Protective Effect of the Human Epineural Patch (hEP) Application after Sciatic Nerve Crush Injury Followed by Nerve Resection and End-to-end Repair
Maria Siemionow, MD, PhD, DSc1, Sonia Brodowska, BS2 and Katarzyna Kozlowska, MD2, 1Deaprtment of Orthopaedics, University of Illinois at Chicago, Chicago, IL, 2University of Illinois at Chicago, Chicago, IL
Introduction: Based on our 20 years of research experience with application of epineural sheath and cellular therapies for enhancement of nerve regeneration after trauma, we reported a novel approach for enhancement of nerve regeneration after crush injury by applying human Epineural Patch (hEP), as an alternative option to human Amniotic Membrane (hAM). In this study, we assessed potential of hEP application as a protective barrier after sciatic nerve crush injury followed by nerve resection and end-to-end repair.
Methods: Regeneration of sciatic nerve after crush injury, resection and end-to-end repair was assessed in 18 athymic nude rats (Crl:NIH-Foxn1rnu) after application of hEP or hAM to the nerve repair site. Right sciatic nerve was crushed above the division into the peroneal and tibial branches, followed by nerve resection of a 1.5mm crushed sciatic nerve segment and end-to-end repair. Three experimental groups (n=6) were assessed: Group 1: sciatic nerve crush injury/resection and repair without protection, Group 2: sciatic nerve crush injury/resection and repair wrapped with hEP, Group 3: sciatic nerve crush injury/resection and repair wrapped with hAM. Assessments were performed at 6- and 12-week after nerve repair and included: functional motor and sensory recovery by toe-spread and pin-prick tests, and assessment of muscle denervation atrophy by Gastrocnemius Muscle Index (GMI).
Results: At 6-week, significant sensory recovery was observed in Group 2, compared with Group 1 (p<0.001) and Group 3 (p<0.5). Assessment at 12-week revealed the highest values of sensory response however without statistical significance. At 6-week after repair, motor outcome significantly improved in Group 2 when compared to Group 1 (p<0.01) and Group 3 (p<0.5). At 12-week endpoint study, the most notable motor recovery was observed in Group 2 when compared to Group 1 (p<0.01). Significant reduction of denervation atrophy was observed in Group 2 when compared to Group 1 (p<0.05) at 12-week.
Conclusions: Application of hEP and hAM after nerve crush injury/resection and end-to-end repair confirmed the protective effect of both, hEP and hAM, at the nerve repair site at 6- and 12-week after surgery. However, functional outcomes and GMI were significantly better after application of hEP compared to hAM. This study introduces hEP as a novel approach for nerve protection and enhancement of regeneration after nerve crush injury followed by nerve resection and end-to-end repair.
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