Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies

Abstract

Unlike other tissues in the body, peripheral nerve regeneration is slow and usually incomplete. Less than half of patients who undergo nerve repair after injury regain good to excellent motor or sensory function and current surgical techniques are similar to those described by Sunderland more than 60 years ago. Our increasing knowledge about nerve physiology and regeneration far outweighs our surgical abilities to reconstruct damaged nerves and successfully regenerate motor and sensory function. It is technically possible to reconstruct nerves at the fascicular level but not at the level of individual axons. Recent surgical options including nerve transfers demonstrate promise in improving outcomes for proximal nerve injuries and experimental molecular and bioengineering strategies are being developed to overcome biological roadblocks limiting patient recovery.

Figure 1

Peripheral nerve anatomy [4].

Figure 2

Degeneration and regeneration after peripheral nerve injury [24].

Figure 3

Axon regeneration after axonotmesis and neurotmesis injuries [15].

Figure 4

Epineural repair as seen through the microscope.

Figure 5

Nonvascularised cable nerve graft to reconstruct 15 cm defect of radial nerve.

Figure 6

Vascularised sural nerve graft insitu before transfer.

Figure 7

Surgical algorithm of peripheral nerve repair [4].

Figure 8

Pronator teres nerve transfer for wrist extension in radial nerve palsy. Video of pronator nerve transfer to reconstruct wrist extension (see Supplementary Material available online at http://dx.doi.org/10.1155/2014/698256).