{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:42:07Z","timestamp":1786632127766,"version":"build-2736575974"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T00:00:00Z","timestamp":1783814400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Muscle and Nerve"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Peripheral nerve fibrosis is a major determinant of surgical outcome and functional recovery after nerve injury, yet standardized approaches to assess its extent remain scarce. Decades ago, Hanno Millesi introduced a comprehensive classification system that grades the degree of fibrosis according to the anatomical layers affected, ranging from paraneurial to endoneurial involvement. Despite its conceptual clarity and clinical relevance, this system remains largely underutilized in contemporary peripheral nerve research. Recent experimental models addressing perineural scarring and anti\u2010fibrotic strategies rarely apply Millesi's classification, thereby limiting comparability and translation of findings. Here, we argue that greater integration of Millesi's classification could enhance experimental design, improve standardization, and guide the interpretation of preclinical and clinical studies on peripheral nerve regeneration. Renewed attention to this underutilized framework may bridge the gap between histological observations, experimental interventions, and the surgical decision\u2010making process in peripheral nerve surgery.<\/jats:p>","DOI":"10.1002\/mus.70344","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T06:48:17Z","timestamp":1783925297000},"page":"547-552","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Millesi's Classification of Nerve Fibrosis Remains Underutilized in Modern Peripheral Nerve Research"],"prefix":"10.1002","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3427-5091","authenticated-orcid":false,"given":"Johannes C.","family":"Heinzel","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Johns Hopkins School of Medicine  Baltimore Maryland USA"},{"name":"Department of Hand\u2010, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Winter","sequence":"additional","affiliation":[{"name":"Department of Neurology Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Department of Neurology Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Daigeler","sequence":"additional","affiliation":[{"name":"Department of Hand\u2010, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Neurology Hertie Institute for Clinical Brain Research (HIH), University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Kolbenschlag","sequence":"additional","affiliation":[{"name":"Department of Hand\u2010, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schmidhammer","sequence":"additional","affiliation":[{"name":"Millesi Center for Surgery of Peripheral Nerves Vienna Private Clinic  Vienna Austria"},{"name":"Ludwig Boltzmann Institute for Traumatology, The Research Center in Cooperation With AUVA  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2921-0928","authenticated-orcid":false,"given":"Sami","family":"Tuffaha","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Lauer","sequence":"additional","affiliation":[{"name":"Department of Hand\u2010, Plastic, Reconstructive and Burn Surgery, BG Klinik Tuebingen University of Tuebingen  Tuebingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,12]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000002600"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0030-1253236"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/3-211-27458-8_1"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00339449"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-211-72958-8_28"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-199404000-00029"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00536263"},{"issue":"20","key":"e_1_2_9_9_1","first-page":"1072","article-title":"Injuries of the Peripheral Nerves During the War","volume":"39","author":"Seddon H. J.","year":"1952","journal-title":"Prensa M\u00e9dica Argentina"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/74.4.491"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/micr.1920140703"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10081613"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2017.11.042"},{"issue":"8","key":"e_1_2_9_14_1","first-page":"1015","article-title":"A Novel Experimental Rat Model of Peripheral Nerve Scarring That Reliably Mimics Post\u2010Surgical Complications and Recurring Adhesions","volume":"10","author":"Lemke A.","year":"2017","journal-title":"Disease Models & Mechanisms"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25073687"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0289677"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jor.24709"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.actbio.2019.02.034"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/ar.23841"},{"issue":"6","key":"e_1_2_9_20_1","first-page":"969","article-title":"Topical Application of Cyclosporine Reduces Epineurial Fibrosis: Gross Post\u2010Surgical, Histopathological and Ultrastructural Analysis in a Rat Sciatic Nerve Model","volume":"27","author":"Cetinalp N. E.","year":"2017","journal-title":"Turkish Neurosurgery"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.3171\/2009.9.SPINE09407"},{"issue":"3","key":"e_1_2_9_22_1","first-page":"1","article-title":"Rapid\u2010Stretch Injury to Peripheral Nerves: Comparison of Injury Models","volume":"135","author":"Yeoh S.","year":"2020","journal-title":"Journal of Neurosurgery"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyz194"},{"issue":"5","key":"e_1_2_9_24_1","first-page":"1","article-title":"Rapid\u2010Stretch Injury to Peripheral Nerves: Implications From an Animal Model","volume":"133","author":"Mahan M. A.","year":"2019","journal-title":"Journal of Neurosurgery"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2004.05.012"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1740925X08000021"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1359-6101(03)00047-9"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0749-0712(01)00012-9"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1042-3680(18)30058-5"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00687818"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(65)90640-9"},{"issue":"12","key":"e_1_2_9_32_1","first-page":"1087","article-title":"Choosing the Right Imaging for the Diagnostics and Assessment of the Course of Peripheral Nerve Injuries","volume":"94","author":"B\u00fcrkle E.","year":"2023","journal-title":"Nervenarzt"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.10.6012"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-018-0609-4"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.3171\/2010.9.JNS10464"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/ons\/opw016"}],"container-title":["Muscle &amp; Nerve"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70344","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/mus.70344","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/mus.70344","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:51:53Z","timestamp":1786629113000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/mus.70344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,12]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/mus.70344"],"URL":"https:\/\/doi.org\/10.1002\/mus.70344","archive":["Portico"],"relation":{},"ISSN":["0148-639X","1097-4598"],"issn-type":[{"value":"0148-639X","type":"print"},{"value":"1097-4598","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,12]]},"assertion":[{"value":"2025-12-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}