Review 101 Dornseifer U et al. Surgical Therapy … Zentralbl Neurochir 2007; 68: 101–110 Bibliography DOI 10.1055/s-2007-984453 Zentralbl Neurochir 2007; 68: 101–110 Published ahead of print: 30 July 2007 © Georg Thieme Verlag KG Stuttgart · New York ISSN 0044-4251 Correspondence Priv. -Doz. Dr. med. N. A. Papadopulos Department of Plastic and Reconstructive Surgery Klinikum rechts der Isar of the Technical University of Munich Ismaningerstr. 22 81675 Munich Germany Tel.: + 49/89/4140 21 71 Fax: + 49/89/4140 48 69 n.papadopulos@lrz.tum.de n_papadopulos@yahoo.com Key words   nerve regeneration   nerve reconstruction   nerve graft   nerve conduits   nerve healing   tissue engineering Schlüsselwörter   Nervenregeneration   Nervenrekonstruktion   Nerventransplantat   Nervenschiene   Nervenheilung   Gewebezüchtung Surgical Therapy of Peripheral Nerve Lesions: Current Status and New Perspectives Chirurgische Therapie Peripherer Nervenläsionen: Aktueller Stand und Neue Perspektiven For years, treatment modalities have consisted either of the coaptation of the two nerve stumps or the interpositioning of a nerve graft between the cut ends. However, the clinical results have never been optimal, and therefore there has been a quest for better options. With the development of several biological and artificial nerve guides and with the aid of tissue engineering, doors Peripheral nerve injury is a common casualty. When treating soft-tissue injuries, it is essential to look for nerve defects, since 4.5 % of all soft-tis- sue injuries are accompanied by defects of regional nerves [37]. Furthermore, the number of peripheral nerve injuries caused by iatrogenic damage should not be ignored, especially in neo- plasia surgery. Author U. Dornseifer 1 , K. Matiasek 2 , M. A. Fichter 3 , A. Rupp 2 , J. Henke 3 , N. Weidner 4 , L. Kovacs 3 , W. Schmahl 2 , E. Biemer 3 , M. Ninkovic 1 , N. A. Papadopulos 3 Affiliation Affiliation addresses are listed at the end of the article Abstract & The severe functional deficits in patients suffering from traumatic peripheral nerve damage under- line the necessity of an optimal therapy. The development of microsurgical techniques in the sixties contributed significantly to the progress in nerve repair. Since then, no major clinical inno- vation has become established. However, with an increased understanding of cellular and molecu- lar mechanisms underlying nerve regeneration, various tubulization concepts have been devel- oped which yield possible alternatives to direct suturing and to autologous nerve grafting in cases of short nerve defects. The vast knowledge gathered in the field of nerve regeneration needs to be further exploited in order to develop alter- native therapeutic strategies to nerve autograft- ing, which can result in donor-site defects and often lead to inappropriate results. Considering the encouraging results from preclinical studies, innovative nerve repair strategies are likely to improve the outcome of reconstructive surgical interventions. This paper outlines, in addition to the fundamentals of nerve regeneration, the current treatment options for defects of periph- eral nerves. This article also reviews the devel- opments in the use of alternative nerve guides and demonstrates new perspectives in the field of peripheral nerve reconstruction. Zusammenfassung & Die schweren Auswirkungen traumatischer Schä- digungen peripherer Nerven auf das Befinden des Patienten unterstreichen die Notwendigkeit einer optimalen Therapie. Nach der Entwicklung mikrochirurgischer Techniken, die zu einem erheblichen Fortschritt im Bereich der Nerven- chirurgie beigetragen haben, konnten sich bis- her klinisch keine wesentlichen Neuerungen etablieren. Mit wachsendem Verständnis der zellulären und molekularen Mechanismen der Nervenheilung gelang es jedoch verschiedene Überbrückungstechniken für Nervendefekte zu entwickeln. Einzelne davon stellen mittlerweile eine mögliche Alternative zur direkten Naht und zum Nerventransplantat bei Überbrückung kurzer Defektstrecken dar. Die oftmals unbefrie- digenden Resultate des Nerventransplantates fordern vor allem in Anbetracht eines mittler- weile umfangreichen Wissens über den Vorgang der Nervenregeneration die Weiterentwicklung neuer Nervenschienen. Auf der Basis bisheriger experimenteller Resultate ist eine weitere Ver- besserung der Ergebnisse nach peripherer Ner- venrekonstruktion denkbar. Ziel dieser Arbeit ist die Darstellung des aktuellen Standes der Rekonstruktion und Regeneration peripherer Nerven. Zudem werden, vor dem Hintergrund der Entwicklung alternativer Nervenschienen und dessen Modifizierungen, neue Perspektiven in diesem Gebiet aufgezeigt. Downloaded by: null. Copyrighted material.