Krzesniak Natalia E, Sarnowska Anna, Figiel-Dabrowska Anna, Osiak Katarzyna, Domanska-Janik Krystyna, Noszczyk Bartłomiej H
Department of Plastic and Reconstructive Surgery, Center of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, Poland.
Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
Neural Regen Res. 2021 May;16(5):856-864. doi: 10.4103/1673-5374.297081.
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 ± 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.
创伤性神经损伤后神经连续性的重建是手外科的金标准。即时、无张力的端端神经缝合可确保最佳预后。恢复情况大多很乐观；然而，在少数情况下，会观察到运动或感觉功能恢复不佳。神经再生过程中会伴有束内和束外瘢痕形成，限制最终恢复效果。对于这些情况，建议进行二期神经松解术。不幸的是，二期翻修和神经lysis术后瘢痕复发无法消除。许多临床前研究观察到间充质干细胞在神经再生过程中的支持作用。然而，在人类中，分析间充质干细胞在周围神经重建和翻修中的临床应用的研究数量有限。本研究的目的是评估在最后一次手术（神经lysis、神经松解）期间注射未分化的脂肪来源的基质/干细胞对先前重建神经的影响。三名患者（一名女性，两名男性；受伤时平均年龄59±4.5岁），他们的正中神经和尺神经重建失败，被纳入本研究。在翻修手术中，松解神经束，在外部神经lysis后，通过微注射将脂肪来源的基质/干细胞沿神经束并围绕相邻组织给药。在36个月的随访期间，患者注意到感觉逐渐恢复的迹象，并因此功能得到恢复。未观察到不良反应。同时进行神经松解并给予脂肪来源的基质/干细胞支持，对于神经重建后需要二期神经松解的患者来说是一种有前景的方法。这种方法可以为恢复失败的患者提供替代手术，并在神经再生有限的情况下实现改善。该研究方案于2016年9月14日获得研究生医学教育中心机构审查委员会（IRB）批准（编号62/PB/2016）。
