Bioactive Silk‐Based Nerve Guidance Conduits for Augmenting Peripheral Nerve Repair

Repair of peripheral nerve injuries depends upon complex biology stemming
from the manifold and challenging injury-healing processes of the peripheral
nervous system. While surgical treatment options are available, they tend
to be characterized by poor clinical outcomes for the injured patients. This
is particularly apparent in the clinical management of a nerve gap whereby
nerve autograft remains the best clinical option despite numerous limitations;
in addition, effective repair becomes progressively more difficult with larger
gaps. Nerve conduit strategies based on tissue engineering approaches and
the use of silk as scaffolding material have attracted much attention in recent
years to overcome these limitations and meet the clinical demand of large
gap nerve repair. This review examines the scientific advances made with
silk-based conduits for peripheral nerve repair. The focus is on enhancing
bioactivity of the conduits in terms of physical guidance cues, inner wall and
lumen modification, and imbuing novel conductive functionalities.