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Chitosan tubes enriched with fresh skeletal muscle fibers for delayed repair of peripheral nerve defects

Neural Regeneration Research 2019年第6期14卷 1079-1084页

作者： alessandro crosio Benedetta Elena Fornasari Giovanna Gambarotta Stefano Geuna Stefania Raimondo Bruno Battiston Pierluigi Tos Giulia Ronchi Department of Orthopedics and Traumatology II-Surgery for Hand and Upper Limb-AOU Città della Salute e della Scienza di Torino-CTO Hospital Department of Clinical and Biological Sciences University of Torino Neuroscience Institute Cavalieri Ottolenghi University of Torino UO Microchirurgia e Chirurgia della Mano Ospedale Gaetano Pini

Nerve regeneration after delayed nerve repair is often unsuccessful. Indeed, the expression of genes associated with regeneration, including neurotrophic and gliotrophic factors, is drastically reduced in the distal stump of chronically transected nerves; moreover, Schwann cells undergo atrophy, losing their ability to sustain regeneration. In the present study, to provide a three-dimensional environment and trophic factors supporting Schwann cell activity and axon re-growth, we combined the use of an effective conduit(a chitosan tube) with a promising intraluminal structure(fresh longitudinal skeletal muscle fibers). This enriched conduit was used to repair a 10-mm rat median nerve gap after 3-month delay and functional and morphometrical analyses were performed 4 months after nerve reconstruction. Our data show that the enriched chitosan conduit is as effective as the hollow chitosan conduit in promoting nerve regeneration,and its efficacy is not statistically different from the autograft, considered the "gold standard" technique for nerve reconstruction. Since hollow tubes not always lead to good results after long defects(> 20 mm), we believe that the conduit enriched with fresh muscle fibers could be a promising strategy to repair longer gaps, as muscle fibers create a favorable three-dimensional environment and release trophic factors. All procedures were approved by the Bioethical Committee of the University of Torino and by the Italian Ministry of Health(approval number: 864/2016/PR) on September 14, 2016.

关键词： tubulization Schwann cells scaffold tissue engineering nerve reconstruction morphometrical analyses grasping test secondary repair median nerve nerve regeneration

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Painful scar neuropathy:principles of diagnosis and treatment

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Plastic and Aesthetic Research 2015年第1期2卷 156-164页

作者： Pierluigi Tos alessandro crosio Pierfrancesco Pugliese Roberto Adani Francesca Toia Stefano Artiaco Department of Orthopedics Reconstructive Microsurgery UnitCity of Health and Sciences of TurinTrauma Hospital10100 TorinoItaly Department of Hand Surgery and Microsurgery University Hospital of Verona37126 VeronaItaly Plastic and Reconstructive Surgery Department of SurgicalOncological and Oral SciencesUniversity of Palermo90127 PalermoItaly

Nerve-tissue interactions are *** nerve injuries may involve intraneural and extraneural scar formation and affect nerve gliding planes,sometimes leading to complex clinical *** 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 *** search retrieved twenty-one papers,twenty of which reported pain reduction or resolution with various *** is no consensus on the best therapeutic approach to neuropathic pain due to scar *** authors report good or excellent results with different techniques,from nerve wrapping with anti-adhesion devices to nerve coverage or wrapping with vascularized *** authors’classification of and therapeutic approach to peripheral nerve scar lesions aims at promoting a logical approach based on the analysis of lesion type(perineural,or endoneural and perineural),pain type(due to traction or external trauma,pain at rest),and number of previous *** need to be informed that multiple procedures may be required,that outcomes may be partial,and that surgery can potentially worsen preoperative *** review found no evidence for the best therapeutic approach to scar neuropathy,but there is consensus on a multidisciplinary approach.

关键词： Complex regional pain syndrome type II painful neuropathy painful scar neuropathy scar neuritis traction neuropathy

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