Secondary release of the peripheral nerve with autologous fat derivates benefits for functional and sensory recovery.

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From: Neural Regeneration Research(Vol. 16, Issue 5)
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Report
Length: 8,699 words
Lexile Measure: 1290L

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Byline: Natalia. Krzesniak, Anna. Sarnowska, Anna. Figiel-Dabrowska, Katarzyna. Osiak, Krystyna. Domanska-Janik, Bartlomiej. Noszczyk

The reconstruction of nerve continuity after traumatic nerve injury is the gold standard in hand surgery. Immediate, tension-free, end-to-end nerve suture ensures the best prognosis. The recovery is mostly promising; however, in a few cases, insufficient outcomes in motor or sensory function are observed. Intra- and extra-fascicular scarring accompanies the nerve regeneration process and limits final outcomes. Secondary nerve release in those cases is recommended. Unfortunately, scarring recurrence cannot be eliminated after secondary revision and neurolysis. The supportive influences of mesenchymal stem cells in the process of nerve regeneration were observed in many preclinical studies. However, a limited number of studies in humans have analyzed the clinical usage of mesenchymal stem cells in peripheral nerve reconstruction and revisions. The objective of this study was to evaluate the effects of undifferentiated adipose-derived stromal/stem cell injection during a last-chance surgery (neurolysis, nerve release) on a previously reconstructed nerve. Three patients (one female, two males; mean age 59 [+ or -] 4.5 years at the time of injury), who experienced failure of reconstructions of median and ulnar nerves, were included in this study. During the revision surgery, nerve fascicles were released, and adipose-derived stromal/stem cells were administered through microinjections along the fascicles and around the adjacent tissues after external neurolysis. During 36 months of follow-up, patients noticed gradual signs of sensory and in consequence functional recovery. No adverse effects were observed. Simultaneous nerve release with adipose-derived stromal/stem cells support is a promising method in patients who need secondary nerve release after nerve reconstruction. This method can constitute an alternative procedure in patients experiencing recovery failure and allow improvement in cases of limited nerve regeneration. The study protocol was approved by the Institutional Review Board (IRB) at the Centre of Postgraduate Medical Education (No. 62/PB/2016) on September 14, 2016.

Introduction

The reconstruction of nerve continuity after traumatic nerve injury is the gold standard in hand surgery. However, in very few cases, when the initial conditions of reconstruction are limited, i.e., the surgery was delayed, the age of the patient was advanced (older than 50 years), a tension-free suture was impossible or the extensive scarring process disturbed the postoperative course, the observed results are far from that which are expected. Patients complain for persistent numbness of hand, sensation deterioration, severe limitation of function due to pain and hypersensitivity (Onne, 1962; Rosen, 1996; Rosen et al., 2000) [Table 1]. In those patients, only partial recovery, or even no signs of sensory restoration, and poor functional recovery can be suspected.{Table 1}

Nerve regeneration is an age-dependent process, and older patients usually obtain worse results than younger patients (Fornander et al., 2010; Mafi et al., 2012). This fact was reported by many researchers and is probably caused by the age-dependent reduction in repair and regenerative processes as well as the time-dependent decrease in number of active axons (Abbas et al., 2016; Hembd et al., 2017; Roh et al., 2019).

Approximately a year after surgery, if...

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Gale Document Number: GALE|A642710620