Repair and Regeneration after Peripheral Neurorrhaphy: A Blinded, Systematic Evaluation of Techniques in an Animal Model
Jacqueline S. Israel, MD; Aaron M. Dingle, PhD; Joseph R. Novello, MS;Justin C. Williams, PhD; Samuel O. Poore, MD, PhD
University of Wisconsin - Madison, Madison, WI
Since the refinement of microsurgical techniques for peripheral neurorrhaphy, there has been relatively little investigation into preferred methods for direct nerve repair after traumatic injury. More recent experimental studies have focused on optimizing biologic and synthetic conduits, decreasing immunogenicity and improving tolerance to nerve allografts, and tissue engineering. Direct, tension-free repair with the fewest required epineural sutures is the most widely accepted technique for repair after complete nerve injury.Fascicular repair offers improved fascicular alignment, with the caveat of increased suture material and resultant nerve fibrosis. Functional outcomes suggest that neither technique consistently demonstrates an advantage over the other, and to our knowledge, no previously published single study has directly compared greater than 3 techniques. We have developed a blinded protocol to perform exposure, transection, and repair of the sciatic nerve in male Sprague Dawley rats using at least 5 different techniques: 1-stitch epineural, 3-stitch epineural, epineural sleeve, fascicular, and fibrin glue. The animals are recovered and postoperative testing is performed to compare nerve conductivity, axon regeneration, vascularization, extracellular matrix remodeling, and regain of function between different repair types. Advanced imaging techniques, such as FITC-dextran vascular imaging and second-harmonic generation microscopy, together with electrophysiological assessment and histopathologic examination, allow for controlled, direct comparison of neurorrhaphy techniques. Future studies using this protocol will explore mechanisms of nerve repair in genetically modified mice and compare techniques in conduit-based repairs.
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