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Page 10 of 16 Garbuzov et al. Plast Aesthet Res 2023;10:9 https://dx.doi.org/10.20517/2347-9264.2022.51

Figure 2. Femoral nerve neurolysis. A 39-year-old patient experienced traumatic neuropathic pain and a 2/5 Medical Research Council
(MRC) score in knee extension. The patient had improvement in knee extension to MRC 4 function and resolution of pain following
femoral nerve (black arrow) neurolysis.

controversy is the potential moral status of the embryo that prohibits ESC harvesting from the inner
blastocytes cell line .
[40]
Induced pluripotent stem cells
To avoid these ethical concerns, Takahashi et al. were the first to induce pluripotent stem cells from animal
(mouse) embryonic or human fibroblasts using transcription factors . Their study was one of the first steps
[41]
toward pluripotency control in somatic cells and providing a safe method for patient-specific stem cell
generation. The first use of iPSC for lower extremity nerve regeneration was the study by Wang et al., in
which they used iPSCs and ESCs to derive natural crest stem cells (NCSC) for the regeneration of sciatic
[42]
nerve damage in rat models . They observed that NCSCs can promote nerve myelination and
[42]
regeneration . Huang et al. conducted an experiment to investigate the regenerative effects of various
[43]
differential stages of human fibroblast-derived iPSCs in the function of transected sciatic nerve . They
observed that the iPSC-derived NCSCs were associated with much better short and long-term sciatic nerve
[43]
regeneration than the induced adult Schwann cells . That said, there is one major concern regarding the
employment of iPSCs and their derivatives in human subjects. Compared with ESCs, iPSCs and their
derivations are susceptible to oncogenic transformations due to the pluripotency induction and
overexpression of oncogenic factors . Although various strategies have been introduced to diminish the
[44]
potential tumorigenicity, their use has been limited to animal models only. A summary of the implications
of iPSC for lower extremity nerve regeneration is obtained in [Table 3].