein graft. In group III, a 1-cm nerve graft was divided to 3 equal parts, with one of the nerve parts being minced with microscissors and placed in the vein graft lumen. Thereafter, a 1-cm tibial nerve defect was repaired by the vein graft filled with minced nerve tissue. The tibial function indices (TFIs) were calculated for functional assessment using the Bain-Mackinnon-Hunter formula. Light and electron microscopic evaluations were performed for morphometric assessment. In addition, the myelinated fibers were counted in all groups. RESULTS The TFIs of group II were found to be the lowest among all the groups after the sixth week, whereas the TFI of group I was found to be better than the other groups after the sixth week. There was no difference in TFIs between group I and group III. On the basis of the number of myelinated fibers, there was no statistically significant difference between group I and group III, whereas the difference was significant (P<0.05) between groups I/III and group II. Presence of peripheral nerves in light microscopic evaluation revealed normal characteristics of myelinated fibers in all groups. The myelinated axon profile was near normal in the nerve graft group in electron microscopic evaluation. However, there were more degenerated axons with disturbed contours and vacuolizations in the vein graft group compared to the minced nerve graft group. CONCLUSIONS We can conclude that using minced nerve tissue in vein grafts as a conduit increases the regeneration of nerves (almost like the nerve graft group) and it may not be caused by donor-site morbidity. It can be used in the repair of nerve defects instead of autogenous nerve grafts after further experimental evidence and clinical trials.
Collapse
Affiliation(s)
- Cihan Sahin
- From the *Department of Plastic and Reconstructive Surgery, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul; †Department of Hand and Upper Extremity Surgery, Gulhane Military Medical Academy, Ankara; ‡Department of Histology and Embryology, Marmara University, Medical School; and §F&P Plastic Reconstructive and Aesthetic Surgery Center, Istanbul, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
|
40
|
Liu Y, Nie L, Zhao H, Zhang W, Zhang YQ, Wang SS, Cheng L. Conserved dopamine neurotrophic factor-transduced mesenchymal stem cells promote axon regeneration and functional recovery of injured sciatic nerve. PLoS One 2014; 9:e110993. [PMID: 25343619 PMCID: PMC4208796 DOI: 10.1371/journal.pone.0110993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 09/28/2014] [Indexed: 01/09/2023] Open
Abstract
Peripheral nerve injury (PNI) is a common disease that often results in axonal degeneration and the loss of neurons, ultimately leading to limited nerve regeneration and severe functional impairment. Currently, there are no effective treatments for PNI. In the present study, we transduced conserved dopamine neurotrophic factor (CDNF) into mesenchymal stem cells (MSCs) in collagen tubes to investigate their regenerative effects on rat peripheral nerves in an in vivo transection model. Scanning electron microscopy of the collagen tubes demonstrated their ability to be resorbed in vivo. We observed notable overexpression of the CDNF protein in the distal sciatic nerve after application of CDNF-MSCs. Quantitative analysis of neurofilament 200 (NF200) and S100 immunohistochemistry showed significant enhancement of axonal and Schwann cell regeneration in the group receiving CDNF-MSCs (CDNF-MSCs group) compared with the control groups. Myelination thickness, axon diameter and the axon-to fiber diameter ratio (G-ratio) were significantly higher in the CDNF-MSCs group at 8 and 12 weeks after nerve transection surgery. After surgery, the sciatic functional index, target muscle weight, wet weight ratio of gastrocnemius muscle and horseradish peroxidase (HRP) tracing demonstrated functional recovery. Light and electron microscopy confirmed successful regeneration of the sciatic nerve. The greater numbers of HRP-labeled neuron cell bodies and increased sciatic nerve index values (SFI) in the CDNF-MSCs group suggest that CDNF exerts neuroprotective effects in vivo. We also observed higher target muscle weights and a significant improvement in muscle atrophism in the CDNF-MSCs group. Collectively, these findings indicate that CDNF gene therapy delivered by MSCs is capable of promoting nerve regeneration and functional recovery, likely because of the significant neuroprotective and neurotrophic effects of CDNF and the superior environment offered by MSCs and collagen tubes.
Collapse
Affiliation(s)
- Yi Liu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
- Shandong University Qilu Hospital Research Center for Cell Therapy, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, China
| | - Lin Nie
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Hua Zhao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
- Shandong University Qilu Hospital Research Center for Cell Therapy, Key Laboratory of Cardiovascular Remodeling and Function Research, Qilu Hospital of Shandong University, Jinan, China
| | - Wen Zhang
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Yuan-Qiang Zhang
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Shuai-Shuai Wang
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Cheng
- Department of Spine Surgery, Qilu Hospital of Shandong University, Jinan, China
- * E-mail:
| |
Collapse
|
|
41
|
Chevrollier J, Pedeutour B, Dap F, Dautel G. Evaluation of emergency nerve grafting for proper palmar digital nerve defects: a retrospective single centre study. Orthop Traumatol Surg Res 2014; 100:605-10. [PMID: 25155205 DOI: 10.1016/j.otsr.2014.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 03/11/2014] [Accepted: 05/13/2014] [Indexed: 02/02/2023]
Abstract
HYPOTHESIS Finger trauma often results in discontinuity of the proper palmar digital nerves. The goal of this study was to retrospectively evaluate the clinical outcomes of emergency nerve grafting and the resulting donor site morbidity. MATERIAL AND METHOD Three women and 13 men who had been operated between 2008 and 2012 were reviewed. The average patient age was 39 years (range 18-78). All were operated on an emergency basis. The average defect was 38 mm long (range 15-60). The nerves were harvested from four sites: lateral antebrachial cutaneous nerve (12 cases), banked finger (2 cases), terminal portion of posterior interosseous nerve (1 case) and anterior interosseous nerve (1 case). The evaluation consisted of patient questioning and clinical examination of the treated finger and donor site. An objective sensory exam was also performed. The results were expressed according to the British Medical Research Council (MRC) classification. RESULTS There was little donor site morbidity (2 cases of symptomatic hypoesthesia, 1 case of scar hypersensitivity). Sixty-nine percent of patients stated that their grafted finger did not cause them any trouble during activities of daily living. Three patients required job retraining. Pain in the grafted finger was 0.6 (range 0-5) on the VAS. Normal sensation was restored in 31% of cases based on the monofilament sensory test; 25% had a slight decrease in touch sensitivity and 25% had reduced protective sensations. Weber's two-point discrimination test found 50% normal sensibility (threshold<6mm) and 6% with mediocre sensibility (threshold of 6-10mm). On the MRC grading scale, 50% of patients were at S4, 6% at S3+, 19% at S3, 12% at S2 and 12% at S1. CONCLUSION There were 56% good results in this patient series (S3+/S4) and no patients at S0. Donor site morbidity was rare. Thus use of nerve grafting is still a relevant option in an emergency setting. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- J Chevrollier
- SOS main, Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 5400 Nancy, France.
| | - B Pedeutour
- SOS main, Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 5400 Nancy, France
| | - F Dap
- SOS main, Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 5400 Nancy, France
| | - G Dautel
- SOS main, Service de chirurgie plastique et reconstructrice de l'appareil locomoteur, Centre chirurgical Emile-Gallé, 5400 Nancy, France
| |
Collapse
|
|
42
|
Gu X, Ding F, Williams DF. Neural tissue engineering options for peripheral nerve regeneration. Biomaterials 2014; 35:6143-56. [PMID: 24818883 DOI: 10.1016/j.biomaterials.2014.04.064] [Citation(s) in RCA: 428] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 04/16/2014] [Indexed: 12/19/2022]
Abstract
Tissue engineered nerve grafts (TENGs) have emerged as a potential alternative to autologous nerve grafts, the gold standard for peripheral nerve repair. Typically, TENGs are composed of a biomaterial-based template that incorporates biochemical cues. A number of TENGs have been used experimentally to bridge long peripheral nerve gaps in various animal models, where the desired outcome is nerve tissue regeneration and functional recovery. So far, the translation of TENGs to the clinic for use in humans has met with a certain degree of success. In order to optimize the TENG design and further approach the matching of TENGs with autologous nerve grafts, many new cues, beyond the traditional ones, will have to be integrated into TENGs. Furthermore, there is a strong requirement for monitoring the real-time dynamic information related to the construction of TENGs. The aim of this opinion paper is to specifically and critically describe the latest advances in the field of neural tissue engineering for peripheral nerve regeneration. Here we delineate new attempts in the design of template (or scaffold) materials, especially in the context of biocompatibility, the choice and handling of support cells, and growth factor release systems. We further discuss the significance of RNAi for peripheral nerve regeneration, anticipate the potential application of RNAi reagents for TENGs, and speculate on the possible contributions of additional elements, including angiogenesis, electrical stimulation, molecular inflammatory mediators, bioactive peptides, antioxidant reagents, and cultured biological constructs, to TENGs. Finally, we consider that a diverse array of physicochemical and biological cues must be orchestrated within a TENG to create a self-consistent coordinated system with a close proximity to the regenerative microenvironment of the peripheral nervous system.
Collapse
Affiliation(s)
- Xiaosong Gu
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China.
| | - Fei Ding
- Jiangsu Key Laboratory of Neuroregeneration, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, JS 226001, China
| | - David F Williams
- Wake Forest Institute of Regenerative Medicine, Winston-Salem, NC, USA.
| |
Collapse
|
|
43
|
Seema SR. Study of sural nerve complex in human cadavers. ISRN ANATOMY 2013; 2013:827276. [PMID: 25938105 PMCID: PMC4392956 DOI: 10.5402/2013/827276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/23/2013] [Indexed: 11/23/2022]
Abstract
Aim. The sural nerve complex (SNC) consists of four named components: medial sural cutaneous nerve (MSCN), lateral sural cutaneous nerve (LSCN), peroneal communicating nerve (PCN), and sural nerve (SN). The formation and distribution of the sural nerve vary in different individuals. SN is universally recognized by surgeons as a site for harvesting an autologous nerve graft. The nerve is widely used for electrophysiological studies. Hence the study of sural nerve complex was taken up. Method. SNC was observed by dissecting 100 lower limbs in the department of anatomy at three different medical colleges, over a period of 10 years. Result. Typical SN was observed in 60% of the cases. MSCN was present in all the cases; in 15% of the cases the MSCN followed an intramural course. LSCN was present in 80% of the cases. PCN was present in 70% of the cases and in most of the cases calibre was larger than that of MSCN. Conclusion. The knowledge about the variation in the origin and course of the SN is important in evaluating sensory axonal loss in distal axonal neuropathies and should be borne in mind by clinicians and surgeons.
Collapse
Affiliation(s)
- S R Seema
- Department of Anatomy, ESIC Medical College & PGIMSR, Rajajinagar, Bangalore, Karnataka 560094, India
| |
Collapse
|
|
44
|
Widgerow AD, Salibian AA, Lalezari S, Evans GRD. Neuromodulatory nerve regeneration: adipose tissue-derived stem cells and neurotrophic mediation in peripheral nerve regeneration. J Neurosci Res 2013; 91:1517-24. [PMID: 24105674 DOI: 10.1002/jnr.23284] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/17/2013] [Accepted: 07/18/2013] [Indexed: 12/17/2022]
Abstract
Peripheral nerve injury requiring nerve gap reconstruction remains a major problem. In the quest to find an alternative to autogenous nerve graft procedures, attempts have been made to differentiate mesenchymal stem cells into neuronal lineages in vitro and utilize these cellular constructs for nerve regeneration. Unfortunately, this has produced mixed results, with no definitive procedure matching or surpassing traditional nerve grafting procedures. This review presents a different approach to nerve regeneration. The literature was reviewed to evaluate current methods of using adipose-derived stem cells (ADSCs) for peripheral nerve regeneration in in vivo models of animal peripheral nerve injury. The authors present cited evidence for directing nerve regeneration through paracrine effects of ADSCs rather than through in vitro nerve regeneration. The paracrine effects rely mainly, but not solely, on the elaboration of nerve growth factors and neurotrophic mediators that influence surrounding host cells to orchestrate in vivo nerve regeneration. Although this paradigm has been indirectly referred to in a host of publications, few major efforts for this type of neuromodulatory nerve regeneration have been forthcoming. The ADSCs are initially "primed" in vitro using specialized controlled medium (not for neuronal differentiation but for sustainability) and then incorporated into a hydrogel base matrix designed for this purpose. This core matrix is then introduced into a natural collagen-based nerve conduit. The prototype design concepts, evidence for paracrine influences, and regulatory hurdles that are avoided using this approach are discussed.
Collapse
Affiliation(s)
- Alan D Widgerow
- Institute of Aesthetic and Plastic Surgery, University of California Irvine, Irvine, California
| | | | | | | |
Collapse
|
|
45
|
A N K, Subhash LP, K R A, M K BR. Anatomical variations in formation of sural nerve in adult Indian cadavers. J Clin Diagn Res 2013; 7:1838-41. [PMID: 24179876 DOI: 10.7860/jcdr/2013/6633.3328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 08/11/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sural nerve is formed by communication of medial sural cutaneous nerve, that arise from tibial nerve in popliteal fossa and peroneal communicating nerve, a branch directly from common peroneal nerve or from lateral sural cutaneous nerve. The sural nerve is universally recognized by surgeons as a site for harvesting an autologous nerve graft and for nerve biopsies in case of neuropathies. SETTING AND DESIGN Anatomy department and an observational study. STATISTICAL ANALYSIS The Mean, Standard Deviation, relevant percentages and p value was calculated by Chi-square test. MATERIAL AND METHODS The study consists of 50 lower limb specimens in 25 cadavers. All the male and female complete cadavers were included in the study. The data was collected by dissection method by using dissection instruments and parameters (measurements) were obtained by using measuring tape. RESULTS The sural nerve complex was dissected and observed in 50 formalin fixed lower limb specimens. Study was done in 16 male and 9 female cadavers. Three types of formation of sural nerve were observed were - Type A was seen in 36 specimens (72%) of cases. Type B was seen in 14 specimens (28%) of cases. Type C sural nerve was not found in present study. Site of union of components of SN was seen in the upper 3(rd) of leg in 5.6%, in middle 3(rd) it was in 33.3% and in lower 3(rd) it was in 58.3% of cases. The length of the sural nerve shows a wide range from 2 cm to 32 cm. The symmetrical distribution was seen in 62.5% in males and 55.6% in female. CONCLUSION The normal anatomy and variations may help to guide during surgeries in the region.
Collapse
Affiliation(s)
- Kavyashree A N
- Assistant Professor, Department of Anatomy, Sri Siddhartha Medical College , Tumkur, Karnataka-572107, India
| | | | | | | |
Collapse
|
|
46
|
Vuksanovic-Bozaric A, Radunovic M, Radojevic N, Abramovic M. The bilateral anatomical variation of the sural nerve and a review of relevant literature. Anat Sci Int 2013; 89:57-61. [DOI: 10.1007/s12565-013-0195-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/24/2013] [Indexed: 11/28/2022]
|
|
47
|
|
|
48
|
Park SY, Ki CS, Park YH, Lee KG, Kang SW, Kweon HY, Kim HJ. Functional recovery guided by an electrospun silk fibroin conduit after sciatic nerve injury in rats. J Tissue Eng Regen Med 2012; 9:66-76. [DOI: 10.1002/term.1615] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 05/15/2012] [Accepted: 08/25/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Sook Young Park
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry; Seoul National University; Seoul 110-768 Republic of Korea
| | - Chang Seok Ki
- Cosmetics and Personal Care Research Institute; Amorepacific Corporation R&D Center; Yongin 446-729 Republic of Korea
| | - Young Hwan Park
- Department of Biosystems and Biomaterials Science and Engineering; Seoul National University; Seoul 151-921 Republic of Korea
| | - Kwang Gill Lee
- Rural Development Administration; National Academy of Agricultural Science; Suwon Republic of Korea
| | - Seok Woo Kang
- Rural Development Administration; National Academy of Agricultural Science; Suwon Republic of Korea
| | - Hae Yong Kweon
- Rural Development Administration; National Academy of Agricultural Science; Suwon Republic of Korea
| | - Hyun Jeong Kim
- Department of Dental Anesthesiology and Dental Research Institute, School of Dentistry; Seoul National University; Seoul 110-768 Republic of Korea
| |
Collapse
|
|
49
|
Nuri T, Ueda K, Maeda S, Otsuki Y. Anatomical study of medial and lateral sural cutaneous nerve: Implications for innervated distally-based superficial sural artery flap. J Plast Surg Hand Surg 2012; 46:8-12. [DOI: 10.3109/2000656x.2011.644720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
|
50
|
Thyagarajan D, Walkey G, Kelly A, Winson I. Extended lateral approach for elective hind foot surgery--a safe and versatile incision. Foot Ankle Surg 2011; 17:274-276. [PMID: 22017902 DOI: 10.1016/j.fas.2010.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Revised: 10/03/2010] [Accepted: 10/12/2010] [Indexed: 02/05/2023]
Abstract
AIM The aim of our study was to review our experience of the extended lateral approach to the hind foot in treatment of non-traumatic foot disorders with particular reference to wound complications. MATERIALS AND METHODS We retrospectively reviewed 51 consecutive patients who under went extended lateral approach to the hind foot for treatment of various non traumatic foot disorders. We documented the indication for surgery, co-morbidity, quality of wound healing and other wound related problems. RESULTS The mean age was 47.9. There were three superficial wound infections (5.8%). One had slight sensory loss close to the scar, one developed hypersensitivity over the scar. There was no wound break down or any deep infection. No sural nerve deficit was noted. Six patients had the calcaneal screw removed due to prominent metal work (11.7%). CONCLUSION The extended lateral approach to hind foot is safe in the surgical treatment of a wide variety of non-traumatic foot conditions. Despite the larger deep dissection, the arterial anatomy ensures reliable wound healing and a low incidence of wound complications.
Collapse
Affiliation(s)
- David Thyagarajan
- Department of Trauma and Orthopaedics, Southmead Hospital, North Bristol NHS Trust, UK.
| | | | | | | |
Collapse
|