Restoration of Neurological Function Following Peripheral Nerve Trauma

Abstract

Following peripheral nerve trauma that damages a length of the nerve, recovery of function is generally limited. This is because no material tested for bridging nerve gaps promotes good axon regeneration across the gap under conditions associated with common nerve traumas. While many materials have been tested, sensory nerve grafts remain the clinical "gold standard" technique. This is despite the significant limitations in the conditions under which they restore function. Thus, they induce reliable and good recovery only for patients < 25 years old, when gaps are <2 cm in length, and when repairs are performed <2-3 months post trauma. Repairs performed when these values are larger result in a precipitous decrease in neurological recovery. Further, when patients have more than one parameter larger than these values, there is normally no functional recovery. Clinically, there has been little progress in developing new techniques that increase the level of functional recovery following peripheral nerve injury. This paper examines the efficacies and limitations of sensory nerve grafts and various other techniques used to induce functional neurological recovery, and how these might be improved to induce more extensive functional recovery. It also discusses preliminary data from the clinical application of a novel technique that restores neurological function across long nerve gaps, when repairs are performed at long times post-trauma, and in older patients, even under all three of these conditions. Thus, it appears that function can be restored under conditions where sensory nerve grafts are not effective.

Keywords: allografts; autografts; axon regeneration; nerve conduits; nerve gaps; nerve repair; platelet-rich plasma; platelet-rich plasma (PRP).

Figure 1

Repairing an ulnar nerve with a 12-cm-long gap. (A) Sewing two 4 × 8 cm collagen sheets together end to end, and then into a 16-cm-long tube around the handle of a surgical tool. (B) The collagen tube cut to a 12.6 cm length and placed in the nerve gap. (C) The proximal and distal nerve stumps secured about 3 mm into the collagen tube. (D) Completed nerve gap repair with the collagen tube filled with autologous platelet-rich plasma (PRP).