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Peripheral Nerve Injury

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A Review on Peripheral Nerve Injury
Abstract
Peripheral nerve injury(PNI) may result in a injury with a gap in the nerve or without gap. It is a largescale problem and is known to affect 2.8% of trauma patients. Unlike CNS, spontaneous regeneration may occur if the injury is small. Although for a deeper injury the regeneration might be partial or may not occur at all. These types of injuries are treated by surgeries using autografts or artificial nerve guidance conduits. Despite, major advancements in the treatment methods, the efficiency of the repair and functional recovery is still unpredictable. The purpose of this review is to present an overview of the Peripheral nerve injury, its pathology, types, and the various methods that are employed …show more content…

An injury on the nerves causes miscommunication between the organ and the brain which may cause pain or may lead to loss of sensation. Neuroregenaration refers to the repair or regrowth of the nerves which involves formation of new neurons, axons, myelin, glia or synapses. An injury in the PNS, if small, has a whole mechanism to heal and regenerate while healing mechanisms in the CNS is different. Regeneration the in the CNS is restricted by the inhibitory signals from the glia and the extracellular environment and forms scars rapidly. Not much is known about the mechanisms of the CNS. This review focuses on the Peripheral Nerve Injury and its treatment.
Over one million people are affected by PNI every year. Unlike the CNS, regeneration is probable in the PNS. Spontaneous regeneration may occur over relatively small injury. For larger damage, surgical repair is needed. (1) Number of microsurgical repair methods is available, depending upon the depth of the injury; they are treated by direct repair or autograft or allograft transplantation …show more content…

These changes at the site of injury begin almost immediately after the injury. The axons sprout multiple regenerating axons within few hours. Schwann cells are known to play an important role in guiding the regeneration of the axons by serving as a physical conduit. The distal segment of the injury undergoes a slow degeneration known as the Wallerian degeneration, after Augustus
VolneyWaller, who first characterized morphological changes in sectioned frog glossopharyngeal and hypoglossal nerves 160 years ago. (9) This involves breakdown of myelin and proliferation of
Schwann cells and invasion of macrophages at the distal end which clears the myelin and axonal debris. Changes in the levels of neurotrophins are also seen at both proximal and distal ends of the injury. It involves increased levels of Nerve Growth Factor (NGF), Brain-derived neurotropic factor (BDGF) is known to be secreted by Schwann cells. The surfaces of the Schwann cells and the surrounding extracellular matrix have increased Laminin, tenacin, neuronal cell adhesion molecules.
The muscles and the sensory organs also show changes such as shrinkage of cells, thickening

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