The aim of this review is to present and compare the various animal models of vascularized nerve grafts described in the literature as well as to summarize preclinical evidence for superior functional results compared...The aim of this review is to present and compare the various animal models of vascularized nerve grafts described in the literature as well as to summarize preclinical evidence for superior functional results compared to non-vascularized free nerve grafts. We also will present the state of the art on prefabricated vascularized nerve grafts. A systematic literature review on vascularized nerve graft models was conducted via the retrieval with the Pub Med database on March 30, 2019. Data on the animal, nerve, and vascularization model, the recipient bed, the evaluation time points and methods, and the results of the study results were extracted and analyzed from selected articles. The rat sciatic nerve was the most popular model for vascularized nerve grafts, followed by the rabbit;however, rabbit models allow for longer nerve grafts, which are suitable for translational evaluation, and produced more cautious results on the superiority of vascularized nerve grafts. Compared to free nerve grafts, vascularized nerve grafts have better early but similar long-term results, especially in an avascular bed. There are few studies on avascular receiving beds and prefabricated nerve grafts. The clinical translation potential of available animal models is limited, and current experimental knowledge cannot fully support that the differences between vascularized nerve grafts and free nerve grafts yield a clinical advantage that justifies the complexity of the procedure.展开更多
Nerve-tissue interactions are critical.Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical presentations.All of these ...Nerve-tissue interactions are critical.Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical presentations.All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term“painful scar neuropathy”.The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis-associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy.The search retrieved twenty-one papers,twenty of which reported pain reduction or resolution with various techniques.There is no consensus on the best therapeutic approach to neuropathic pain due to scar tethering.Most authors report good or excellent results with different techniques,from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized tissue.The authors’classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type(perineural,or endoneural and perineural),pain type(due to traction or external trauma,pain at rest),and number of previous operations.Patients need to be informed that multiple procedures may be required,that outcomes may be partial,and that surgery can potentially worsen preoperative conditions.The review found no evidence for the best therapeutic approach to scar neuropathy,but there is consensus on a multidisciplinary approach.展开更多
Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes.Several different classifications have been used to describe the pathophysiological mechanisms leading to the ...Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes.Several different classifications have been used to describe the pathophysiological mechanisms leading to the clinical deficit,from simple and reversible compression-induced demyelination,to complete transection of nerve axons.Neurophysiological data localize,quantify,and qualify(demyelination vs.axonal loss)the clinical and subclinical deficits.High-resolution ultrasound can demonstrate the morphological extent of nerve damage,fascicular echotexture(epineurium vs.perineurium,focal alteration of the cross-section of the nerve,any neuromas,etc.),and the surrounding tissues.High field magnetic resonance imaging provides high contrast neurography by fat suppression sequences and shows structural connectivity through the use of diffusion-weighted sequences.The aim of this review is to provide clinical guidelines for the diagnosis of nerve injuries,and the rationale for instrumental evaluation in the preoperative and postoperative periods.While history and clinical approach guide neurophysiological examination,nerve conduction and electromyography studies provide functional information on conduction slowing and denervation to assist in monitoring the onset of re-innervation.High-resolution nerve imaging complements neurophysiological data and allows direct visualization of the nerve injury while providing insight into its cause and facilitating surgical treatment planning.Indications and limits of each instrumental examination are discussed.展开更多
The present special issue collects the best papers from the“EuRePS”(European Residents in Plastic Surgery)Meeting,which was held in Favignana from 18th to 21st of June 2015.The scientific committee selected the best...The present special issue collects the best papers from the“EuRePS”(European Residents in Plastic Surgery)Meeting,which was held in Favignana from 18th to 21st of June 2015.The scientific committee selected the best 5 presentations,to be published on PAR journal thanks to an agreement with the editorial board.展开更多
Peripheral nerve surgery has achieved a great improvement in the last century.The introduction of microsurgery and the technical advances in reparative and reconstructive techniques has been instrumental in advancing ...Peripheral nerve surgery has achieved a great improvement in the last century.The introduction of microsurgery and the technical advances in reparative and reconstructive techniques has been instrumental in advancing nerve surgery techniques.Yet,in the last few decades,the scientific progress has slowed down significantly,and surgery is still far from reaching an optimal functional recovery in most cases.展开更多
文摘The aim of this review is to present and compare the various animal models of vascularized nerve grafts described in the literature as well as to summarize preclinical evidence for superior functional results compared to non-vascularized free nerve grafts. We also will present the state of the art on prefabricated vascularized nerve grafts. A systematic literature review on vascularized nerve graft models was conducted via the retrieval with the Pub Med database on March 30, 2019. Data on the animal, nerve, and vascularization model, the recipient bed, the evaluation time points and methods, and the results of the study results were extracted and analyzed from selected articles. The rat sciatic nerve was the most popular model for vascularized nerve grafts, followed by the rabbit;however, rabbit models allow for longer nerve grafts, which are suitable for translational evaluation, and produced more cautious results on the superiority of vascularized nerve grafts. Compared to free nerve grafts, vascularized nerve grafts have better early but similar long-term results, especially in an avascular bed. There are few studies on avascular receiving beds and prefabricated nerve grafts. The clinical translation potential of available animal models is limited, and current experimental knowledge cannot fully support that the differences between vascularized nerve grafts and free nerve grafts yield a clinical advantage that justifies the complexity of the procedure.
文摘Nerve-tissue interactions are critical.Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical presentations.All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term“painful scar neuropathy”.The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis-associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy.The search retrieved twenty-one papers,twenty of which reported pain reduction or resolution with various techniques.There is no consensus on the best therapeutic approach to neuropathic pain due to scar tethering.Most authors report good or excellent results with different techniques,from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized tissue.The authors’classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type(perineural,or endoneural and perineural),pain type(due to traction or external trauma,pain at rest),and number of previous operations.Patients need to be informed that multiple procedures may be required,that outcomes may be partial,and that surgery can potentially worsen preoperative conditions.The review found no evidence for the best therapeutic approach to scar neuropathy,but there is consensus on a multidisciplinary approach.
文摘Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes.Several different classifications have been used to describe the pathophysiological mechanisms leading to the clinical deficit,from simple and reversible compression-induced demyelination,to complete transection of nerve axons.Neurophysiological data localize,quantify,and qualify(demyelination vs.axonal loss)the clinical and subclinical deficits.High-resolution ultrasound can demonstrate the morphological extent of nerve damage,fascicular echotexture(epineurium vs.perineurium,focal alteration of the cross-section of the nerve,any neuromas,etc.),and the surrounding tissues.High field magnetic resonance imaging provides high contrast neurography by fat suppression sequences and shows structural connectivity through the use of diffusion-weighted sequences.The aim of this review is to provide clinical guidelines for the diagnosis of nerve injuries,and the rationale for instrumental evaluation in the preoperative and postoperative periods.While history and clinical approach guide neurophysiological examination,nerve conduction and electromyography studies provide functional information on conduction slowing and denervation to assist in monitoring the onset of re-innervation.High-resolution nerve imaging complements neurophysiological data and allows direct visualization of the nerve injury while providing insight into its cause and facilitating surgical treatment planning.Indications and limits of each instrumental examination are discussed.
文摘The present special issue collects the best papers from the“EuRePS”(European Residents in Plastic Surgery)Meeting,which was held in Favignana from 18th to 21st of June 2015.The scientific committee selected the best 5 presentations,to be published on PAR journal thanks to an agreement with the editorial board.
文摘Peripheral nerve surgery has achieved a great improvement in the last century.The introduction of microsurgery and the technical advances in reparative and reconstructive techniques has been instrumental in advancing nerve surgery techniques.Yet,in the last few decades,the scientific progress has slowed down significantly,and surgery is still far from reaching an optimal functional recovery in most cases.
