Adipose Tissue Uses in Peripheral Nerve Surgery

Currently, many different techniques exist for the surgical repair of peripheral nerves. The degree of injury dictates the repair and, depending on the defect or injury of the peripheral nerve, plastic surgeons can perform nerve repairs, grafts, and transfers. All the previously listed techniques are routinely performed in human patients, but a novel addition to these peripheral nerve surgeries involves concomitant fat grafting to the repair site at the time of surgery. Fat grafting provides adipose-derived stem cells to the injury site. Though fat grafting is performed as an adjunct to some peripheral nerve surgeries, there is no clear evidence as to which procedures have improved outcomes resultant from concomitant fat grafting. This review explores the evidence presented in various animal studies regarding outcomes of fat grafting at the time of various types of peripheral nerve surgery.

Robotic-Assisted Peripheral Nerve Surgery: A Systematic Review

Background Robotic-assisted techniques are a tremendous revolution in modern surgery, and the advantages and indications were well discussed in different specialties. However, the use of robotic technique in plastic and reconstructive surgery is still very limited, especially in the field of peripheral nerve reconstruction. This study aims to identify current clinical applications for peripheral nerve reconstruction, and to evaluate the advantages and disadvantages to establish potential uses in the future. Methods A review was conducted in the literatures from PubMed focusing on currently published robotic peripheral nerve intervention techniques. Eligible studies included related animal model, cadaveric and human studies. Reviews on robotic microsurgical technique unrelated to peripheral nerve intervention and non-English articles were excluded. The differences of wound assessment and nerve management between robotic-assisted and conventional approach were compared. Results Total 19 studies including preclinical experimental researches and clinical reports were listed and classified into brachial plexus reconstruction, peripheral nerve tumors management, peripheral nerve decompression or repair, peripheral nerve harvesting, and sympathetic trunk reconstruction. There were three animal studies, four cadaveric studies, eight clinical series, and four studies demonstrating clinical, animal, or cadaveric studies simultaneously. In total 53 clinical cases, only 20 (37.7%) cases were successfully approached with minimal invasive and intervened robotically; 17 (32.1%) cases underwent conventional approach and the nerves were intervened robotically; 12 (22.6%) cases converted to open approach but still intervened the nerve by robot; and 4 (7.5%) cases failed to approach robotically and converted to open surgery entirely. Conclusion Robotic-assisted surgery is still in the early stage in peripheral nerve surgery. We believe the use of the robotic system in this field will develop to become popular in the future, especially in the fields that need cooperation with other specialties to provide the solutions for challenging circumstances.

Contribution of the staff of the Military medical academy to the development of peripheral nerve surgery

The formation of the neurosurgical service in our country, as well as the development of peripheral nerve surgery, is inextricably linked with prominent figures - employees of the S. M. Kirov Military Medical Academy: L.M. Puseppa, V.N. Shamova, V.I. Grebenyuk, B.A. Samotokina, A.N. Solomina, E.I. Usanova, E.D. Alekseeva, F.S. Govenko, B.V. Martynova, A.E Belousova, etc. Already from the beginning of the 20th century, Ludwig Martynovich Pusepp has been actively engaged in the diagnosis and surgical treatment of peripheral nerve damage at the Imperial Military Medical Academy. In the second half of the XX century. peripheral nerve surgery undergoes an important stage: the transition to microsurgery. This stage is marked by the rapid development and implementation of microsurgical techniques in the treatment of patients suffering from traumatic lesions of limbs and nerves. The Academy is actively developing revascularization and reinnervation techniques for injuries to the limbs. Based on the analysis of the data of the Great Patriotic War and the war in Afghanistan, the Academy staff published works on the organization of medical care and surgical treatment of combat injuries of peripheral nerves. Thanks to the active scientific and practical work of A.E. Belousova, N.G. Gubochkina, E.D. Alekseeva, F.S. Govenko, B.V. Martynova at the beginning of the XXI century. Clinic of Neurosurgery of the S. M. Kirov Military Medical Academy becomes a leading institution in Russia, where they provide assistance to patients suffering from injuries and diseases of the peripheral nervous system.