Artikel
The effects of porcine extracellular matrix nerve wrap as an adjunct to primary epineurial repair
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Autoren
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Philip Hanwright
- Johns Hopkins University School of Medicine, Baltimore, United States
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Jennifer Rath
- Johns Hopkins University School of Medicine, Baltimore, United States
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Nicholas Von Guionneau
- Johns Hopkins University School of Medicine, Baltimore, United States
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Benjamin Slavin
- University of Miami, Miller School of Medicine, Miami, United States
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Dan Zlotolow
- Shriner's Hospital for Children, Philadelphia, United States
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W.P. Andrew Lee
- Johns Hopkins University School of Medicine, Baltimore, United States
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Jaimie Shores
- Johns Hopkins University School of Medicine, Baltimore, United States
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A. Lee Dellon
- Johns Hopkins University School of Medicine, Baltimore, United States
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Sami Tuffaha
- Johns Hopkins University School of Medicine, Baltimore, United States
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The use of nerve wraps has been advocated as a means of protecting and isolating the neurorrhapy site; however, there is a paucity of data to support their use. The most commonly used commercially-available nerve wrap is an extracellular matrix (ECM) membrane derived from porcine small intestine submucosa (AxoGen, Alachua, FL). The purpose of this study is to characterize the effects of using this wrap as an adjunct to primary epineural repair.
Methods: Lewis rats were randomized to undergo median nerve transection and epineural suture repair, either with or without the use of a wrap around the coaptation site (n=10 per group). Animals were sacrificed at five weeks for quantitative histologic analysis of intraneural scar formation and inflammatory cell infiltration at the repair site, as well as distal axonal regeneration and neuromuscular junction reinnervation. These groups were repeated with a 15-week endpoint to allow for weekly assessments of functional recovery with grip strength testing.
Results and Conclusions: The wrapped group demonstrated significantly less intraneural collagen deposition at the coaptation site at five weeks (Figure 1 [Fig. 1], p=0.01). There were no statistically significant differences for inflammatory-cell density, number of regenerating axons, or percent reinnervation of neuromuscular junctions at either endpoint. Initial functional recovery was observed earlier in the wrapped group than the unwrapped group (5 weeks vs. 6 weeks, p=0.090); at the 15-week endpoint, there was no statistically significant difference between wrapped and unwrapped grip strength (1.29±0.12 N vs. 1.06±0.10 N, p=0.17). No deleterious effects were observed with use of the wrap.
The use of the porcine ECM nerve wrap as an adjunct to primary epineurial repair is safe and effective in reducing the rate of intraneural collagen deposition at the neurorrhapy site. Potential trends towards modest improvement in inflammatory cellular infiltration, motor reinnervation and functional recovery were noted that did not reach statistical significance.
