Investigating a new entubulation strategy to overcome peripheral nerve injury

摘要

Nerve injury can be devastating for afflicted patients, potentially resulting in life-long disabilities. Currently a nerve autograft is the gold standard for treating nerve injury, allowing extensive regeneration and end-organ rein-nervationHowever, autografting is inherently flawed as it requires that a second nerve injury be created in the patient to treat the primary injury; this may result in surgical scarring and a painful neuroma. Alternative strategies using synthetic conduits offergreat promise, but have yet to prove efficacy or equivalency to the nerve autograft.Biological and synthetic conduits for nerve repair have been utilized for over a century (reviewed in). In the 1940's, Weiss championed their use as an alternative to suture repair demonstrating their effect over very short gaps to successfully bridge the proximal and distal nerve stumps. Since then, multiple biological and synthetic conduits for nerve repair have been attempted, including areteries, veins, muscle and poly(glycolic acid), silicone and collagen. The biological events occurring within aconduit used in peripheral nerve repair have been reviewed by Seckel6. When the two nerve stumps are positioned within the proximal and distal parts of a tube, the conduit fills within a day with serous fluid, which has neurotrophic activity7. Matrixprecursors accumulate, and over several days, a coaxial, acellular fibronectin positive, laminin negative matrix forms, which acts as a scaffold for migrating cells from the proximal and the distal nerve stumps. Over a period of 2 weeks, a tissue cableforms within the hollow conduit that tapers from both proximal and distal stumps towards the centre, thereby limiting effective axonal regeneration and functional recovery