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 peripheral nerve damage, typically involve large segmental nerve deficits. Standard repair uses autologous nerve graft, secured by suture. 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 nerve environment. Our studies have shown that biocompatible chemical crosslinking of human amnion considerably strengthens and protects it from biodegradation in vivo that compromises their function as nerve wrap sealants. Rodent studies of segmental nerve deficit repair using isograft show the best performing wrap fixation method to be sutureless photochemical tissue bonding with the crosslinked amnion wrap. Autograft is often unavailable in wounded warriors, due to extensive tissue damage and amputation and, importantly, we also showed nerve regeneration using our approach with an a cellular nerve allograft to be equivalent to standard autograft repair in rodent models. Outcomes have now been validated in a large animal swine model with 5 cm ulnar nerve deficit where electrophysiological outcomes for light-activated sealing of a commercial nerve graft conduit AvanceTM were equivalent to standard of care autograft.
- Anatomy and Physiology
- Medicine and Medical Research