Human acellular nerve allograft in repair of traumatic nerve defect of upper extremity: A preliminary observation / 中华显微外科杂志

Objective:To observe clinical outcomes of the repair of traumatic nerve defects in the proximal upper extremities by human acellular nerve allograft(hANG).Methods:Nerve defects in the upper extremities in 8 patients were repaired by hANG from March 2017 to January 2019. The patients were 6 males and 2 females with mean age of 35.4 (21-53) years old. The nerve defects were 2 radial nerve in distal upper arm, 4 median nerve in forearm, 1 interosseous dorsal nerve and 1 ulnar nerve in forearm. All injuries were acute nerve injury. Two patients had combined injury of upper arm muscle, 4 of forearm muscle and 1 of brachial artery defect. All wound were moderate to severe contaminated. The length of nerve defects was 30-60 (mean 45) mm. The surgical procedures were fixation of fracture, repair of the muscle and discovery of the broken ends of nerve and to repair with hANG. The postoperative follow-up period ranged 18 to 40 (mean 30.6) months to observe the local response of recovery. The efficacy was evaluated by the Upper Extremity Function Evaluation Standard set up by Hand Surgery Branch of Chinese Medical Association and Grading Standard of Muscle Strength.Results:No graft rejection was observed in all cases. Primarily healing was in 5 patients. Delayed healing in 2 patients and free skin grafting was performed. Local flap transfer was performed to repair the wound in 1 patient who developed a skin necrosis 10 days after surgery. Two patients with median nerve defects had nerve function restored well. The strength of finger grip and thumb opposition muscle restored to grade IV and the sensory function had restored S 3+. The interosseous dorsal nerve in 1 patient restored well. The strength of extensor digitorum tendon had restored to grade IV. Based on the evaluation criteria for the upper extremity issued by the Hand Surgery of the Chinese Medical Association, 3 patients was rated in excellent for function recovery, 1 in fair and 4 in poor. Conclusion:After throughout debridement, hANG can be applied in the repair of traumatic nerve defect in the proximal upper extremity in an emergency surgery and it can partially restore the nerve function.

Lower Limb Reconstruction - Fasciocutaneous Sural Flap / Reconstrução de membro inferior- retalho fasciocutâneo sural

Abstract Objective The present study aims to evaluate the use of the reverse-flow sural fasciocutaneous flap to cover lesions in the distal third of the lower limb. Methods A total of 24 cases were analyzed, including 20 traumatic injuries, 3 sports injuries, and 1 case of tumor resection. Results Among the 24 evaluated medical records, 16 patients were male, and 8 were female. Their age ranged from6 to 75 years old. Most of the patients evolved with total healing of the flap (n= 21). There was only one case of total necrosis of the flap in an insulin-dependent diabetic, high blood pressure patient, evolving to subsequent limb amputation. In two cases, there was partial necrosis and subsequent healing by secondary intention; one of these patients was a heavy smoker. Complications were associated with comorbidities and, unlike other studies, no correlation was observed with the learning curve. There was also no correlation with the site or size of the lesion to be covered. Conclusion It is clinically relevant that the success rate of the reverse-flow sural fasciocutaneous flap technique was of 87.5%. This is a viable and effective alternative in the therapeutic arsenal for complex lower limb lesions.

Resumo Objetivo Avaliar o uso do retalho fasciocutâneo sural de fluxo reverso na cobertura de lesões no terço distal dos membros inferiores. Métodos Foram analisados 24 casos, 20 de origem traumática, três por lesões esportivas e um por ressecção de lesão tumoral. Resultados Dos 24 prontuários avaliados, 16 eram homens e oito mulheres. A idade variou de seis a 75 anos. A maioria dos pacientes evoluiu com cicatrização total do retalho (21). Houve apenas um caso de necrose total do retalho em paciente diabético insulinodependente e hipertenso, evoluiu para posterior amputação do membro. Em dois casos, houve necrose parcial composterior cicatrização por segunda intenção, um desses pacientes era tabagista pesado. As complicações foram associadas às comorbidades e, ao contrário do evidenciado por outros estudos, não houve correlação com a curva de aprendizado. Também não houve correlação com o local ou o tamanho da lesão a ser coberta. Conclusão Tem-se como relevância clinica que a técnica de retalho fasciocutâneo sural de fluxo reverso usada obteve 87,5% de sucesso, é uma opção viável e eficaz no arsenal terapêutico das lesões complexas dos membros inferiores.

Effects of Triptolide on Biological Activity of Sciatic Nerve in Cold Preservation and Nerve Regeneration after Allogeneic Transplantation in Rats / 中国康复理论与实践

@#Objective To investigate the effects of triptolide (T10) on biological activity of sciatic nerve in cold preservation and nerve regeneration after allogeneic transplantation. Methods Cell Counting Kit-8 (CCK-8) was used to test the proliferation of SCs in logarithmic phase in 1×10-6 mol/L, 1×10-7 mol/L, 1×10-8 mol/L and 1×10-9 mol/L of T10 solution. The sciatic nerves from Sprague-Dawley rats were pretreated in 0 mol/L, 1×10-6 mol/L, 1×10-7 mol/L, 1×10-8 mol/L and 1×10-9 mol/L of T10 solution at 4 ℃ or 37 ℃ for 24 hours (n = 6). The expression of nerve growth factor (NGF), glial cell line-derived neurotrophic factor (GDNF) and brain-derived neurotrophic factor (BDNF) was detected with Western blotting. Other sciatic nerve fragments were randomly divided into fresh nerve group (group A, n = 30), DMEM preservation group (group B, n = 30), T10 preservation group (group C, n = 30), T10 pretreatment DMEM preservation group (group D, n = 30) and T10 pretreatment T10 preservation (group E, n = 30), and were stored under 4 ℃ for four weeks. Calcein-AM/PI double staining laser confocal microscope and flow cytometry were used to detect the living cells and dead cells. The expression of the major histocompatibility complex (MHC)-I, MHC-II and intercellular cell adhesion molecule-1 (ICAM-1) was detected with Western blotting. The corresponding sciatic nerves were used to repaire 10 mm defects in Wistar rats (named groups A', B', C', D' and E'), and fresh sciatic nerve from Wistar rats were also used to do it (group F'). Compound muscle action potential (CMAP) and motor nerve conduction velocity (MNCV) were tested 16 weeks after transplantation, and then the grafts were observed for the nerve regeneration. Results SCs proliferated as the controls in the T10 solution with a concentration of 1×10-9 to 1×10-7 mol/L (P > 0.05). The expression of all the neurotrophic factors was more under 37 ℃ than under 4 ℃ in all the concentrations of T10 solution, and it was the most in the concentration of 1×10-8 mol/L whenever under 37 ℃ or 4 ℃ (P < 0.05). After four weeks of cold preservation, compared with groups B, C and D, the living nerve cells were the most in group E, and the expression of MHC-I, MHC-II and ICAM-1 was the least (P < 0.05). CMAP, MNCV and the never regeneration were better in group E' than in groups A', B', C' and D' (P < 0.05). A large number of myelinated nerve fibers were observed in groups E' and F', uniformity in size, wide distribution, and with myelin sheath, compared with those in groups A', B', C' and D'. Conclusion A certain concentration of T10 can induce the sciatic nerve of rats to express neurotrophic factor in vitro, which can improve the biological activity of cold preservation nerves, reduce the immunogenicity, and promote the regeneration of recipient nerve after allogeneic transplantation. It is even better to be pretreated with T10 before cold preservation.

Use of superficial peroneal nerve graft for treating peripheral nerve injuries / Emprego do enxerto do nervo fibular superficial para tratamento de lesões de nervos periféricos

To evaluate the clinical results from treating chronic peripheral nerve injuries using the superficial peroneal nerve as a graft donor source. METHODS: This was a study on eleven patients with peripheral nerve injuries in the upper limbs that were treated with grafts from the sensitive branch of the superficial peroneal nerve. The mean time interval between the dates of the injury and surgery was 93 days. The ulnar nerve was injured in eight cases and the median nerve in six. There were three cases of injury to both nerves. In the surgery, a longitudinal incision was made on the anterolateral face of the ankle, thus viewing the superficial peroneal nerve, which was located anteriorly to the extensor digitorum longus muscle. Proximally, the deep fascia between the extensor digitorum longus and the peroneal longus muscles was dissected. Next, the motor branch of the short peroneal muscle (one of the branches of the superficial peroneal nerve) was identified. The proximal limit of the sensitive branch was found at this point. RESULTS: The average space between the nerve stumps was 3.8 cm. The average length of the grafts was 16.44 cm. The number of segments used was two to four cables. In evaluating the recovery of sensitivity, 27.2% evolved to S2+, 54.5% to S3 and 18.1% to S3+. Regarding motor recovery, 72.7% presented grade 4 and 27.2% grade 3. There was no motor deficit in the donor area. A sensitive deficit in the lateral dorsal region of the ankle and the dorsal region of the foot was observed. None of the patients presented complaints in relation to walking. CONCLUSIONS: Use of the superficial peroneal nerve as a graft source for treating peripheral nerve injuries is safe and provides good clinical results similar to those from other nerve graft sources.

Avaliar resultados clínicos do tratamento das lesões crônicas de nervos periféricos com o nervo fibular superficial como fonte doadora de enxerto. MÉTODOS: Estudo de 11 pacientes com lesões de nervos periféricos nos membros superiores tratados com enxerto do ramo sensitivo do nervo fibular superficial, com intervalo médio de 93 dias entre a data de registro da lesão e a cirurgia. Foram observadas lesões do nervo ulnar em oito pacientes e do nervo mediano em seis. Em três ambos os nervos foram lesados. Na cirurgia faz-se incisão longitudinal na face anterolateral no tornozelo, visualiza-se o nervo fibular superficial, situado anteriormente ao músculo extensor longo dos artelhos. Proximalmente disseca-se a fáscia profunda entre os músculos extensor longo dos artelhos e o fibular longo. A seguir, identifica-se o ramo motor do músculo fibular curto, um dos ramos do nervo fibular superficial. O limite proximal do ramo sensitivo encontra-se nesse ponto. RESULTADOS: A média do espaço entre os cotos nervosos foi de 3,8 cm, comprimento médio dos enxertos de 16,44 cm, número de segmentos usados de dois a quatro cabos. Na avaliação da recuperação da sensibilidade, 27,2% evoluíram para S2+, 54,5% para S3 e 18,1% para S3+. Quanto à recuperação motora, 72,7% apresentavam grau 4 e 27,2%, grau 3. Não houve déficit motor da área doadora, observou-se déficit sensitivo na região dorso lateral do tornozelo e dorsal do pé. Nenhum paciente apresentou queixas à deambulação. CONCLUSÕES: O uso do nervo fibular superficial no tratamento das lesões de nervos periféricos como fonte de enxerto é seguro e proporciona resultados clínicos semelhantes a outras fontes de enxerto de nervos.

A preliminary clinical report on bridging digital nerve defect with human acellular nerve graft / 中华显微外科杂志

Objective To evaluate the safety and efficacy of the human acellular nerve allograft (hANG)for nerve repair in the clinical setting,and report the early outcomes of bridging digital nerve defect with the hANG. Methods Four patients with 5 digital nerve injuries were included in this pilot study.The nerves defect ranged from 10-20 mm and were bridged with the hANG(manufactured by Zhongda Medical Equipment Co.,Ltd,Guangzhou,China).Four digital nerve acute injuries in 3 patients were repaired with hANG primarily,while the nerve in another patient was reconstructed secondarily.The procedure was performed under a 10-manifying operating microscope.The nerve stumps were debrided until the normal fascicles could be seen.hANG was inserted between the proximal and distal stumps and end-to-end neurorrhaphy was performed with 9-0 sutures.Postoperative cares included dressing change and administration of antibiotics.No immunosuppressants had been used.The follow-up time ranged from 1 to 3 months.The wound and blood sample were examined for the safety of hANG.The nerve function Wag evaluated according to the scoring system proposed by the Nerve Injuries Committee of the British Medical Research Council. Results All wounds healed primarily.The adverse effects,such as rejection,allergy,infection,and toxicity to the liver and kidney were absent.The results of blood biochemistry test were within the normal range.The injured nerve achieved good functional recovery.In 2 cages,the 2 point discrimination(2PD)was 8mm(S3~+,excellent). Conclusion Based on the short term follow-up,using hANG to repair digital nerve defect as long as 20mm was safe,and the nerve functional recovery is pretty good.

Comparison of two extraction techniques for larger chemically aceilular nerve allografts / 中国矫形外科杂志

[Objective]To compare two preparing procedures for larger chemically acellular nerve allografts (CANA). [Methods]The sciatic nerves of pigs were exposed by a muscle-splitting incision and were isolated free of the underlying fascia. The 60-mm-long segments of the nerve were obtained. They were treated according to the following decellularization processes.In group I,the nerve segments were treated with 7% Triton-100 solution and 7% sodium deoxycholate for two times.In group II,another protocol was created with the detergents Triton X-200,sulfobetaine-16,and sulfobetaine-10 for two times. The degrees of decellularization,activity of laminin,degrees of demyelination,and integrity of the nerve fiber tube were observed under microscope and were assessed by a scoring system.[Results]In both experimental groups the activity of laminin was present and the degrees of decellularization were complete. As for the demyelization of the nerve segments,the myelin sheath in Group II was partially preserved,but it completely disappeared in Group Ⅰ. The structure of the nerve fiber tube in Groups Ⅰ and Ⅱ were not as integral as that in the normal group.[Conclusion]It may be a better method for the larger CANA,to be treated with TritonX-100 and sodium deoxycholate during the decellularization procedure.

Evaluation of the regeneration of chemically extracted acellular facial nerve allograft for the whole facial nerve defect in rat with multiple retrograde tracing / 中国矫形外科杂志

[Objective]To evaluate the axonal transport function of the regenerate nerve of buccal branch,marginal mandibular branch and cervical branch after chemically extracted acellular facial nerve allograft to the whole facial nerve defect in rat using fluoro-gold(FG),quantum dot(QD) and fast blue(FB).[Method]The extracranial section of facial nerve and branches were dissected under light microscope,and 10-mm-long segments of facial nerve gap were made on the left side.The defect was repaired by acellular facial nerve allografts with epineural suture method.Two months later,fluoro-gold(FG),quantum dot(QD) and fast blue(FB) were injected into distal bridged side of buccal branch,marginal mandibular branch and cervical branch.After three days,the slices of brain stem were collected and the facial motoneuron was observed under fluorescences microscope.[Result]There were three kinds of different fluorescences in the frozen sections of the facial nerve originated from the brainstem nuclei under the fluorescence microscope.Fluoro-gold(FG),quantum dot(QD) and fast blue(FB) labeled neurons were shown yellow,red and blue colors,respectively.[Conclusion]According to estimation of axonal branching by triple retrograde labeling,it was found that the regenerate facial nerve repaired the gap,and nerve continuity obtained restoration.The evaluation method of this study is simple,reliable and easy.It is an ideal evaluation method.

Regeneration of rat sciatic nerve inhanced by chemical acellular xenogeneous nerve grafts:a functional evaluation / 中国矫形外科杂志

[Objective]To observe the nerve regeneration and functional recovery in the adult rats.[Method]The sciatic nerves on the left side of 15 rats were exposed and 1.0 cm long segments of the nerves were removed from the mid-thigh level and replaced by rabbit nerve made acellular through chemical extraction.At 4 months after procedure,the nerve regeneration and function recovery were examined with HE staining,NF-160 immunohistochemical staining,electrophysiological tests and sciatic functional index(SFI).[Result]In the rats repaired by acellular nerves,regenerated axons re-entered into the acellular xeno-nerve segments without excessive sign of inflammation following implantation.As stimuling(1.5 mA,0.1 ms,1.0 Hz) to the proximal sciatic nerves,the implanted segment resulted in motor evoked potentials,which were recorded from posterior tibial muscles.SFI showed a partial recovery of locomotion of the limb with sciatic nerve defect.[Conclusion]Sciatic nerves defect can be repaired by chemical acellular xenogeneous nerves in rats.There was partial functional recovery,which revealed the grafting with chemical acellular xenogeneous nerves may be a promising mehod for nerve defect in clinical.

Repair of rat sciatic nerve defect with optimized acellular rat nerve / 中国矫形外科杂志

0.05),but all statistically distinguishable from fresh allografts(P

Immunological study on sciatic nerve transplant tolerance induced by intrathymic injection of allogenic antigen / 中国免疫学杂志

Objective:To investigate the effect of intrathymic injection of allogenic antigen to sciatic nerve transplantation.Methods:C57BL/6(H-2b) mice were used as donors and BALB/c(H-2d) as recipients. The recipients were divided into four groups: auto-transplantation group, allogenic transplantation group, allogenic transplantation and using immunosuppressive drugs,intrathymic injection group: 3 mol/L KCl MHC antigen extractions were injected into the recipients’ thymus before two weeks before the sciatic nerves were transplanted. In the third week all the recipients underwent immunological detections for IL-2R,TNF-?,mixed lymphocytes culture and apoptosis.Results:All the detections indicated that it was of significant difference between intrathymic injection group and those in allogenic transplantation group.Conclusion:The immunological rejection of allogenic peripheral nerve transplantation can be somewhat inhibited by intrathymic injection of allogenic MHC antigen.

Repairing Function of Embryonic Spinal Cord on the Defect Tissue after Acute Spinal Cord Injury in Adult Rats / 中华创伤杂志

Using microsurgery techniques, we transplanted a piece of embryonic spinal cord (E_(14)) into spinal cord of adult rats that were hemisectly injured, with a small cavity left in it. The results were observed at days 7, 15. 30, 60, 120 and 240 after operation. The findings showed that 74% of the transplants could survive under pathological environment of the host spinal cord. They not only grew and differentiated continuously but also connected tightly with the host tissue. It is suggested that the defect tissue of injured adult spinal cord may at least be repaired with homotypic tissue by transplanting embryonic spinal cord cautiously with suitable age.

FREE GRAFTING WITH VASCULARIZED SUPERFICIAL BRANCH OF RADIAL NERVE AND SURAL NERVE / 解放军医学杂志

Composite transplants of the superficial branch of the radial nerve with radial artery and vein and sural nerve with small saphenous vein or peroneal artery and vein were used in 10 patients with large loss of nerve trunks. The recipients included median nerve in 7 patients, and ulnar nerve in 3. Average loss of nerve trunks was 12.5cm. After the operation, the patients were followed-up for 8 months to 5 years. Regeneration of nerve fibers was estimated to be 1.4mm every day. Functional recovery was satisfactory.

Establishing an experimental animal model of phallic reconstruction with sensory restoration / 第二军医大学学报

Objective:To establish an experimental phalloplasty model with sensory restoration in rabbits and to explore a new surgical technique to improve the postoperative sensory function in phallic reconstruction. Methods: Adult male New Zealand white rabbit was used. Penile reconstruction was performed with superficial epigastric faciovascular pedicle flap. Free saphenous nerve graft was dissected, embedded in the flap, and end-to-end anastomosed to dorsal nerve of penis. Postoperatively, H-E staining and CGRP immunohistochemical staining were applied to observe the morphology of the regenerated nerves in the reconstructed penis at different stages. Results:Only a few CGRP-positive fibers scattered in deep corium in the reconstructed penis 1 month after surgery, while the quantity of CGRP nerve fibers increased markedly and the CGRP-positive fibers appeared in both superficial corium and papillae corii after 3 months. Six months postoperatively, the positive nerve fibers were also observed around the cutaneous accessories and in the epidermis-corium boundary layer. Conclusion: This rabbit model demonstrates the possibility of a new method for phalloplasty with sensory recovery, which may redound to clinical application.

DEDIFFERENTIATION OF MACROGLIAL CELLS AFTER OPTIC NERVE INJURY AND ITS INDUCTION WITH PREDEGENERATED COMMON PERONEAL NERVE IN RATS / 解剖学报

Objective To investigate the dedifferentiation of neuroglial cells and its induction after optic nerve injury. Methods Adult male SD rats were randomly divided into 4 groups the normal control group,the injury group,the transplantation group and the microcrush and transplantation group.Optic nerves were harvested at days 3,7,14 and 28 after the operation.HE staining was used to count the number of neuroglial cells.Immunohistochemistry,Western blotting and in situ hybridization histochemistry were employed together with computerized image analysis to evaluate the expressions of Nestin,GFAP,MBP,NF,BDNF,Nogo-A and Nogo-A mRNA.Immunofluorescence double staining was used to detect the co-expression of Nestin and GFAP or Nestin and MBP. Results The number of cells only increased at day 7 after the nerve injury, the expressions of Nestin,MBP,Nogo-A and Nogo-A mRNA were up-regulated,the expressions of GFAP,NF and BDNF were down-regulated,and some Nestin-GFAP positive cells and a few of Nestin-MBP positive cells were detected in the injury group.Compared with the injury group,the number of cells was increased sometime after the nerve injury;the expressions of Nestin,GFAP,BDNF and NF were up-regulated,the expressions of MBP,Nogo-A and Nogo-A mRNA were down-regulated,and the number of Nestin-GFAP positive cells increased in the transplantation group and the microcrush and transplantation group.Conclusion After optic nerve injury,some astrocytes undergo dedifferentiation while the macroglial cells display a gene expression pattern that is unfavorable for nerve regeneration.Pre-degenerated peripheral nerves could enhance the dedifferentiation of astrocytes and induce the gene expression pattern of macroglial cells that is favorable for nerve regeneration.