Abstract
Currently, many different techniques exist for the surgical repair of peripheral nerves. The degree of injury dictates the repair and, depending on the defect or injury of the peripheral nerve, plastic surgeons can perform nerve repairs, grafts, and transfers. All the previously listed techniques are routinely performed in human patients, but a novel addition to these peripheral nerve surgeries involves concomitant fat grafting to the repair site at the time of surgery. Fat grafting provides adipose-derived stem cells to the injury site. Though fat grafting is performed as an adjunct to some peripheral nerve surgeries, there is no clear evidence as to which procedures have improved outcomes resultant from concomitant fat grafting. This review explores the evidence presented in various animal studies regarding outcomes of fat grafting at the time of various types of peripheral nerve surgery.
Highlights
The concept of nerve surgery is astounding; we have developed the ability through microsurgery to suture the epineurium of one nerve, or of different nerves, together to promote the regeneration of the nerve and reinnervation of its structures
Animal experiments demonstrate that various types of peripheral nerve surgeries have the potential to benefit from the addition of adipose-derived stem cells (ADSCs) during surgery
ADSCs have proven beneficial for nerve regeneration on multiple levels, including by secreting growth factors and by morphing into Schwann-like cells, which can modulate genes in a way that facilitates peripheral nerve healing
Summary
The concept of nerve surgery is astounding; we have developed the ability through microsurgery to suture the epineurium of one nerve, or of different nerves, together to promote the regeneration of the nerve and reinnervation of its structures. Regenerative medicine explores the use of novel biomaterials to enhance success rates and outcomes for patients undergoing nerve repair. One such biomaterial, adipose tissue, has been repurposed to enhance the healing of peripheral nerves following surgical repair. Autogenous fat grafting is a method of delivering ADSCs without having to process the tissue, which avoids the FDA regulations that are placed on purified cells from adipose tissue [6] In this manner, fat grafting is an accessible method that keeps costs low, is minimally invasive, and does not pose the risk of an immune response [16]
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