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Bert R. Bratton, David G. Kline, William Coleman and Alan R. Hudson

U se of autogenous interfascicular grafts to repair nerve injury that required suture has been described by Millesi, et al., 18 and is accepted procedure by many who are actively involved in clinical peripheral nerve surgery. Millesi, et al., stated that “nerve regeneration after grafting without tension is much better than after direct end-to-end suture under moderate tension even though the regenerating axons must cross two suture lines when grafts are used.” Routine use of autogenous nerve grafts for most repairs rather than mobilization of the nerve

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Adarsh K. Gulati

S uccessful regeneration of axons is known to occur over considerable distances through grafts consisting of peripheral nerve placed between injured peripheral nervous tissue as well as in central nervous tissue. 1, 3, 18, 23 The “endoneurial tube(s)” in the peripheral nerve graft is believed to be important in guiding and promoting the growth of the regenerating axon. 18, 20 Several recent investigations have attributed particular importance to the Schwann cell basal lamina in supporting axonal growth. Basal lamina components such as laminin and

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Pavel Haninec, Filip Šámal, Robert Tomáš, Ladislav Houstava and Petr Dubový

and electrophysiological data suggested the lesion was limited to the level of anterior rami of the spinal nerves and trunks. The standard technique of nerve grafting was used to repair injured anterior rami of spinal nerves, trunks, cords, and peripheral nerves. Intraoperative decisions during direct repair (grafting) procedures were guided by electrophysiological methods, mainly by NAP recording. The NAP recording was carried out with the aim of demonstrating the presence or absence of regenerating myelinated fibers through the site of the lesion. Another goal

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Grant A. Robinson and Roger D. Madison

, each weighing 180 to 220 g, were anesthetized by intraperitoneal injection of 7% chloral hydrate (0.42 mg/g) in 0.9% sodium chloride. The rats' body temperatures were maintained using a heating pad. Peripheral Nerve Grafting To serve as an autologous graft, a portion (approximately 3 cm) of the peroneal branch of the sciatic nerve from the right hindlimb was harvested using microscissors. Via an intraorbital approach, the left optic nerve was transected approximately 0.5 mm from the eye by using microscissors. One end of the graft was apposed to the ocular stump of

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Martijn J. A. Malessy, Sjoerd G. van Duinen, Hans K. P. Feirabend and Ralph T. W. M. Thomeer

R apid and violent traction to the brachial plexus may cause extensive loss of continuity of nerve fibers. Characteristically, the damage is distributed along the length of the nerve and may involve entire segments. 33 In addition, secondary retrograde changes may further reduce the number of viable axons. 25 The extent of nerve defects necessitates the use of long nerve grafts, which in combination with inevitable fascicular mismatching negatively influences the outcome of repair. 34 Although the efficacy of nerve grafting in improving the outcome in severe

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Adarsh K. Gulati and Geoffrey P. Cole

on the various cellular components of the nerve tissue (such as Schwann cells and endothelial cells). 1, 20 It is evident that, for an allograft to be successful, the immunogenicity of the allograft and/or the host immune response must be altered. 18, 22 It has been proposed that the “endoneurial tubes,” comprised of Schwann cells and their basal lamina, guide the regenerating axons through the nerve grafts. Several recent studies have described the ability of endoneurial basal lamina, in the absence of viable Schwann cells, to support axonal regeneration

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Paul C. Francel, Kevin S. Smith, F. Alan Stevens, Soon C. Kim, James Gossett, Cynthia Gossett, Mark E. Davis, Marc Lenaerts and Paul Tompkins

A lthough much effort has been put into refining the methods used to repair long nerve gaps, the nerve autograft remains the gold standard for repair. Repair is effected by the regeneration of axons along the nerve graft scaffold and eventually into the distal motor endplates or sensory organs. 10 This procedure is accompanied by potential donor site complications that include numbness, painful neuroma formation, and unacceptable scarring. In an effort to avoid these complications, a variety of conduit tube repairs have been used for short nerve gaps

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Roberto Pallini, Eduardo Fernandez, Liverana Lauretti, Elisabetta Dell'Anna, Frank La Marca, Carlo Gangitano, Aurora Del Fà, Corrado Olivieri-Sangiacomo, Alessandro Sbriccoli and Gian Franco Rossi

controlled with saline irrigation at room temperature. Following blunt dissection of the neck muscles down to the bifurcation of the right common carotid artery, the right SCG was exposed and the cranial sympathetic nerve was cut close to the ganglion. In the 27 experimental animals, a 40-mm-long nerve graft was removed from the sciatic nerve and tunneled subcutaneously from the cervical region to the parietal cortex. One end of the nerve graft was placed facing the rostral (postganglionic) pole of the SCG and sutured to the capsula with 10-0 Ethicon stitches. The other

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Brachial plexus repair by peripheral nerve grafts directly into the spinal cord in rats

Behavioral and anatomical evidence of functional recovery

Jayme Augusto Bertelli and Jean Claude Mira

I n mammals, extended regeneration of the peripheral nerve system is a well-known process. On the other hand, regeneration of injured axons in the central nervous system (CNS) is generally abortive, and synaptic contacts with target neurons are not usually reestablished. The fact that peripheral nerves provide a favorable environment for the support of axonal elongation has been demonstrated for peripheral nerves grafted into the CNS. 1, 3, 13, 17, 25, 27, 28, 33 Over the years, peripheral nerve grafts have attracted interest, especially as a possible means

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Carmen L. A. M. Vleggeert-Lankamp, Jasper Wolfs, Ana Paula Pêgo, Rutgeris van den Berg, Hans Feirabend and Egbert Lakke

T he porosity of a synthetic nerve graft is one of the factors to consider when seeking to improve nerve regeneration. Favorable effects of permeability are attributed to inward diffusion of growth factors and ECM proteins, 22 and to outward diffusion of waste products. Impermeable tubes, conversely, may have a positive effect on nerve regeneration because they insulate the area of axonal outgrowth, they prevent the invasion of connective tissue that leads to scarring, and growth factors generated inside the tube may be unable to diffuse away. 38