American Society for Peripheral Nerve
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Neurorrhaphy Augmented with Light-Bonded Autologous Tissue
Nicolò Rossi, MD1; María Béjar-Scribner, MD1; Benjamin B Scott, MD2; David M. Kostyra, BS3; Kristina Jones, BS3; Giuseppe M Peretti, MD4; Mark A Randolph, MAS1; Robert W. Redmond, PhD3
1Plastic & Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 2Massachussetts General Hospital, Harvard Medical School, Boston, MA; 3Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; 4Department of Biomedical Sciences for Health, University of Milan, Milano, Italy

Introduction: Photochemical tissue bonding (PTB) uses light and a photoactive dye to create covalent crosslinks between a nerve wrap material and the epineurial surface that results in a watertight seal around the neurorrhaphy, thus reducing the suture burden and sealing the regenerating nerve microenvironment. We have previously demonstrated the ability of PTB to bond and seal nerves using different materials, including crosslinked human amniotic membrane (xHAM). In this study, we tested autologous vein as a photo-sealed wrap over 16 weeks of follow-up in a rodent sciatic nerve transection and repair model, testing the motor and sensory function of the limb combined with histologic assessment.
Materials & methods: Twenty-four Lewis rats underwent transection of the sciatic nerve. Animals were then randomized to three treatment groups; standard neurorrhaphy (SN), xHAM with PTB, and autologous vein wrap with PTB. Four animals were used as femoral vein donors. Functional recovery was assessed at four-weeks intervals using walking track analysis. Gastrocnemius muscle mass preservation, histology, and histomorphometry were evaluated at 16 weeks.
Results: Nerves treated with PTB-sealed autologous vein improved functional recovery, although the comparison between groups was not significantly different (SN: -0.69 +- 0.23; XHAM: -0.64 +- 0.16; Vein: -0.62+- 0.25). The comparison of the muscle mass preservation between control and experimental side showed good muscle mass preservation but no statistical difference between groups (SN: - 0.70+- 0.06; XHAM: - 0.71+- 0.08; Vein: - 0.74 +- 0.07). The histomorphometric analysis found good axonal regeneration in all repair techniques.
Conclusions: These results demonstrate that peripheral nerve injury can be repaired with autologous tissue using a photochemical technique with results similar to those achieved with the current gold standard. Although not reaching statistical significance in this pilot study, the group treated with autologous veins and PTB showed improved results than the other groups for functional recovery, gastrocnemius muscle mass preservation, histology, and histomorphometric analysis. Using autologous vein for nerve wrapping with PTB would remove foreign body concerns and would be readily available and easily collected during routine surgery. This study illustrates a new repair method that could restore normal endoneurial homeostasis in a less traumatic fashion following nerve transection injury.


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