American Association for Hand Surgery
Theme: Beyond Innovation

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Side-to-Side Supercharging Improves Functional Recovery Following Long Acellular Nerve Allograft Repair in a Rat Model
Jonathan Isaacs, MD1; Satya Mallu, MD1; Gaurangkumar Patel, B.S.2; Monika Debkowska, MD2
1Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, 2Virginia Commonwealth University, Richmond, VA

Introduction:
Processed acellular nerve allograft (PNA) is becoming an increasingly popular modality for addressing segmental nerve defects during nerve repair. The neurotrophic potential of PNA decreases with longer graft lengths due to a loss of Schwann cell support. Donor axons introduced into the side of a long autograft or chronically denervated nerve stump (by reverse end-to-side nerve repair or "supercharging") enhance axon regeneration and recovery. Side-to-side grafting (a variation of supercharging) between PNA and regional in situ nerve trunks may be able to increase the effective "critical length" of the PNA.
Methods:
Seventy-two female Sprague-Dawley rats underwent tibial nerve resection and repair with 20 or 40mm length PNA or Isograft. Some animals also underwent single bridge graft treatment and other animals received triple bridge graft treatment (Fig.1 and 2). After 20 weeks, muscles were assessed for force generation and muscle weight.
Results:
For 20mm grafts, there was no statistical difference between PNA with or without bridge graft treatment and isograft.
For 40mm grafts, isograft repairs achieved higher muscle weights and muscle force generation then PNA. However, muscle weight and force were not statistically different between isograft and PNA treated with 3 side-to-side bridge grafts. PNA treated with 3 bridge grafts also achieved higher muscle weights and force generation than untreated PNA.
Conclusions:
Triple (but not single) side-to-side bridge grafting improved the critical length of PNA from 20mm to 40mm is a rodent model.



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