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A novel surgical approach for peripheral nerve regeneration after acute crush injury in rats.
Can Ozturk, MD
Jacek Szopinski, MD,PhD, Maria Madajka, PhD,
Thomas B. Sullivan, BSE, Maria Siemionow, MD, PhD
Cleveland Clinic Departmant of Plastic Surgery
2012-02-10
Presenter: Can Ozturk
Affidavit:
The animal surgeries, clinical and histological evaluations were done by the research fellow.
Director Name: Maria Siemionow
Author Category: Attending
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
How does this presentation meet the established conference educational objectives?
Our study can be referred to objective number 3. We are introducing a new biologic material application for nerve wrapping for decreasing adhesion, improving results and outcomes after nerve injuries.
How will your presentation be used by practicing physicians in the audience?
Our study may have a potential for clinical application in the future which may enhance the nerve recovery after nerve injuries and nerve decompression surgeries.
Purpose:
We hypothesize that naïve epineural sheath (ES) creates optimal conditions for nerve regeneration in both normal and unfavorable wound healing conditions.
Materials and Methods:
Eighty male Lewis rats were allocated into 8 experimental groups of 10 rats each and a 2 mm long, 17.4 Nt/mm crushing force was applied for 5 minutes to the right sciatic nerve. The crushed nerve was left without intervention as a control, or was wrapped with fat, isogenic, or allogenic ES in groups I-IV, respectively.
In groups V-VIII, unfavorable wound conditions were created by removing epineural sheath prior to crush injury and the same interventions were done. Nerve regenerations were assessed by functional assessment tests, histomorphometrical and immunostaining analysis.
Results:
Functional evaluation; Toe spread test showed improved motor recovery in unfavorable wound conditions after isogenic ES application. Pin prick test showed improved sensorial recovery in both normal and unfavorable wound conditions after both isogenic and allogenic ES applications at 6 weeks. Gastrocnemius muscle index results were similar in all groups. Somatosensorial evoked potential tests showed that ES applications revealed shorter P1 latencies at 6 weeks in both normal and unfavorable wound conditions. All groups had comparable results for mean fiber diameters, myelin thickness and axon density.
Immunofluorescence staining showed that application of the epineural sheath reduced number of macrophages and enhanced VEGF expression compared to adipose tissue group.
Conclusion:
Application of the ES served as a protective barrier and created an optimal microenvironment for nerve regeneration by acting as a proangiogenic scaffold providing VEGF.
