Abstract
SummaryArtificial and non-artificial nerve grafts are the gold standard in peripheral nerve reconstruction in cases with extensive loss of nerve tissue, particularly where a direct end-to-end suture or an autologous nerve graft is inauspicious. Different materials are marketed and approved by the US Food and Drug Administration (FDA) for peripheral nerve graft reconstruction. The most frequently used materials are collagen and poly(DL-lactide-ε-caprolactone). Only one human nerve allograft is listed for peripheral nerve reconstruction by the FDA. All marketed nerve grafts are able to demonstrate sufficient nerve regeneration over small distances not exceeding 3.0 cm. A key question in the field is whether nerve reconstruction on large defect lengths extending 4.0 cm or more is possible. This review gives a summary of current clinical and experimental approaches in peripheral nerve surgery using artificial and non-artificial nerve grafts in short and long distance nerve defects. Strategies to extend nerve graft lengths for long nerve defects, such as enhancing axonal regeneration, include the additional application of Schwann cells, mesenchymal stem cells or supporting co-factors like growth factors on defect sizes between 4.0 and 8.0 cm.
Highlights
Peripheral nerve damage is a severe and critical problem in all disciplines of surgery
Neurogen® is a collagen based nerve tube demonstrating a satisfying recovery rate of 43% of level 1 trauma treated patients with peripheral nerve defects pending between 2.5–20.0 mm in length [13]
After 6 months, the results indicated that regeneration in allografts with Mesenchymal stem cells (MSCs) are better than in acellular controls, but still inferior to grafts pre-seeded with Schwann cells and isografts
Summary
Peripheral nerve damage is a severe and critical problem in all disciplines of surgery. All marketed and FDA approved nerve grafts demonstrate satisfying recovery on defect length from up to 3.0 cm with a minimal amount of side effects or regeneration failure. Despite these high number of FDA approved and commercially available artificial nerve grafts for reconstruction of peripheral nerve defects, no implant is approved and available for defect sizes extending 3.0 cm or longer in length. G. plexus nerves by trauma or long length tumor infiltration of peripheral nerve tissue are challenging in reconstruction These review gives a brief overview about current approaches in peripheral nerve surgery for critical gap sizes between 4.0 and 8.0 cm in small and large animal models using acellular nerve grafts or pre-seeded conduits Extended and multiple injuries of e. g. plexus nerves by trauma or long length tumor infiltration of peripheral nerve tissue are challenging in reconstruction These review gives a brief overview about current approaches in peripheral nerve surgery for critical gap sizes between 4.0 and 8.0 cm in small and large animal models using acellular nerve grafts or pre-seeded conduits
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