Surgical Therapy of Peripheral Nerve Lesions: Current Status and New Perspectives

Abstract

The severe functional deficits in patients suffering from traumatic peripheral nerve damage underline the necessity of an optimal therapy. The development of microsurgical techniques in the sixties contributed significantly to the progress in nerve repair. Since then, no major clinical innovation has become established. However, with an increased understanding of cellular and molecular mechanisms underlying nerve regeneration, various tubulization concepts have been developed which yield possible alternatives to direct suturing and to autologous nerve grafting in cases of short nerve defects. The vast knowledge gathered in the field of nerve regeneration needs to be further exploited in order to develop alternative therapeutic strategies to nerve autografting, which can result in donor-site defects and often lead to inappropriate results. Considering the encouraging results from preclinical studies, innovative nerve repair strategies are likely to improve the outcome of reconstructive surgical interventions. This paper outlines, in addition to the fundamentals of nerve regeneration, the current treatment options for defects of peripheral nerves. This article also reviews the developments in the use of alternative nerve guides and demonstrates new perspectives in the field of peripheral nerve reconstruction.

Zusammenfassung

Die schweren Auswirkungen traumatischer Schädigungen peripherer Nerven auf das Befinden des Patienten unterstreichen die Notwendigkeit einer optimalen Therapie. Nach der Entwicklung mikrochirurgischer Techniken, die zu einem erheblichen Fortschritt im Bereich der Nervenchirurgie beigetragen haben, konnten sich bisher klinisch keine wesentlichen Neuerungen etablieren. Mit wachsendem Verständnis der zellulären und molekularen Mechanismen der Nervenheilung gelang es jedoch verschiedene Überbrückungstechniken für Nervendefekte zu entwickeln. Einzelne davon stellen mittlerweile eine mögliche Alternative zur direkten Naht und zum Nerventransplantat bei Überbrückung kurzer Defektstrecken dar. Die oftmals unbefriedigenden Resultate des Nerventransplantates fordern vor allem in Anbetracht eines mittlerweile umfangreichen Wissens über den Vorgang der Nervenregeneration die Weiterentwicklung neuer Nervenschienen. Auf der Basis bisheriger experimenteller Resultate ist eine weitere Verbesserung der Ergebnisse nach peripherer Nervenrekonstruktion denkbar. Ziel dieser Arbeit ist die Darstellung des aktuellen Standes der Rekonstruktion und Regeneration peripherer Nerven. Zudem werden, vor dem Hintergrund der Entwicklung alternativer Nervenschienen und dessen Modifizierungen, neue Perspektiven in diesem Gebiet aufgezeigt.

Key words

nerve regeneration - nerve reconstruction - nerve graft - nerve conduits - nerve healing - tissue engineering

Schlüsselwörter

Nervenregeneration - Nervenrekonstruktion - Nerventransplantat - Nervenschiene - Nervenheilung - Gewebezšchtung

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