Autologous Fascia Nerve Wrap as an Adjunct to Primary Epineurial Repair
Emma Rowley, BS1,2, Zach Zamore, BA3, William M Padovano, MD MPHS4, Chenhu Qiu, MS, PhD5, Zohra V Aslami, BA4, Weitzner K Aidan, BS3, Rachana Suresh, MBBS MPH4, Erica B Lee, MS4, Sami H Tuffaha, MD1 and Esperanza Mantilla Rivas, MD6, 1Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, 2University of Nevada, Reno School of Medicine, Reno, NV, 3Johns Hopkins School of Medicine, Baltimore, MD, 4Johns Hopkins University School of Medicine, Baltimore, MD, 5Johns Hopkins University, Baltimore, MD, 6Johns Hopkins, Baltimore, MD
Background:
Nerve wraps are used to bolster nerve coaptations, as they offer the theoretical benefits of reducing axonal escape and intraneural scar infiltration. We posit that autologous fascia has the potential to serve as an ideal nerve wrap, as it is composed of native collagen and has a composition closely resembling epineurium. We hypothesize that autologous fascia nerve wraps will readily incorporate into the epineurium at the coaptation site and provide a barrier to contain regenerating axons and reduce inflammatory cell infiltration. We evaluated these hypotheses in a rat sciatic nerve transection and repair model and a size-mismatched sciatic-to-common peroneal nerve transfer model.
Methods:
A total of 84 Lewis rats were divided into six groups (n = 14 per group): sciatic transection with repair +/- fascia wrap (matched repair), sciatic-to-common peroneal nerve transfer +/-fascia wrap (mismatched repair), sciatic transection without repair (positive control), and sham surgery (negative control). 1 cm^2 fascia grafts were obtained from gluteal muscles near the coaptation sites. Animals were harvested at either 4 weeks or 12 weeks post-operative for histologic evaluation of the coaptation site and evaluation of cytokine expression in the nerve and dorsal root ganglia (DRG) using ELISA.
Results:
At 4 weeks post-operative, groups that received fascia nerve wraps demonstrated significantly reduced expression of pro-inflammatory cytokines, TNF-α and IL-1β, at the DRG relative to groups that underwent nerve repair alone. Additionally, fascia wrap groups demonstrated significantly greater expression of anti-inflammatory cytokines, TGF-β and IL-10, relative to nerve repair alone. At 12-weeks post-operative, the matched and mismatched groups with fascia demonstrated a significantly decreased collagen content within the native epineurium compared to the matched repair groups without fascia. At 12 weeks post operative, the mean number of regenerated cell bodies in the matched groups with fascia were significantly higher than in the repair groups without fascia.
Conclusions:
Autologous fascia wraps are a simple adjunct that can reduce intraneural inflammation and collagen deposition in both size-matched and size-mismatched nerve coaptations. The greater number of retrograde labeled neurons that regenerated beyond the coaptation site suggests that the fascia wraps limited axonal escape. Fascia grafts are technically straightforward to harvest, readily available, free of cost, and may be a useful tool in the peripheral nerve surgeon’s armamentarium.
Back to 2024 Abstracts