Guided Nerve Regeneration after Peripheral Nerve Injuries

Abstract

eddon classified nerve injuries into three categories: neuroapraxia, axonotmesis and neurotmesis. After complete axonal transection, the neuron undergoes a number of degenerative processes, followed by attempts at regeneration. A distal growth cone seeks out connections with the degenerated distal fiber to re-innervate its territory whether muscle or skin. Early primary repair with epineural microsutures is performed when a tension free coaptation in a well vascularized bed can be achieved. Other repairs include group fascicular and fascicular repair requiring intra-nerve dissection and direct matching and suturing of fascicular groups. Despite its anatomical attractiveness, overall group fascicular repair is no better than epineural repair in functional outcomes. The autograft has long been considered the gold standard for peripheral nerve repair, but the drawbacks of this method continue to encourage the development of novel techniques that yields similar or enhanced success in nerve regeneration.