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Review
. 2020;1(2):49-59.
doi: 10.1007/s43152-020-00002-z. Epub 2020 Apr 21.

Strategies for Peripheral Nerve Repair

Affiliations
Review

Strategies for Peripheral Nerve Repair

Matthew Wilcox et al. Curr Tissue Microenviron Rep. 2020.

Abstract

Purpose of review: This review focuses on biomechanical and cellular considerations required for development of biomaterials and engineered tissues suitable for implantation following PNI, as well as translational requirements relating to outcome measurements for testing success in patients.

Recent findings: Therapies that incorporate multiple aspects of the regenerative environment are likely to be key to improving therapies for nerve regeneration. This represents a complex challenge when considering the diversity of biological, chemical and mechanical factors involved. In addition, clinical outcome measures following peripheral nerve repair which are sensitive and responsive to changes in the tissue microenvironment following neural injury and regeneration are required.

Summary: Effective new therapies for the treatment of PNI are likely to include engineered tissues and biomaterials able to evoke a tissue microenvironment that incorporates both biochemical and mechanical features supportive to regeneration. Translational development of these technologies towards clinical use in humans drives a concomitant need for improved clinical measures to quantify nerve regeneration.

Keywords: Nerve biomechanics; Nerve regeneration; Quantitative MRI; Quantitative neurophysiology; Repair Schwann cells.

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Conflict of interest statement

Conflict of InterestsThe authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Reconstructive nerve procedures. a Nerve transfer is commonly deployed in severe proximal nerve injuries to restore elbow flexion (Oberlin’s nerve transfer). Synergistic donor motor nerves (fascicles ulnar and median nerves to wrist flexors) in close proximity to the injured nerve (musculocutaneous nerve) are dissected, divided and redirected to grow into the damaged nerve. b The nerve autograft is often selected to repair excessive acute gaps. A sensory (often sural) nerve is harvested and used to bridge the nerve gap. c Free functioning muscle transfer is elected in chronic nerve injuries. A donor muscle (such as the gracilis) and its neurovascular bundle are removed and grafted into the site of injury to restore function (such as elbow flexion). N, nerve; A, artery; V, vein
Fig. 2
Fig. 2
Strategies to improve peripheral nerve repair. Effective new therapies for peripheral nerve repair are likely to include engineered tissues and biomaterials that incorporate biological and mechanical features to support regeneration. Translational development of these technologies towards clinical use in humans requires improved clinical outcome measures of nerve regeneration. Motor unit number estimation: serial single motor unit potentials recorded from rat tibialis anterior using an incremental stimulation technique. Magnetic resonance imaging: T2-weighted MRI scans of uninjured and nerve injured biceps muscles from patient who sustained C5/6 Avulsion. a Uninjured biceps muscle (uninjured contralateral arm) outlined in red. b Subacutely denervated biceps muscle (3 months following injury) demonstrating increased signal (arrow) and atrophy of the biceps muscle (outlined in red) compared to a

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