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Hydrophilic Polymers Promote Immediate Physiologic Recovery after Nerve Repair with Collagen Tubes
Gabriel Del Corral, MD; Kevin W. Sexton, MD; L. B. Nanney, PhD; R. Bruce Shack, MD; W. P. Thayer, MD, PhD
Plastic Surgery, Vanderbilt University, Nashville, TN

Background: Traumatic neuropathies (TN) are a common source of morbidity in the United States affecting approximately 5% of all admissions to a level one trauma center. It has been reported that less than 50% of these injuries will obtain a functional recovery and less than 5% will obtain a full recovery. We sought to improve the rate of physiologic recovery following repair of transected nerves using hydrophilic polymers. This technique is based on the ability to fuse axons of severed cell membranes using hydrophilic polymers, generating functional and morphological neuronal continuity.  Our hypothesis is that nerve physiology can be restored by using fusion combined with collagen tubes if performed before the onset of Wallerian degeneration. Our technique may be applicable for cases of nerve injury including patients with acute traumatic deficits and also patients in need of reconstruction after oncologic resection.

Methods: Sprague Dawley rats were anesthetized with isoflourane.  The right sciatic nerve was exposed. Baseline compound action potentials (CAPs) were stimulated and recorded using a Powerlab data acquisition system (ADInstruments).  Then nerve was then transected.  The nerve underwent repair in an end-to-end fashion within a commercially available collagen nerve tube.  CAPS were recorded as above.  A series of solutions (Calcium free Krebís solution [0.5 mM EGTA in 99 mM NaCl, 5 mM KCl, 1.2 mM KH2P04, 1.3 mM MgS04, 26 mM NaHC03, 10 mM Na ascorbate, 10 mM dextrose, pH 7.35, 295 mM], 1000 μm Methylene Blue in Calcium free Krebís solution, and 190 mM Polyethylene glycol 3.35 kD in distilled water) were applied through the tube.  After 3 minutes, solution CAPS were obtained in the same manner above. 

Results: Five nerve tube repairs were were performed.  Prism 5, (GraphPad Software, Inc.) was used for all data comparisons.  Baseline CAPs had average amplitude of 4.26 + 1.58 mV.  No CAPs could be obtained after standard nerve tube repair (0 + 0 mV).  After solution exposure, post repair CAPs were obtained with a mean of 4.336 + 1.808 mV.  Using 1 way ANOVA comparison with Tukeyís multiple comparison test there was no statistical difference between the preoperative and solution exposure (p>.05), however there was a significant difference between the standard repair and solution exposure groups (p=. 0237).

Conclusions: PEG allows for immediate return of physiologic function after standard nerve tube repair.

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