Microsurgery 

About: Microsurgery is an academic journal published by Wiley-Blackwell. The journal publishes majorly in the area(s): Free flap & Transplantation. It has an ISSN identifier of 0738-1085. Over the lifetime, 4136 publications have been published receiving 72289 citations.

Schwann cells, neurotrophic factors, and peripheral nerve regeneration

Abstract: The peripheral nervous system retains a considerable capacity for regeneration. However, functional recovery rarely returns to the preinjury level no matter how accurate the nerve repair is, and the more proximal the injury the worse the recovery. Among a variety of approaches being used to enhance peripheral nerve regeneration are the manipulation of Schwann cells and the use of neurotrophic factors. Such factors include, first, nerve growth factor (NGF) and the other recently identified members of the neurotrophin family, namely, brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), neurotrophin-4/5 (NT-4/5); second, the neurokines ciliary neurotrophic factor (CNTF) and leukemia inhibitory factor (LIF); and third, the transforming growth factors (TGFs)-β and their distant relative, glial cell line–derived neurotrophic factor (GDNF). In this review article we focus on the roles in peripheral nerve regeneration of Schwann cells and of the neurotrophin family, CNTF and GDNF, and the relationship between these. Finally, we discuss what remains to be understood about the possible clinical use of neurotrophic factors. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:397–405, 1998

Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair.

Abstract: Nerve repair is usually accomplished by direct suture when the two stumps can be approximated without tension. In the presence of a nerve defect, the placement of an autologous nerve graft is the current gold standard for nerve restoration. However, over the last 20 years, an increasing number of research articles reported on the use of non-nervous tubes (tubulization) for repairing nerve defects. The clinical employment of tubes (both biological and synthetic) as an alternative to autogenous nerve grafts is mainly justified by the limited availability of donor tissue for nerve autografts and the related morbidity. In addition, tubulization was proposed as an alternative to direct nerve sutures in order to create optimal conditions for nerve regeneration over the short empty space intentionally left between two nerve stumps. This paper outlines recent important advances in this field. Different tubulization techniques proposed so far are described, focusing in particular on studies that reported on the employment of tubes with patients. Our personal clinical experience on tubulization repair of sensory nerve lesions (digital nerves), using both biological and synthetic tubes, is presented, and the clinical results are compared. In our case series, both types of tubes led to good clinical results. Finally, we speculate about the prospects in the clinical application of tubulization for peripheral nerve repair.

Complications from silicon-polymer intubulation of nerves.

Abstract: Three cases are reported to illustrate the potential danger of silicon-polymer intubulation of nerve for either nerve repair or following neurolysis Since silicon-polymer intubulation of nerve is now a proven model for producing chronic nerve compression, its use clinically may be contraindicated where neural regeneration is the desired goal

Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions.

Abstract: Purpose: As alternatives to autograft become more conventional, clinical outcomes data on their effectiveness in restoring meaningful function is essential. In this study we report on the outcomes from a multicenter study on processed nerve allografts (Avance 1 Nerve Graft, AxoGen, Inc). Patients and Methods: Twelve sites with 25 surgeons contributed data from 132 individual nerve injuries. Data was analyzed to determine the safety and efficacy of the nerve allograft. Sufficient data for efficacy analysis were reported in 76 injuries (49 sensory, 18 mixed, and 9 motor nerves). The mean age was 41 6 17 (18–86) years. The mean graft length was 22 6 11 (5–50) mm. Subgroup analysis was performed to determine the relationship to factors known to influence outcomes of nerve repair such as nerve type, gap length, patient age, time to repair, age of injury, and mechanism of injury. Results: Meaningful recovery was reported in 87% of the repairs reporting quantitative data. Subgroup analysis demonstrated consistency, showing no significant differences with regard to recovery outcomes between the groups (P > 0.05 Fisher’s Exact Test). No graft related adverse experiences were reported and a 5% revision rate was observed. Conclusion: Processed nerve allografts performed well and were found to be safe and effective in sensory, mixed and motor nerve defects between 5 and 50 mm. The outcomes for safety and meaningful recovery observed in this study compare favorably to those reported in the literature for nerve autograft and are higher than those reported for nerve conduits. V V C 2011 Wiley Periodicals, Inc. Microsurgery 00:000–000, 2011.

Revascularization of the heart by laser

Abstract: The possibility of revascularizing the myocardium with high-energy laser was investigated based on the finding that the laser beam could produce small channels in the tissue of the myocardium that were devoid of debris and scarring. The technique was investigated in 4 groups of 6 mongrel dogs each. In 3 of the groups, the left anterior descending (LAD) coronary artery was ligated above the first diagonal branch and the myocardium was treated with the laser energy according to the protocol of that group. In the fourth control group, the LAD artery was ligated but the myocardium was not subjected to laser treatment. In the first 3 groups, the myocardium was protected by the channels produced by the application of the laser energy. The animals were subsequently sacrificed at various intervals. In the control group, all of the animals died within 20 minutes of ligation of the artery. At autopsy, the epicardial sites of the channels created by the laser were clearly visible and a lack of charring in the channels was demonstrated. The penetration through the endocardial surface could be demonstrated. Microscopically, the channels were patent and endothelialized. It is concluded that the channels created in the myocardium effectively helped to protect the myocardium from acute coronary artery occlusion in this model in dogs.