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Silk-based nerve guidance conduits with macroscopic holes modulate the vascularization of regenerating rat sciatic nerve

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Neural Regeneration Research 2025年第6期20卷 1789-1800页

作者： Carina Hromada Patrick Heimel Markus Kerbl LászlóGál Sylvia Nürnberger Barbara Schaedl James Ferguson Nicole Swiadek Xavier Monforte Johannes C.Heinzel Antal Nógrádi Andreas H.Teuschl-Woller David Hercher Department Life Science Engineering University of Applied Sciences Technikum WienViennaAustria Austrian Cluster for Tissue Regeneration ViennaAustria Ludwig Boltzmann Institute for Traumatology The Research Center in Cooperation with AUVAViennaAustria University clinic of Dentistry Medical University of ViennaViennaAustria Department of Plastic Reconstructive and Aesthetic SurgeryLandesklinikum Wiener Neustadt2700 Wiener NeustadtAustria Department of Anatomy Histology and EmbryologyAlbert Szent-Györgyi Medical SchoolUniversity of SzegedSzegedHungary Medical University of Vienna Department of Orthopedics and Trauma SurgeryDevision of Trauma SurgeryViennaAustria Department of Hand- PlasticReconstructive and Burn SurgeryBG Unfallklinik TuebingenUniversity of TuebingenTuebingenGermany

Peripheral nerve injuries induce a severe motor and sensory deficit. Since the availability of autologous nerve transplants for nerve repair is very limited, alternative treatment strategies are sought, including the use of tubular nerve guidance conduits(tNGCs). However, the use of tNGCs results in poor functional recovery and central necrosis of the regenerating tissue, which limits their application to short nerve lesion defects(typically shorter than 3 cm). Given the importance of vascularization in nerve regeneration, we hypothesized that enabling the growth of blood vessels from the surrounding tissue into the regenerating nerve within the tNGC would help eliminate necrotic processes and lead to improved regeneration. In this study, we reported the application of macroscopic holes into the tubular walls of silk-based tNGCs and compared the various features of these improved silk^(+) tNGCs with the tubes without holes(silk^(–) tNGCs) and autologous nerve transplants in an 8-mm sciatic nerve defect in rats. Using a combination of micro-computed tomography and histological analyses, we were able to prove that the use of silk^(+) tNGCs induced the growth of blood vessels from the adjacent tissue to the intraluminal neovascular formation. A significantly higher number of blood vessels in the silk^(+) group was found compared with autologous nerve transplants and silk^(–), accompanied by improved axon regeneration at the distal coaptation point compared with the silk^(–) tNGCs at 7 weeks postoperatively. In the 15-mm(critical size) sciatic nerve defect model, we again observed a distinct ingrowth of blood vessels through the tubular walls of silk^(+) tNGCs, but without improved functional recovery at 12 weeks postoperatively. Our data proves that macroporous tNGCs increase the vascular supply of regenerating nerves and facilitate improved axonal regeneration in a short-defect model but not in a critical-size defect model. This study suggests that further optimizatio

关键词： axon regeneration blood vessel functional recovery macroporous nerve lesion peripheral nerve repair sciatic nerve silk-based nerve guidance conduit vascularization

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Does crossover innervation really affect the clinical outcome？ A comparison of outcome between unilateral and bilateral digital nerve repair

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Neural Regeneration Research 2016年第9期11卷 1499-1505页

作者： Melike Oruc Kadri Ozer Ozlem Colak Yüksel Kankaya Ugur Kocer Ankara Training and Research Hospital Plastic Reconstructive and Aesthetic Surgery Clinic Ankara Turkey Aydin State Hospital Plastic Reconstructive and Aesthetic Surgery Clinic Aydin Turkey Istanbul Okmeydani Training and Research Hospital Plastic Reconstructive and Aesthetic Surgery Clinic Istanbul Turkey

Digital nerve injuries are the mostly detected nerve injury in the upper extremity. However, since the clinical phenomenon of crossover innervation at some degree from uninjured digital nerve to the in- jured side occurs after digital nerve injuries is sustained, one could argue that this concept might even result in the overestimation of the outcome of the digital nerve repair. With this knowledge in mind, this study aimed to present novel, pure, focused and valuable clinical data by comparing the outcomes of bilateral and unilateral digital nerve repair. A retrospective review of 28 fingers with unilateral or bilateral digital nerve repair using end-to-end technique in 19 patients within 2 years was performed. Weber＇s two-point discrimination, sharp/dull discrimination, warm/cold sensation and Visual Analog Scale scoring were measured at final 12-month follow ups in all patients. There was no significant difference in recovery of sensibility after unilateral and bilateral digital nerve repairs. Though there is crossover innervation microscopically, it is not important in the clinical evaluation period. According to clinical findings from this study, crossover innervations appear to be negligible in the estimation of outcomes of digital neurorrhaphy.

关键词： nerve regeneration digital nerve repair unilateral bilateral crossover innervation sensibility neurorrhaphy nerve sprouting neural regeneration

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Leucocyte-and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities

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burns & Trauma 2019年第1期7卷 98-106页

作者： Kadri Ozer Ozlem Colak Aydin State Hospital PlasticReconstructive and Aesthetic Surgery Clinic09100 AydinTurkey Istanbul Okmeydani Training and Research Hospital PlasticReconstructive and Aesthetic Surgery Clinic34384 IstanbulTurkey

Background:Generally,advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing *** this report,the use of leukocyte-and platelet-rich fibrin(L-PRF)is emphasized for complex wounds as an alternative,simple,inexpensive,time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue,including bone,tendon,and *** aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures ***:Between January 2016 and December 2017,17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital,*** treatment was administered twice per week in the outpatient *** on the size and extension of the complex wound,two to five blood samples were collected into 8.5 ml dry,glass vacuum tubes with no anticoagulant,and samples were immediately centrifuged at 1630×g for 5 min to obtain *** healing was defined as the day of complete wound ***:The median values of the initial wound size and wound duration were 12 cm^(2)(interquartile range,6 to 23 cm^(2))and 8 months before first admission(interquartile range,4 to 18 months),*** wounds showed significant improvements after L-PRF therapy and full closure after a median of 18months,with an interquartile range of 11 to 34 months of L-PRF *** were recurrences of wounds during the first 6 months after *** adverse events were ***:Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable,facilitate the formation of granulation tissue and epithelization,and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.

关键词： Leukocyte-and platelet-rich fibrin Complex wound Bare bone Bare tendon

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The role of vascularization in nerve regeneration of nerve graft

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Neural Regeneration Research 2020年第9期15卷 1573-1579页

作者： Tiam M.Saffari Meiwand Bedar Caroline A.Hundepool Allen T.Bishop Alexander Y.Shin Department of Orthopedic surgery Mayo ClinicRochesterMNUSA Department of Plastic Reconstructive and Hand SurgeryErasmus Medical CenterRotterdamthe Netherlands

Vascularization is an important factor in nerve graft survival and function. The specific molecular regulations and patterns of angiogenesis following peripheral nerve injury are in a broad complex of pathways. This review aims to summarize current knowledge on the role of vascularization in nerve regeneration, including the key regulation molecules, and mechanisms and patterns of revascularization after nerve injury. Angiogenesis, the maturation of pre-existing vessels into new areas, is stimulated through angiogenic factors such as vascular endothelial growth factor and precedes the repair of damaged nerves. Vascular endothelial growth factor administration to nerves has demonstrated to increase revascularization after injury in basic science research. In the clinical setting, vascularized nerve grafts could be used in the reconstruction of large segmental peripheral nerve injuries. Vascularized nerve grafts are postulated to accelerate revascularization and enhance nerve regeneration by providing an optimal nutritional environment, especially in scarred beds, and decrease fibroblast infiltration. This could improve functional recovery after nerve grafting, however, conclusive evidence of the superiority of vascularized nerve grafts is lacking in human studies. A well-designed randomized controlled trial comparing vascularized nerve grafts to non-vascularized nerve grafts involving patients with similar injuries, nerve graft repair and follow-up times is necessary to demonstrate the efficacy of vascularized nerve grafts. Due to technical challenges, composite transfer of a nerve graft along with its adipose tissue has been proposed to provide a healthy tissue bed. Basic science research has shown that a vascularized fascial flap containing adipose tissue and a vascular bundle improves revascularization through excreted angiogenic factors, provided by the stem cells in the adipose tissue as well as by the blood supply and environmental support. While it was previou

关键词： angiogenesis fascial flap nerve graft nerve injury nerve regeneration peripheral nerve vascular endothelial growth factor vascularization vascularized nerve graft

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New autologous material for the frontalis suspension technique:superficial temporal fascia

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International Journal of Ophthalmology(English edition) 2016年第2期9卷 315-317页

作者： Elif Sari Hulda Rifat Ozakpinar Ali Teoman Tellioglu Department of Plastic Reconstructive and Aesthetic Surgery Kirikkale University Faculty of Medicine clinic of Plastic Reconstructive and Aesthetic SurgeryDiskapi Yildirim Beyazit Education and Research Hospital Department of Plastic Reconstructive and Aesthetic Surgery Yildirim Beyazit University Faculty of Medicine

The frontalis suspension technique, which is a well-known surgical procedure, has been used for congenital ptosis for many years [1]. Several autologous and foreign grafts or materials have been preferred for this suspension, such as collagen, tensor fascia lata, palmaris longus tendon, deep temporal fascia, catgut, prolene, silicone, stainless steel, and supramid suture . Each of these have their own advantages and disadvantages; however, the superficial temporal fascia has not been used for the frontalis suspension method before.

关键词： Figure New autologous material for the frontalis suspension technique

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The interaction of stem cells and vascularity in peripheral nerve regeneration

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Neural Regeneration Research 2021年第8期16卷 1510-1517页

作者： Sara Saffari Tiam M.Saffari Dietmar J.O.Ulrich Steven E.R.Hovius Alexander Y.Shin Division of Hand and Microvascular surgery Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA Department of Plastic and reconstructive surgery Radboud University Medical CenterNijmegenthe Netherlands

The degree of nerve regeneration after peripheral nerve injury can be altered by the microenvironment at the site of injury. Stem cells and vascularity are postulated to be a part of a complex pathway that enhances peripheral nerve regeneration;however, their interaction remains unexplored. This review aims to summarize current knowledge on this interaction, including various mechanisms through which trophic factors are promoted by stem cells and angiogenesis. Angiogenesis after nerve injury is stimulated by hypoxia, mediated by vascular endothelial growth factor, resulting in the growth of preexisting vessels into new areas. Modulation of distinct signaling pathways in stem cells can promote angiogenesis by the secretion of various angiogenic factors. Simultaneously, the importance of stem cells in peripheral nerve regeneration relies on their ability to promote myelin formation and their capacity to be influenced by the microenvironment to differentiate into Schwann-like cells. Stem cells can be acquired through various sources that correlate to their differentiation potential, including embryonic stem cells, neural stem cells, and mesenchymal stem cells. Each source of stem cells serves its particular differentiation potential and properties associated with the promotion of revascularization and nerve regeneration. Exosomes are a subtype of extracellular vesicles released from cell types and play an important role in cell-to-cell communication. Exosomes hold promise for future transplantation applications, as these vesicles contain fewer membrane-bound proteins, resulting in lower immunogenicity. This review presents pre-clinical and clinical studies that focus on selecting the ideal type of stem cell and optimizing stem cell delivery methods for potential translation to clinical practice. Future studies integrating stem cell-based therapies with the promotion of angiogenesis may elucidate the synergistic pathways and ultimately enhance nerve regeneration.

关键词： angiogenesis exosomes nerve graft nerve regeneration peripheral nerve injury revascularization Schwann cells stem cells stem cell delivery vascularity

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Platelet-rich plasma:the role in neural repair

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Neural Regeneration Research 2015年第12期10卷 1920-1921页

作者： Margherita Giorgetti Gabriele Siciliano Department of Hand surgery and reconstructive Microsurgery University of Pisa Department of clinical and Experimental Medicine Neurological ClinicUniversity of Pisa

The efficacy of platelet-rich plasma（PRP）to promote tissue regeneration has been largely confirmed in several clinical settings,such as in human maxillo-facial（Froum et al.,2002）,heart（Vu et al.,2015）and orthopa... 详细信息

关键词： Platelet-rich plasma PRP

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Role of adipose tissue grafting and adipose-derived stem cells in peripheral nerve surgery

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Neural Regeneration Research 2022年第10期17卷 2179-2184页

作者： Tiam M.Saffari Sara Saffari Krishna S.Vyas Samir Mardini Alexander Y.Shin Department of Orthopedic surgery Division of Microvascular and Hand SurgeryMayo ClinicRochesterMNUSA Radboud University Medical Center Radboud Institute for Health SciencesDepartment of Plastic SurgeryNijmegenThe Netherlands Department of surgery Division of Plastic and Reconstructive SurgeryMayo ClinicRochesterMNUSA

The application of autologous fat grafting in reconstructive surgery is commonly used to improve functional *** review aims to provide an overview of the scientific evidence on the biology of adipose tissue,the role of adipose-derived stem cells,and the indications of adipose tissue grafting in peripheral nerve *** tissue is easily accessible through the lower abdomen and inner ***-vascularized adipose tissue grafting does not support oxidative and ischemic stress,resulting in variable survival of adipocytes within the first 24 *** of adipose tissue with a stromal vascular fraction is purported to increase the number of adipose-derived stem cells and is postulated to augment the long-term stability of adipose tissue *** science nerve research suggests an increase in nerve regeneration and nerve revascularization,and a decrease in nerve fibrosis after the addition of adipose-derived stem cells or adipose *** clinical studies,the use of autologous lipofilling is mostly applied to secondary carpal tunnel release revisions with promising *** the use of adipose-derived stem cells in peripheral nerve reconstruction is relatively new,more studies are needed to explore safety and long-term effects on peripheral nerve *** Food and Drug Administration stipulates that adipose-derived stem cell transplantation should be minimally manipulated,enzyme-free,and used in the same surgical procedure,*** tissue grafts that contain native adipose-derived stem cells or stromal vascular *** research may be shifted towards the use of tissue-engineered adipose tissue to create a supportive microenvironment for autologous graft ***-ready alternatives could be enhanced with adipose-derived stem cells or growth factors and eliminate the need for adipose tissue harvest.

关键词： adipose tissue adipose-derived stem cells angiogenesis autologous fat grafting nerve injury nerve regeneration paracrine environment peripheral nerve reconstruction stem cell secretome tissue engineering

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A prospective analysis of risk factors for pediatric burn mortality at a tertiary burn center in North India

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burns & Trauma 2017年第3期5卷 199-208页

作者： Amol Dhopte Rahul Bamal Vinay Kumar Tiwari Department of Plastic Reconstructive and Maxillofacial surgery Government Medical College and Hospital Nagpur 440003 India Department of burns Plastic and Maxillofacial Surgery VMMC&Safdarjung Hospital New Delhi India Department of burns and Plastic surgery PGIMER&RML Hospital New Delhi India

Background:None of the available mortality predicting models in pediatric burns precisely predicts outcomes in every population. Mortality rates as well as their risk factors vary with regions and among different centers within the regions. The aim of this study was to identify socio-demographic and clinical risk factors for mortality in pediatric burns in an effort to decrease the mortality in these patients. Methods:A prospective analytical study was conducted in patients up to the age of 18 years admitted for burn injuries in a tertiary care burn center in India from January to December 2014. clinical and demographic data was col ected through questionnaire-interview and patient fol ow-up during their stay in the hospital. Univariate and multivariate firth logistic regression was used to identify various risk factors for mortality in pediatric burns. Results:A total of 475 patients were admitted during the study period. Overal mortality was 31.3%(n=149) in this study. Mean age of the patients who died was 8.68 years. Of the 149 deaths, 74 were males and 75 were females (male to female ratio=0.98). Mean total body surface area (TBSA) involved of the patients who expired was 62%. Inhalational injury was seen in 15.5%(n=74) of pediatric burn admissions. Mortality was significantly higher (74.3%) in patients with inhalation injury. Mortality was highest in patients with isolates of Acinetobacter + Klebsiella (58.3%), followed by Pseudomonas + Klebsiella (53.3%), Acinetobacter (31.5%), and Pseudomonas (26.3%) (p burns, higher TBSA, presence of inhalation injury, increased depth of burn, and positive microbial cultures. On multivariate analysis, higher TBSA was identified as an independent risk factor for mortality. The adjusted odds ratios for TBSA involvement was 21.706 (25.1-50%), 136.195 (50.1-75%), and 1019.436 (75.1-100%), respectively. Conclusion: TBSA

关键词： Pediatric burns Mortality Risk factors Microbiological cultures India

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Facial and Body Fillers Clpdate

Facial and Body Fillers Clpdate

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中华医学会整形外科学分会第十一次全国会议、中国人民解放军整形外科学专业委员会学术交流会、中国中西医结合学会医学美容专业委员会全国会议

作者： miodrag M.colic the Belgrade University clinic for burns Plastic and Reconstructive Surgery

New trends in facial and body rejuvenation point out the importance of implementation of new and less invasive aesthetic surgical procedures in our everyday practice,as well as their use in dermatology and cosmetics. In facial aesthetics there is always a permanent search for classical or universal beauty,through history and art as well,and certainly aesthetic procedures are here to help us to achieve that goal and establish true criteria. Aesthetic surgery has always been irreplaceable factor in facial rejuvenation.

关键词： Facial and Body Fillers Clpdate

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