Peripheral nerve injuries account for 4 % of all injuries, and the consequences of trauma are a major medical and social problem, since they are characterized by a significant and long-term decline in limb function, and a high level of disability in patients. According to our data, up to 40% of patients sought specialized care for more than 6 months after the injury, and 19.9% were treated conservatively for an unreasonably long period of time. It led to an increase in the portion of unsatisfactory treatment results, since the prognosis of the further functional and useful degree of nerve recovery worsens with increasing time after injury.
The main objective was to select the optimal option of biocompatible material for implementation in practice in case of traumatic peripheral nerve damage.
Materials and methods. The analysis of medical literature for 2015–2020 was conducted. First of all, it should be noted that modern non-biological resorbable tubes are made of polyglycolic and polylactic acids. Non-resorbable tubes, including silicone, have shown undesirable effects, including axon compression during regeneration and the reaction of a fibrous foreign body. Hollow cylindrical tubes can be manufactured in several ways, such as electrospinning, crosslinking, physical film rolling, injection molding, melt extrusion, and braiding.
Adequate surgical treatment of peripheral nerve injuries requires that the surgeon, in addition to an accurate knowledge of the anatomical details of the affected area, would also be familiar with microsurgical methods and had necessary equipment to operate. The main procedure in peripheral nerve surgery is the restoration of nerve continuity, which can be obtained by direct coaptation between the two ends of a severed nerve or by the introduction of nerve grafts to replace a defect in nerve tissue.
Polyester is the most common synthetic material used in neural tissue engineering, along with polylactic acid, polycaprolactone, and polyglycolic acid. In combination with mesenchymal stem cells of the bone marrow, polylactic acid showed better results and accelerated the recovery of peripheral nerves. Polylactic acid directed the migration of Schwann's cells and induced the formation of a normal nervous structure. It was proved that the polycaprolactone material had an effect similar to that of autografts in nerve repair, and its characteristics were better than in a polylactic acid tube. Polyglycolic acid also possesses sufficient mechanical properties and can be used to repair a nerve defect. Artificial synthetic materials have good biocompatibility and biodegradability with minimal toxicity. For the production of high-purity polymer monomers, which are necessary for the manufacture of the frame, much time and financial costs are required. Moreover, the elasticity and hardness of such materials are imperfect.
Three main natural biomaterials are used in tissue repair: collagen, silk, and gelatin. Collagen tube is the most widely used biological material in clinical practice. Silk materials with the protein fibroin, which promote the release of certain substrates, such as nerve growth factor particles, and provide more nutrients and a more favorable microenvironment for nerve repair, are worth noticing. Silk fibroin has good compatibility with the neurons of the dorsal root ganglia and supports cell growth. Gelatin materials are preferred due to the reduction of micromanipulation during nerve recovery. Natural biomaterials are easy to obtain in sufficient quantities; they have good biocompatibility and biodegradability and are easily absorbed by the body. However, each natural biomaterial has its drawbacks. Some of them are brittle or break down in a humid environment. Some natural materials are insoluble in water and traditional organic solvents, which limits their use. One of the most widely used biopolymers of natural origin is chitosan. Chitosan, derived by chitin deacetylation, plays a supporting, protective, and guiding role in the early stage of recovery of peripheral nerves and can provide a relatively stable, localized microenvironment during regeneration. Chitosan is absorbed and gradually decomposed in the late phase of recovery and regeneration of the nervous system.
Issues regarding graphene-based nanomaterials use are considered. Graphene is a two-dimensional carbon nanomaterial with good optical, electrical and mechanical properties. It should be noted that when graphene nanoparticles are incorporated into a chitosan or gelatin frame and used to repair peripheral nerve damage in rats, this has contributed to the regeneration of the damaged nerve more quickly. Graphene also reduced the inflammatory response and accelerated the migration of endogenous neuroblasts.
Hence, the use of these materials is not well understood due to the significant duration of recovery of the denervated proximal end of the nerve, so further research is needed to identify the advantages or disadvantages of their use.
2. Houshyar S, Bhattacharyya A, Shanks R. Peripheral Nerve Conduit: Materials and Structures. ACS Chem Neurosci. 2019 Aug 21;10(8):3349-3365. doi: 10.1021/acschemneuro.9b00203
3. Jiang Z, Song Y, Qiao J, Yang Y, Zhang W, Liu W, Han B. Rat sciatic nerve regeneration across a 10-mm defect bridged by a chitin/CM-chitosan artificial nerve graft. Int J Biol Macro-mol. 2019 May 15;129:997-1005. doi: 10.1016/j.ijbiomac.2019.02.080
4. Crosio A, Fornasari BE, Gambarotta G, Geuna S, Raimondo S, Battiston B, Tos P, Ronchi G. Chitosan tubes enriched with fresh skeletal muscle fibers for delayed repair of peripheral nerve defects. Neural Regen Res. 2019 Jun;14(6):1079-1084. doi: 10.4103/1673-5374.250628
5. Beris A, Gkiatas I, Gelalis I, Papadopoulos D, Kostas-Agnantis I. Current concepts in peripheral nerve surgery. Eur J Orthop Surg Traumatol. 2019 Feb;29(2):263-269. doi: 10.1007/s00590-018-2344-2
6. Homaeigohar S, Tsai TY, Young TH, Yang HJ, Ji YR. An electroactive alginate hydrogel nanocomposite reinforced by functionalized graphite nanofilaments for neural tissue engineering. Carbohydr Polym. 2019 Nov 15;224:115112. doi: 10.1016/j.carbpol.2019.115112
7. Wei C, Yang X, Wang X. A green route for the fabrication of thermo-sensitive chitosan nerve conduits and their property evaluation. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Nov 15;33(11):1439-1445. doi: 10.7507/1002-1892.201904009
8. Farzamfar S, Salehi M, Tavangar SM, Verdi J, Mansouri K, Ai A, Malekshahi ZV, Ai JA novel polycaprolactone/ carbon nanofiber composite as a conductive neural guidance channel: an in vitro and in vivo study. Prog Biomater. 2019 Dec;8(4):239-248. doi: 10.1007/s40204-019-00121-3
9. Safa B, Jain S, Desai MJ, Greenberg JA, Niacaris TR. Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study. 2020 Feb 26. doi: 10.1002/micr.30574
10. Pei-Xun Zhang, Na Han, PhD, Yu-Hui Kou, Qing-Tang Zhu, Xiao-Lin Liu. Tissue engineering for the repair of peripheral nerve injury. Neural Regen Res. 2019 Jan; 14(1): 51–58. PMCID: PMC6263012, PMID: 30531070. doi: 10.4103/1673-5374.243701
11. Johnson PJ, Wood MD, Moore AM, Mackinnon SE. Tissue engineered constructs for peripheral nerve surgery. Eur Surg. 2013 Jun; 45(3). PMCID: PMC3875220. NIHMSID: NIHMS489025. PMID: 24385980. doi: 10.1007/s10353-013-0205-0
12. Gaudin R, Knipfer C, Henningsen A, Smeets R, Heiland M, Hadlock T. Approaches to Peripheral Nerve Repair: Generations of Biomaterial Conduits Yielding to Replacing Autologous Nerve Grafts in Craniomaxillofacial Surgery. BioMed Research International 2016. ID 3856262. doi:10.1155/2016/3856262
13. Arslantunali D, Dursun T, Yucel D, Hasirci N, Hasirci V. Peripheral nerve conduits: technology update. Med Devices (Auckl) v.7; 2015. PMC4257109. PMID: 25489251. doi: 10.2147/MDER.S59124
14. Su Ryon Shin, Yi-Chen Li, Hae Lin Jang, Parastoo Khoshakhlagh, Mohsen Akbari, Amir Nasajpour, Yu Shrike Zhang, Ali Tamayol, Ali Khademhosseini. Graphene-based materials for tissue engineering. Adv Drug Deliv Rev. 2016 Oct 1; 105 (Pt B): 255–274. PMCID: PMC5039063. NIHMSID: NIHMS779793. PMID: 27037064. doi: 10.1016/j.addr.2016.03.007
15. Ho Pan Bei, Yuhe Yang, Qiang Zhang, Yu Tian, Xiaoming Luo, Mo Yang, Xin Zhao. Graphene-Based Nanocomposites for Neural Tissue Engineering. Molecules. 2019 Feb; 24(4): 658. PMCID: PMC6413135. PMID: 30781759. doi: 10.3390/molecules24040658
This work is licensed under a Creative Commons Attribution 4.0 International License.