Peripheral nerve injuries remain a challenging problem in need of better treatment strategies.Despite best efforts at surgical reconstruction and postoperative rehabilitation,patients are often left with persistent,de...Peripheral nerve injuries remain a challenging problem in need of better treatment strategies.Despite best efforts at surgical reconstruction and postoperative rehabilitation,patients are often left with persistent,debilitating motor and sensory deficits.There are currently no therapeutic strategies proven to enhance the regenerative process in humans.A clinical need exists for the development of technologies to promote nerve regeneration and improve functional outcomes.Recent advances in the fields of tissue engineering and nanotechnology have enabled biomaterial scaffolds to modulate the host response to tissue repair through tailored mechanical,chemical,and conductive cues.New bioengineered approaches have enabled targeted,sustained delivery of protein therapeutics with the capacity to unlock the clinical potential of a myriad of neurotrophic growth factors that have demonstrated promise in enhancing regenerative outcomes.As such,further exploration of combinatory strategies leveraging these technological advances may offer a pathway towards clinically translatable solutions to advance the care of patients with peripheral nerve injuries.This review first presents the various emerging bioengineering strategies that can be applied for the management of nerve gap injuries.We cover the rationale and limitations for their use as an alternative to autografts,focusing on the approaches to increase the number of regenerating axons crossing the repair site,and facilitating their growth towards the distal stump.We also discuss the emerging growth factor-based therapeutic strategies designed to improve functional outcomes in a multimodal fashion,by accelerating axonal growth,improving the distal regenerative environment,and preventing end-organs atrophy.展开更多
Peripheral nerve injuries(PNI)in the lower extremity are an uncommon but highly morbid condition.Recent advances in our understanding of nerve physiology and microsurgical techniques have inspired renewed faith in ner...Peripheral nerve injuries(PNI)in the lower extremity are an uncommon but highly morbid condition.Recent advances in our understanding of nerve physiology and microsurgical techniques have inspired renewed faith in nerve surgery and sparked a creative renaissance in the tools,approaches,and reconstructive schemas available to surgeons in the management of lower extremity PNIs.In this article,we review the literature and provide a principles-based approach for the surgical management of lower extremity PNIs with an emphasis on techniques for functional reconstruction after complete nerve injury.General principles in management include early diagnosis with electrodiagnostics and imaging,early surgical exploration,and opting for nerve and tendon transfers when primary reconstruction of the injured nerve is unfavorable(e.g.,delayed reconstruction,unavailability of proximal or distal nerve stumps,or long regenerative distance).The goal of functional reconstruction should be to restore independent gait,so understanding the roles of major neuromuscular units during the gait cycle informs the selection of donor nerves and tendons for transfer.Based on these principles and literature to date,specific algorithms for surgical management are presented for femoral,sciatic,tibial,and common peroneal nerves.We recognize limitations of the current literature,namely the predominance of case series evidence,and call for the accrual of more patient data in surgical management of PNIs.展开更多
基金supported by The Plastic Surgery Foundation Research Pilot Grant,No.627383(to KAS).
文摘Peripheral nerve injuries remain a challenging problem in need of better treatment strategies.Despite best efforts at surgical reconstruction and postoperative rehabilitation,patients are often left with persistent,debilitating motor and sensory deficits.There are currently no therapeutic strategies proven to enhance the regenerative process in humans.A clinical need exists for the development of technologies to promote nerve regeneration and improve functional outcomes.Recent advances in the fields of tissue engineering and nanotechnology have enabled biomaterial scaffolds to modulate the host response to tissue repair through tailored mechanical,chemical,and conductive cues.New bioengineered approaches have enabled targeted,sustained delivery of protein therapeutics with the capacity to unlock the clinical potential of a myriad of neurotrophic growth factors that have demonstrated promise in enhancing regenerative outcomes.As such,further exploration of combinatory strategies leveraging these technological advances may offer a pathway towards clinically translatable solutions to advance the care of patients with peripheral nerve injuries.This review first presents the various emerging bioengineering strategies that can be applied for the management of nerve gap injuries.We cover the rationale and limitations for their use as an alternative to autografts,focusing on the approaches to increase the number of regenerating axons crossing the repair site,and facilitating their growth towards the distal stump.We also discuss the emerging growth factor-based therapeutic strategies designed to improve functional outcomes in a multimodal fashion,by accelerating axonal growth,improving the distal regenerative environment,and preventing end-organs atrophy.
文摘Peripheral nerve injuries(PNI)in the lower extremity are an uncommon but highly morbid condition.Recent advances in our understanding of nerve physiology and microsurgical techniques have inspired renewed faith in nerve surgery and sparked a creative renaissance in the tools,approaches,and reconstructive schemas available to surgeons in the management of lower extremity PNIs.In this article,we review the literature and provide a principles-based approach for the surgical management of lower extremity PNIs with an emphasis on techniques for functional reconstruction after complete nerve injury.General principles in management include early diagnosis with electrodiagnostics and imaging,early surgical exploration,and opting for nerve and tendon transfers when primary reconstruction of the injured nerve is unfavorable(e.g.,delayed reconstruction,unavailability of proximal or distal nerve stumps,or long regenerative distance).The goal of functional reconstruction should be to restore independent gait,so understanding the roles of major neuromuscular units during the gait cycle informs the selection of donor nerves and tendons for transfer.Based on these principles and literature to date,specific algorithms for surgical management are presented for femoral,sciatic,tibial,and common peroneal nerves.We recognize limitations of the current literature,namely the predominance of case series evidence,and call for the accrual of more patient data in surgical management of PNIs.
