Published Special Issues
Topic: Peripheral Nerve Repair and Regeneration
  • Preface to special issue on "Peripheral Nerve Repair and Regeneration"

    Francesca Toia
    Published on: 15 Jul 2015
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  • Clinical neurophysiology and imaging of nerve injuries: preoperative diagnostic work-up and postoperative monitoring

    Andrea Gagliardo , Francesca Toia , Francesco Maggì , Alessio Vincenzo Mariolo , Michele Cillino , Francesco Moschella
    Peripheral nerve injuries are a heterogeneous group of lesions that may occurs secondary to various causes. Several different classifications have been used to describe the pathophysiological mechanisms leading to the clinical deficit, from simple and reversible compression-induced demyelination, to complete transection of nerve axons. Neurophysiological data localize, quantify, and qualify (demyelination vs. axonal loss) the clinical and subclinical deficits. High-resolution ultrasound can demonstrate the morphological extent of nerve damage, fascicular echotexture (epineurium vs....
    Published on: 15 Jul 2015
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  • Painful scar neuropathy: principles of diagnosis and treatment

    Pierluigi Tos , Alessandro Crosio , Pierfrancesco Pugliese , Roberto Adani , Francesca Toia , Stefano Artiaco
    Nerve-tissue interactions are critical. Peripheral nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes, sometimes leading to complex clinical presentations. All of these pathological entities involve pain as the main clinical symptom and can be subsumed under the term “painful scar neuropathy”. The authors review the literature on treatment approaches to peripheral nerve scar neuropathy and the outcomes of neurolysis‑associated procedures and propose a simple classification and a therapeutic approach to scar neuropathy. The search retrieved...
    Published on: 15 Jul 2015
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  • The management of neuropathic pain from neuromas in the upper limb: surgical techniques and future directions

    Tereze Laing , Aftab Siddiqui , Manu Sood
    Neuropathic pain of the upper limb results from damage or disease of the upper limb somatosensory system caused by wide range of pathologies including peripheral neuromas. Treatment strategies depend on making an accurate diagnosis, recognizing co-existing pathologies, and formulating an individualized treatment plan that commonly involves multiple modalities. A long list of nonsurgical and surgical methods acting peripherally (neuromodulation, nerve blocks, surgical manipulation of the nerve) and centrally (medications, spinal cord, and deep brain stimulation) has been described and it is...
    Published on: 15 Jul 2015
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  • Neuropathic pain after bilateral sagittal split osteotomy: management and prevention

    Jimoh Olubanwo Agbaje , Ivo Lambrichts , Reinhilde Jacobs , Constantinus Politis
    Neuropathic pain is characterized by spontaneous and provoked pain and other signs reflecting neural damage. Aberrant regeneration following peripheral nerve lesions leaves neurons unusually sensitive and prone to spontaneous pathological activity, abnormal excitability and heightened sensitivity to stimuli. This review covers the current understanding of neuropathic pain after bilateral sagittal split osteotomy (BSSO) of the lower jaw. The reported incidence of neuropathic pain after mandibular osteotomies is less than 1%, while the incidence in patients with iatrogenic inferior alveolar...
    Published on: 15 Jul 2015
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  • Recalcitrant cubital tunnel syndrome

    Adolfo Vigasio , Ignazio Marcoccio , Eleonora Morandini
    Ulnar nerve neuropathy at the elbow represents the second most frequent compression neuropathy of the upper extremity. Of the five different anatomical areas responsible for ulnar nerve compression at the elbow region, the epitrochlear-olecranon channel and Osborne’s arcade are the most common. An additional cause of nerve damage is a dynamic process in which the ulnar nerve dislocates anteriorly at the epitrochlear-olecranon level during elbow flexion, partially or completely, causing nerve friction and constriction leading to chronic neuropathic pain. Failure after primary surgery is...
    Published on: 15 Jul 2015
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  • Vascularized nerve “grafts”: just a graft or a worthwhile procedure?

    Salvatore D’Arpa , Karel Etienne Yvonne Claes , Filip Stillaert , Britt Colebunders , Stan Monstrey , Phillip Blondeel
    The aim of this review is to extrapolate evidence regarding the use of vascularized nerve grafts (VNGs) in peripheral nerve reconstruction and summarize available data on their indications, if any, and clinical applications. A review of the literature via the PubMed database was performed with analysis of ninety-five articles on the experimental and clinical studies of VNGs. Eight relevant questions were selected to be answered about VNGs. VNGs allow faster nerve regeneration and convey a functional advantage under certain clinical conditions such as large nerves, proximal lesions, and...
    Published on: 15 Jul 2015
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  • Nerve transfers of the forearm and hand: a review of current indications

    Paolo Sassu , Katleen Libberecht , Anders Nilsson
    Nerve transfer surgery, also referred to neurotization, developed in the mid 1800s with the use of animal models, and was later applied in the treatment of brachial plexus injuries. Neurotization is based on the concept that following a proximal nerve lesion with a poor prognosis, expendable motor or sensory nerves can be re-directed in proximity of a specific target, whether a muscle or skin territory, in order to obtain faster re-innervation. Thanks to the contribution of several authors including Oberlin, MacKinnon and many others, the field of nerve transfer surgery has expanded in...
    Published on: 15 Jul 2015
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  • Sensory protection to enhance functional recovery following proximal nerve injuries: current trends

    Boa Tram Nghiem , Ian C. Sando , Yaxi Hu , Melanie G. Urbanchek , Paul S. Cederna
    Proximal nerve injury can lead to devastating functional impairment. Because axonal regeneration is slow, timely reinnervation of denervated muscle does not occur. These denervated muscles atrophy and lose function. Sensory protection is a surgical technique thought to prevent denervated muscle impairment using local sensory nerves to provide trophic support to the muscle until motor nerves can regenerate, and neuromuscular junctions are reestablished. We performed a comprehensive literature search using multiple databases to find primary articles reporting on the outcomes and treatment of...
    Published on: 15 Jul 2015
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  • “Babysitting” procedures in proximal nerve trunk injuries: two case reports and a review

    Michele R. Colonna , Antonio Russo , Mariarosaria Galeano , Gabriele Delia , Giorgio E. Pajardi , Francesco Stagno d’Alcontres
    One of the most important goals in treating proximal nerve injuries is to maintain the function of distal effectors during axonal regeneration. “Babysitting”, that is, connecting the injured nerve to a healthy trunk provides a bypass for distal neural regeneration or reactivation. It avoids degeneration of sensory and motor terminations, with minimal donor nerve damage. We present a technique where a nerve graft is used between ulnar and median nerve through two end‑to‑side sutures in the distal third of the forearm, in two different cases of proximal ulnar nerve injury. Both patients were...
    Published on: 15 Jul 2015
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  • Tissue-engineered constructs for peripheral nerve repair: current research concepts and future perspectives

    Alba C. de Luca , Wassim Raffoul , Francesco Giacalone , Maddalena Bertolini , Pietro G. di Summa
    Traumatic injuries resulting in peripheral nerve lesions lead to important morbidity with devastating social and economic consequences. When the lesioned nerve cannot be sutured directly, a nerve graft is generally required to bridge the gap. Although autologous nerve grafting is still the first choice for reconstruction, it has the severe disadvantage of the sacrifice of a functional nerve. Research in tissue engineering and nerve regeneration may have a dramatic impact on clinical and surgical treatment of such nerve lesions. The authors review the latest concepts in tissue engineering...
    Published on: 15 Jul 2015
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  • Endoscopic telemicrosurgery or minimally invasive robotically-assisted microsurgery for peripheral nerve repair

    Satoshi Ichihara , Sybille Facca , Frédéric Bodin , Sarah Hendriks , André Gay , Philippe Liverneaux
    Microsurgery comprises a variety of surgical procedures such as neurovascular anastomoses, performed under optical magnification and with fine instrumentation. While refinements have been made since its advent in the 1960s, robotics offers the potential for major technological advancement. Endoscopic telemicrosurgery is minimally invasive, robotically-assisted microsurgery. This technique removes some limitations of conventional microsurgery and enhances visual and manual dexterity. Vision is enhanced through greater magnification, three‑dimensionality, and functionalization, all through an...
    Published on: 15 Jul 2015
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  • Nerve regeneration in vascularized composite allotransplantation: current strategies and future directions

    Anirudh Arun , Nicholas B. Abt , Sami Tuffaha , Gerald Brandacher , Angelo A. Leto Barone
    Vascularized composite allotransplantation (VCA) has emerged as a viable treatment option for limb and face reconstruction of severe tissue defects. Functional recovery after VCA requires not only effective immunosuppression, but also consideration of peripheral nerve regeneration to facilitate motor and sensory reinnervation of donor tissue. At the time of transplantation, the donor and recipient nerves are typically coapted in an end‑to‑end fashion. Following transplantation, there are no therapies available to enhance nerve regeneration and graft reinnervation, and functional outcomes...
    Published on: 15 Jul 2015
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