Electrical Stimulation and Platelet-Rich Plasma as Complementary Approaches for Peripheral Nerve Regeneration

Peripheral nerve injuries (PNIs) remain a major cause of long-term disability, with standard treatments such as microsurgical repair and autologous grafting often yielding incomplete recovery due to slow axonal regeneration, fibrotic scarring, and limited reinnervation. Emerging therapies, including electrical stimulation (ES) and platelet-rich plasma (PRP), have shown promise but remain insufficient as standalone interventions. ES enhances axonal elongation, remyelination, and neuroplasticity by upregulating regeneration-associated genes and neurotrophins, while PRP delivers autologous growth factors that promote angiogenesis, Schwann cell activation, immunomodulation, and antioxidant defense. Both therapies converge on shared pathways by reducing inflammation, oxidative stress, and scar formation, thereby remodeling the microenvironment into a pro-regenerative niche. Preclinical evidence indicates that combining ES and PRP provides complementary benefits, with ES priming the injury site and PRP sustaining trophic support, resulting in superior axonal density, myelination, and functional recovery compared to monotherapies. Future directions emphasize personalized protocols, optimized ES parameters, standardized PRP formulations, and integration with biomaterials and closed-loop stimulation systems. Translation to clinical practice, however, requires standardized guidelines and rigorous randomized controlled trials to validate these multimodal strategies and enable patient-specific regenerative therapies.