Augmentation of regeneration in peripheral nervous system surgery

Abstract

The peripheral nervous system exhibits a much larger capacity for regeneration than the central. Numerous non-surgical approaches that complement surgical treatment and support nerve regeneration have been developed to improve the outcome of nerve repair. For some of these methods, a positive effect on the regeneration of peripheral nervous system elements has been demonstrated, while others are still under the pinnacle of science in order to clarify their impact. Laser phototherapy is a supportive factor for accelerating and enhancing axonal regeneration. Results of the experimental study on denervated muscles suggest that laser treatment can restore its function to a substantial degree when initiated at the earliest possible postinjury stage. Low intensity ultrasound stimulates nerve regeneration through a thicker myelin coating, and improves functional recovery with better conductivity. Low-intensity electrical stimulation improves nerve regeneration, substantially accelerating axon outgrowth from the proximal to the distal nerve stumps, so that muscle reinnervation occurs significantly earlier. These methods may be complemented with specific physical treatment for further improvement. Cholecalciferol induces significant locomotor and electrophysiological recovery by increasing: number of preserved or newly formed axons at the proximal end; mean diameter of the axon at the distal end; myelination at distal and proximal ends. Magnesium improves regeneration of the nerves probably through Schwan's cells peservation from apoptosis by suppressing the inflammatory response. Multidisciplinary approach is of the utmost importance. The best results in nerve surgery may only be achieved when an adequate physical treatment, stimulation and supplementation is engaged in the recovery of a compliant patint.