Large Extremity Peripheral Nerve Repair
Technical Report,30 Sep 2012,29 Sep 2016
Massachusetts General Hospital Boston United States
Pagination or Media Count:
In current war trauma, 20-30 of all extremity injuries and 80 of penetrating injuries being associated with peripheralnerve damage, typically involve large segmental nerve deficits. Standard repair uses autologous nerve graft, secured bysuture. Outcomes are unsatisfactory, affecting quality of life and return to active duty. We have investigated a sutureless,light-activated technology for sealing nerve grafts to produce an immediate seal that optimizes the regenerating nerveenvironment. Our studies have shown that biocompatible chemical crosslinking of human amnion considerably strengthensand protects it from biodegradation in vivo that compromises their function as nerve wrap sealants. Rodent studies ofsegmental nerve deficit repair using isograft show the best performing wrap fixation method to be sutureless photochemicaltissue bonding with the crosslinked amnion wrap. Autograft is often unavailable in wounded warriors, due to extensivetissue damage and amputation and, importantly, we also showed nerve regeneration using our approach with an acellularnerve allograft to be equivalent to standard autograft repair in rodent models. Outcomes have now been validated in a largeanimal swine model with 5 cm ulnar nerve deficit where electrophysiological outcomes for light-activated sealing of acommercial nerve graft conduit AvanceTM were equivalent to standard of care autograft.
- Medicine and Medical Research
- Anatomy and Physiology