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Regeneration and Recovery

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Surgical Disorders of the Peripheral Nerves

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Abstract

Much of what is now known about the regeneration of nerves is based on the work of Ramon Y. Cajal (1928) who developed concepts about the regrowth of divided axons, the formation of growth cones, the re-ordering of growing axons into new fascicles (Cajal 1928a, Cajal 1928b), and the guidance of new axons to their target tissues. He postulated the existence of “allowing or attracting substances” (Cajal 1928c) and gave credit to Forsmann (1900) for introducing the term neurotropism. Cajal described neurotropism as an effect which was initially one of general attraction emanating from the distal stump which later became more individual and specific as the new axon approached its end organ and in particular, the muscle spindle or the Golgi tendon organ. He also outlined the likelihood of a neurotrophic influence provided by the Schwann cells: “the nutritive and tutorial functions of the cells of Schwann had already been recognized by the embryologists, many of whom believed that the success of the thickening of young fibres and the development of the medullary sheath were the principal functions of these cells. We may especially cite Graham Kerr (1904) who studied the behaviour of these cells in the normal development of nerves, and Mott and Halliburton (1901), who attributed to the bands of Büngner of the peripheral stump of cut nerves the function of feeding and protecting recently arrived sprouts. There is only a step between the recognition of these cells as a nutritive placenta and the admission in them of secretions capable of stimulating and orientating the sprouts that are wandering in the scar.”(Cajal 1928c) These concepts have, in effect, been confirmed by later work.

Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election Professor in Neurological Orthopaedic Surgery, University College, London

Visiting Professor, Department of Academic Neurology, Imperial College, London

Honorary Orthopaedic Consultant, Hospital for Sick Children Great Ormond Street, London

The National Hospital for Nervous Diseases, Queen Square, London

Raigmore Hospital, Inverness

Honorary Orthopaedic Surgeon to the Royal Navy

Consultant in Charge, War Nerve Injuries Clinic at the Defence Medical Rehabilitation Centre, Headley Court, Leatherhead, Surrey

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  1. University College, London, UK

    Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election (Professor in Neurological Orthopaedic Surgery)

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  1. Rolfe Birch M. Chir, FRCP&S (Glas), FRCS (Edin), FRCS (Eng) by election
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Birch, R. (2010). Regeneration and Recovery. In: Surgical Disorders of the Peripheral Nerves. Springer, London. https://doi.org/10.1007/978-1-84882-108-8_4

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