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Loop nerve graft prefabrication for peripheral nerve defect reconstruction.

Sinan Öksüz1, Fikret Eren2, Ceyhun Cesur3

  • 1Department of Plastic Reconstructive and Aesthetic Surgery, University of Health Sciences Gülhane Faculty of Medicine, Ankara-Türkiye.

Ulusal Travma Ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery : TJTES
|August 3, 2022
PubMed
Summary

Loop nerve graft prefabrication enhances axonal regeneration in delayed nerve reconstruction. This technique improved nerve repair outcomes without increasing repair time, suggesting potential for immediate long nerve defect repairs.

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Area of Science:

  • Regenerative Medicine
  • Neurosurgery
  • Biomaterials Science

Background:

  • Delayed autologous nerve grafting is often necessary for severe injuries, but prolonged repair times negatively impact outcomes.
  • Loop nerve graft prefabrication offers a novel approach to improve and accelerate nerve reconstruction, particularly for injuries involving tissue loss.

Purpose of the Study:

  • To evaluate the efficacy of loop nerve graft prefabrication in improving and accelerating nerve graft reconstruction in a rat model.
  • To compare functional and histological outcomes of loop nerve graft prefabrication with conventional and staged conventional nerve grafting techniques.

Main Methods:

  • A 1.5 cm peroneal nerve segment was used as an autologous nerve graft in Sprague-Dawley rats, allocated into three groups: conventional interpositional nerve graft, loop nerve graft prefabrication, and staged conventional interpositional nerve graft.
  • Functional recovery was assessed using the Peroneal Function Index (PFI), alongside electrophysiological and histological analyses after 8 weeks.
  • Loop nerve graft prefabrication involved a two-stage repair: initial end-to-end suturing to proximal stumps and end-to-side to distal stumps, followed by transposition.

Main Results:

  • Loop nerve graft prefabrication (Group 2) showed significantly higher axon counts (2531±91.18) compared to conventional (Group 1: 2227±260.4) and staged conventional (Group 3: 2194±201.1) methods (p<0.05).
  • No significant difference in PFI or electrophysiology was observed between loop prefabrication and conventional grafting, but both were superior to staged conventional grafting.
  • Staged conventional grafting (Group 3) resulted in poorer functional and electrophysiological outcomes compared to the other two groups.

Conclusions:

  • Loop nerve graft prefabrication effectively enhances axonal regeneration in delayed nerve reconstruction without increasing repair duration.
  • The technique shows promise for accelerating prolonged regeneration times and may be suitable for immediate long nerve defect reconstructions.
  • Higher axon counts achieved with loop prefabrication warrant further investigation for its application in primary long nerve gap repairs.