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Evaluation of Clinical Alternatives to Nerve Autograft in Long Gap Median Nerve Defects
Jacqueline Bliley, Matthias Waldner, Gabriella Dibernardo, Ryan Schroth, Chris Mahoney, Damian Grybowski, Debra Bourne, Isaac James, Tyler Simpson, Casey Tompkins-Rhoades, Ana Taylor, Aaron Dees, Donald Crammond, Kacey G. Marra
University of Pittsburgh Medical Center
2016-01-31
Presenter: Jacqueline Bliley
Affidavit:
Jacqueline Bliley
Director Name: Peter Rubin
Author Category: Other Specialty Resident
Presentation Category: Basic Science Research
Abstract Category: Hand
Background: Standard treatment for peripheral nerve gaps involves donor nerve excision and transplantation into the defect (i.e. an autograft). Donor site morbidity, including numbness and the formation of neuromas, are disadvantages of autografts. Current clinically available nerve guides do not actively support regeneration through growth factor delivery. We are investigating a poly(caprolactone) (PCL) nerve guide and neurotrophic factor delivery, as well as a decellularized nerve allograft in non-human primates (NHPs) to support regeneration over long gaps (>3 cm).
Methods: 5-cm median nerve defects were repaired with autograft, decellularized nerve allograft, a poly(caprolactone) (PCL) conduit, or a PCL conduit with glial cell line-derived neurotrophic factor (GDNF) microspheres. NHPs were trained to retrieve treats from a Klüver board. Successful retrieval percentage was recorded. Intraoperative nerve conduction velocity (NCV), muscle (CMAP), and sensory (SNAP) evoked potentials were obtained. Explants were also evaluated for Schwann cell and nerve fiber density.
Results and Conclusions: A trend towards increased functional recovery was observed in the GDNF-treated, decellularized nerve, and autograft groups compared to our negative control PCL/empty microsphere group. Nerve conduction and CMAPs were evident at one year in both PCL/GDNF and decellularized nerve groups suggesting that both treatments support regeneration across the 5-cm gap and support muscle reinnervation. Increased nerve conduction and CMAP amplitude were seen in the autograft group. No significant differences were observed in Schwann cell density between autograft, PCL/GDNF, or decellularized nerve; however, significantly more nerve fibers were found in the autograft and decellularized nerve groups compared to PCL/GDNF.
