J Reconstr Microsurg 2015; 31(09): 660-667
DOI: 10.1055/s-0035-1558463
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Decellularized Nerves for Upper Limb Nerve Reconstruction: A Systematic Review of Functional Outcomes

Maria Florencia Deslivia
1   Interaction and Robotics Research Center, Korea Institute of Science and Technology, Seoul, Korea
2   Department of HCI and Robotics, University of Science and Technology, Daejeon, Korea
,
Hyun-Joo Lee
3   Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
,
Arnold Adikrishna
4   Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
,
In-Ho Jeon
4   Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
› Institutsangaben
Weitere Informationen

Publikationsverlauf

22. Februar 2015

10. Juni 2015

Publikationsdatum:
17. August 2015 (online)

Abstract

Background This is a systematic review for evaluating the evidence for functional outcomes after decellularized nerve use in clinical setting. Decellularized nerves are allografts whose antigenic components have been removed, leaving only a scaffold that promotes the full regeneration of axons.

Methods Literature research was performed using the PubMed/MEDLINE database for English language studies with the keywords “decellularized nerve” and “processed nerve allograft.” Inclusion criteria were prospective and retrospective case reviews in clinical settings. Exclusion criteria were case reports and case series.

Results We retrieved six level VIII studies and one level VI study (classified according to the Jovell and Navarro–Rubio scale) with a total of 131 reconstructions. The basic data ranges of the studies were as follows: patient age, 18 to 86 years; duration between initial injury and nerve reconstruction procedure, 8 hours to 4 years; and follow-up period, 40 days to 2 years. The maximum lengths of the nerve gap for chemically washed decellularized nerves and cryopreserved decellularized nerves were 50 and 100 mm, respectively. Quantitatively, the functional outcome ranges were as follows: static two-point discrimination, 3 to 5 mm; and moving two-point discrimination, 2 to 15 mm. For motor assessment, all patients had a > M3 Medical Research Council score. It is also important to notice that a large variability occurs in almost every factor in the reviewed studies.

Conclusion Our study is the first to summarize the clinical results of decellularized nerves. Decellularized nerves have been used to bridge nerve gaps ranging from 5 to 100 mm with associated satisfactory outcomes in static and moving two-point discriminations.

 
  • References

  • 1 Driscoll PJ, Glasby MA, Lawson GM. An in vivo study of peripheral nerves in continuity: biomechanical and physiological responses to elongation. J Orthop Res 2002; 20 (2) 370-375
  • 2 Ruijs AC, Jaquet JB, Kalmijn S, Giele H, Hovius SE. Median and ulnar nerve injuries: a meta-analysis of predictors of motor and sensory recovery after modern microsurgical nerve repair. Plast Reconstr Surg 2005; 116 (2) 484-494 , discussion 495–496
  • 3 Rinkel WD, Huisstede BM, van der Avoort DJ, Coert JH, Hovius SE. What is evidence based in the reconstruction of digital nerves? A systematic review. J Plast Reconstr Aesthet Surg 2013; 66 (2) 151-164
  • 4 Rinker B, Vyas KS. Clinical applications of autografts, conduits, and allografts in repair of nerve defects in the hand: current guidelines. Clin Plast Surg 2014; 41 (3) 533-550
  • 5 Giusti G, Willems WF, Kremer T, Friedrich PF, Bishop AT, Shin AY. Return of motor function after segmental nerve loss in a rat model: comparison of autogenous nerve graft, collagen conduit, and processed allograft (AxoGen). J Bone Joint Surg Am 2012; 94 (5) 410-417
  • 6 Moore AM, MacEwan M, Santosa KB , et al. Acellular nerve allografts in peripheral nerve regeneration: a comparative study. Muscle Nerve 2011; 44 (2) 221-234
  • 7 Whitlock EL, Tuffaha SH, Luciano JP , et al. Processed allografts and type I collagen conduits for repair of peripheral nerve gaps. Muscle Nerve 2009; 39 (6) 787-799
  • 8 Liberati A, Altman DG, Tetzlaff J , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 2009; 6 (7) e1000100
  • 9 Gunn S, Cosetti M, Roland Jr JT. Processed allograft: novel use in facial nerve repair after resection of a rare racial nerve paraganglioma. Laryngoscope 2010; 120 (Suppl. 04) S206
  • 10 Shanti RM, Ziccardi VB. Use of decellularized nerve allograft for inferior alveolar nerve reconstruction: a case report. J Oral Maxillofac Surg 2011; 69 (2) 550-553
  • 11 Brooks DN, Weber RV, Chao JD , et al. Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions. Microsurgery 2012; 32 (1) 1-14
  • 12 Cho MS, Rinker BD, Weber RV , et al. Functional outcome following nerve repair in the upper extremity using processed nerve allograft. J Hand Surg Am 2012; 37 (11) 2340-2349
  • 13 Ducic I, Fu R, Iorio ML. Innovative treatment of peripheral nerve injuries: combined reconstructive concepts. Ann Plast Surg 2012; 68 (2) 180-187
  • 14 Guo Y, Chen G, Tian G, Tapia C. Sensory recovery following decellularized nerve allograft transplantation for digital nerve repair. J Plast Surg Hand Surg 2013; 47 (6) 451-453
  • 15 Karabekmez FE, Duymaz A, Moran SL. Early clinical outcomes with the use of decellularized nerve allograft for repair of sensory defects within the hand. Hand (NY) 2009; 4 (3) 245-249
  • 16 Squintani G, Bonetti B, Paolin A , et al. Nerve regeneration across cryopreserved allografts from cadaveric donors: a novel approach for peripheral nerve reconstruction. J Neurosurg 2013; 119 (4) 907-913
  • 17 Taras JS, Amin N, Patel N, McCabe LA. Allograft reconstruction for digital nerve loss. J Hand Surg Am 2013; 38 (10) 1965-1971
  • 18 Jovell AJ, Navarro-Rubio MD. Evaluación de la evidencia científica. Med Clin (Barc) 1995; 105 (19) 740-743
  • 19 Huber GC. A study of the operative treatment for loss of nerve substance in peripheral nerves. J Morphol 1895; 11: 629-740
  • 20 Schmidt G. Eduard albert and the beginning of human nerve grafting. Acta Chir Austriaca. 1993; 25: 287-288
  • 21 Hudson TW, Evans GR, Schmidt CE. Engineering strategies for peripheral nerve repair. Clin Plast Surg 1999; 26 (4) 617-628 , ix
  • 22 Zuo J, Hernandez YJ, Muir D. Chondroitin sulfate proteoglycan with neurite-inhibiting activity is up-regulated following peripheral nerve injury. J Neurobiol 1998; 34 (1) 41-54
  • 23 Wang Y, Sunitha M, Chung KC. How to measure outcomes of peripheral nerve surgery. Hand Clin 2013; 29 (3) 349-361
  • 24 Weber RA , et al. A randomized prospective study of PGA conduits for digital nerve reconstruction is humans. Plast Recon Surgery 2000; 106: 1036-1045
  • 25 Wangensteen KJ, Kalliainen LK. Collagen tube conduits in peripheral nerve repair: A retrospective analysis. Hand (NY) 2009; 5: 273-277
  • 26 Neubauer D, Graham JB, Muir D. Nerve grafts with various sensory and motor fiber compositions are equally effective for the repair of a mixed nerve defect. Exp Neurol 2010; 223 (1) 203-206
  • 27 Saheb-Al-Zamani M, Yan Y, Farber SJ , et al. Limited regeneration in long acellular nerve allografts is associated with increased Schwann cell senescence. Exp Neurol 2013; 247: 165-177