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Sutureless repair of transacted nerves using photo-activated epineural collagen wrap
Minghao Zheng, MD, PhD, FRCPath
1; Zoran Pletikosa, MD
2; David Mahns, PhD
3; John Morley, PhD
3; David M. Brogan, MD
41The University of Western Australia, Perth, Western Australia, Australia; 2University of Western Sydney, Penrith, NSW, Australia; 3University of Western Sydney, Campbelltown, NSW, Australia; 4Washington University School of Medicine, St. Louis, MO
Hypothesis
Suturing is the standard surgical treatment technique for nerve transection injuries but can cause disruption of axon growth and foreign-body reactive inflammation. Here we have developed a photonic sensing collagen based epineural substitute for nerve repair without sutures. We hypothesised that by using the photo-activated epineural collagen (PEC), we can eliminate the use of sutures, minimise, or avoid additional suture induced injury inflicted by tissue handling and needle penetration and shorten the surgical procedure of nerve repair.
Methods
Rat sciatic nerve transection model (N=45) was used to compare suture and sutureless repair using PEC at 4, 8, 17 weeks. For suture repaired groups, transected nerves were sutured with three epineural 9-0 nylon monofilaments. For PEC groups, after aligning two nerve ends PEC was wrapped around the nerve to form a double layered cuff. Laser irradiation was used for three times over the 120 second period to produce bonding. Outcomes assessments include behavioural tests (thermal stimuli and withdrawal threshold tests), Measurement of gastrocnemius muscle weight and histology by performing trichrome, osmium and silver staining.
Results
Sensory recovery assessment showed that compared to suture repaired nerves, PEC demonstrated significantly better sensory recovery, less hyperaesthesia and 2-3 weeks earlier return to the baseline. Motor recovery assessment showed while the muscle activity has not returned to normal at 17 weeks in all groups, PEC repaired nerves demonstrated significantly greater gastrocnemius muscle CMAP and weight compared to suture repaired nerves. Histological assessment showed that PEC repaired nerves maintained good alignment of the coapted stumps and in time PEC slowly degraded becoming an integral part of the epineurium without inflammatory reaction. Axon regeneration showed good progress and by week 17 post-surgery the nerve was largely normal in histological appearance. There was no presence of the residual membrane material around the nerve at this point, and the epineurium showed structural features comparable to intact nerves. Sutured nerves showed suboptimal alignment of the coapted ends with a marked thickening in the transection area. Inflammatory cellular response was very marked at week 4. There was disordered histological architecture of the fascicles with numerous axons misdirected and not getting across the transection line, or being forced to detour to avoid the sutures that got deeply embedded in the nerve. Substantial scarring within the nerve was identified in all time points.
Summary points
The photo-activated collagen based epineural substitute developed is superior for nerve repair with suture.
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