Peripheral nerve lengthening as a regenerative strategy

Abstract

Peripheral nerve injury impairs motor, sensory, and autonomic function, incurring substantial financial costs and diminished quality of life. For large nerve gaps, proximal lesions, or chronic nerve injury, the prognosis for recovery is particularly poor, even with autografts, the current gold standard for treating small to moderate nerve gaps. In vivo elongation of intact proximal stumps towards the injured distal stumps of severed peripheral nerves may offer a promising new strategy to treat nerve injury. This review describes several nerve lengthening strategies, including a novel internal fixator device that enables rapid and distal reconnection of proximal and distal nerve stumps.

Keywords: biomedical device; mechanical loading; nerve injury; nerve regeneration; nerve transfer; peripheral nerve.

Figure 1

Schematics of nerve lengthening strategies. Blue: Proximal stump; yellow: distal stump; red: autograft (or other graft). Arrows represent direction of tension placed on respective stumps. Sutures are indicated at stump-graft or stump-stump interfaces.

Figure 2

Schematic of nerve internal fixator device modified from (Chuang et al., 2013). (A, B) Implanted device uses hypotube with nerve cuff to pull intact proximal stump past distal stump. (C) Cuffed nerve regions and device are explanted, allowing clean reattachment of proximal stump to distal stump.