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Neurologic Evaluation of Long Segment Nerve Repair with Epineural Sheath Conduit in Sheep – A Preliminary Report
Grzegorz Kwiecien, Can Oztürk, Safak Uygur, Jacek Szopinski, Adam Bobkiewicz, Maria Madajka, Vlodek Siemionow, Maria Siemionow
Cleveland Clinic
2013-03-15
Presenter: Grzegorz Kwiecien
Affidavit:
The above resident actively participated in all components of the study.
Director Name: Maria Siemionow
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Hand
Background: Autograft repair following peripheral nerve injury is often challenging, especially in multitrauma patients with lack of potential donor sites. Alternative allografting requires long-term immunosuppression which is associated with adverse side effects and results in poor functional outcome. Thus, there is need for new, simple repair technique.
Objective: The aim of this study is to assess the outcome of long segment nerve repair using epineural sheath conduit (ES).
Material and Methods: 7 outbred sheep were used in this study. A 6 cm median nerve defect was created in both forelimbs. Autologous ES filled with saline was used to microsurgically repair the nerve on one side, whereas interposed autograft repair of the contralateral nerve served as control. Electrophysiological evaluation was performed using: transdermal nerve stimulation (TNS), measurement of nerve conduction velocity (NCV) and somatosensory evoked potentials (SSEP). TNS was evaluated preoperatively, at 3 and 6 months following repair. At 6 months, median nerve was dissected and NCV and SSEP were recorded.
Results: All animals presented vivid hoof twitch responses to TNS at 6 months after repair using both techniques. Both techniques resulted in recordable action potentials distally to the repair site following direct nerve stimulation with 0.4 - 2.0 mA. In all animals direct stimulation of the distal nerve elicited recordable action potentials over the sensory cortex.
Conclusion: This study shows feasibility of application of ES conduit in restoration of long nerve defects in large animal model. The neuroconductive properties of nerve following repair using ES conduit were observed.
