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Nerve Connector Assisted Co-Aptation of Acellular Nerve Allograft
Jonathan Isaacs, MD; Satya Mallu, MD; Amy Kite, MD; Gaurangkumar Patel, BS; Gordon Graham, MD
Virginia Commonwealth University, Richmond, VA
Introduction: Nerve connectors are small conduits used to assist the technical co-aptation between nerve stumps including nerve grafts. Small gaps are considered acceptable when repairing in situ nerves. We hypothesize that when used to inset acellular nerve allograft, however, even small gaps will be detrimental to nerve regeneration.
Materials & Methods: Sixty (three month old) Spraque-Dawley rats underwent a 14mm unilateral tibial nerve injury and subsequent repair using various combinations of acellular nerve grafts and nerve connectors. Proximal repairs for all groups utilized direct contact with the nerve stump within a 4mm connector. Variations in distal repair methods (allograft length, nerve gap, and connector length) defined our four groups (N=15 for all groups). Group A: 14mm allograft, no distal gap, and 4mm distal connector. Group B: 11.5mm allograft, 2.5mm distal gap, and 6.5mm distal connector. Group C: 9mm allograft, 5mm distal gap, and 9mm distal connector. Group D: 14mm allograft, no distal gap, and no distal connector. At three months post-repair, muscle size and function were assessed.
Results: Developed force was significantly lower in Group C (0.073±0.077N) compared to the other three groups (Group A=0.529±0.312N, Group B=0.461±0.462N, Group D=0.409±0.327N). Group C (0.314±0.059gm) had significantly lower muscle weight compared to Groups A (0.935±0.277gm), B (0.837±0.374gm) and D (1.206±0.299gm).
Conclusion: Nerve regeneration and subsequently muscle size and function were significantly impaired as gap distance between the distal end of the allograft and the tibial nerve increased to 5mm. Peripheral nerve surgeons should be aware of the potential compromise of outcomes with gaps of more than a few millimeters when using nerve connectors to assist in nerve allograft repair.
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