Large Extremity Peripheral Nerve Repair
Annual rept. 30 Sep 2013-29 Sep 2014
MASSACHUSETTS GENERAL HOSPITAL BOSTON
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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 are investigating a sutureless, light-activated technology for sealing nerve grafts to produce an immediate water-tight seal that protects and optimizes the regenerating nerve environment. Our studies have shown that biocompatible chemical crosslinking of thin amnion and SIS sections considerably strengthens the materials and protects them from rapid biodegradation in vivo that would compromise their function as nerve wrap sealants during the regeneration process. Outcomes of 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. Often, autograft is unavailable due to extensive tissue damage and amputation. Importantly, We have shown nerve regeneration using our approach with an acellular nerve allograft to be equivalent to standard autograft repair in rodent models. An ongoing large animal validation study will pave the way for human studies of this technology.
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