1
|
Tsujisaka R, Suzuki T, Shibata S, Iwamoto T, Taguchi T, Nakamura M. Effect of Alaska pollock-gelatin sheet on repair strength and regeneration of nerve. J Hand Surg Eur Vol 2025; 50:76-84. [PMID: 38780096 DOI: 10.1177/17531934241251670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The aim of the study was to investigate the repair strength and the biocompatibility of Alaska pollock-derived gelatin (ApGltn) sheet for nerve repair. Cadaveric digital nerves were repaired with double suture, single suture + ApGltn sheet, single suture + fibrin glue, single suture, ApGltn sheet and fibrin. Maximum failure loads were measured (20 nerves each). Rat sciatic nerves were repaired with double suture, single suture + ApGltn sheet, single suture, ApGltn sheet, fibrin glue and resection (10 nerves each). Macroscopic appearance, muscle weight and histopathological findings were examined 8 weeks postoperatively. The mean failure load of ApGltn sheet (0.39 N) was significantly higher than that of a fibrin (0.05 N), and that of single suture + ApGltn sheet (1.32 N) was significantly higher than that of a single suture alone (0.97 N). Functional and histological assessments showed similar nerve recovery among the suture, ApGltn and fibrin groups. ApGltn sheet has potential for clinical application as an alternative to fibrin.
Collapse
Affiliation(s)
- Ryosuke Tsujisaka
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Shibata
- Electron Microscope Laboratory, Keio University School of Medicine, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tetsushi Taguchi
- Graduate School of Pure and Applied Sciences, University of Tsukuba, Ibaraki, Japan
- Polymers and Biomaterials Field, Research Center for Functional Materials, National Institute for Materials Science, Ibaraki, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Le ELH, Iorio ML, Greyson MA. Targeted muscle reinnervation in upper extremity amputations. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:3717-3725. [PMID: 37814069 PMCID: PMC11490433 DOI: 10.1007/s00590-023-03736-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Targeted muscle reinnervation (TMR) is a relatively recent surgical innovation that involves the coaptation of major peripheral nerves to a recipient motor branch that innervates an expendable muscle target. The original indication for TMR was augmentation and optimization of myoelectric signals in the amputated limb for use of myoelectric prosthetics. Incidentally, surgeons and patients discovered that the technique also could treat and prevent phantom and residual limb pain. TMR is performed at the time of amputation or delayed any time after the amputation, and TMR can also be performed at any level of amputation. In the upper extremity, studies have detailed the various techniques and coaptations possible at each amputation level to create intuitive myoelectric signals and treat neurogenic pain. Treatment of peripheral nerves in the amputee with TMR should be a consideration for all patients with major upper extremity amputations, especially at large institutions able to support multidisciplinary limb salvage teams. This review article summarizes the current literature and authors' techniques and recommendations surrounding TMR in the upper extremity amputee including techniques relevant to each level of upper extremity amputation.
Collapse
Affiliation(s)
- Elliot L H Le
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA
| | - Matthew L Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA
| | - Mark A Greyson
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, 12631 East 17Th Ave, Room 6111, Aurora, CO, 80045, USA.
| |
Collapse
|
3
|
Wlodarczyk AI, Collin EC, Pereira MJN, Bindra R, Power DM. Biomechanical Evaluation of an Atraumatic Polymer-assisted Peripheral Nerve Repair System Compared with Conventional Neurorrhaphy Techniques. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e6151. [PMID: 39267729 PMCID: PMC11392492 DOI: 10.1097/gox.0000000000006151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/24/2024] [Indexed: 09/15/2024]
Abstract
Background Microsuturing, the gold standard for peripheral nerve repair, can create tension and damage at the repair site, potentially impacting regeneration and causing neuroma formation. A sutureless and atraumatic polymer-assisted system was developed to address this challenge and support peripheral nerve repair. The system is based on a biocompatible and biodegradable biosynthetic polymer and consists of a coaptation chamber and a light-activated polymer for securing to the nerve. In this study, we compare the system's biomechanical performance and mechanism of action to microsutures and fibrin repairs. Methods The system's fixation force was compared with microsutures and fibrin glue, and evaluated across various nerve diameters through tensile testing. Tension and tissue morphology at the repair site were assessed using finite element modeling and scanning electron microscopy. Results The fixation force of the polymer-assisted repair was equivalent to microsutures and superior to fibrin glue. This force increased linearly with nerve diameter, highlighting the correlation between polymer surface contact area and performance. Finite element modeling analysis showed stress concentration at the repair site for microsuture repairs, whereas the polymer-assisted repair dissipated stress along the nerve, away from the repair site. Morphological analysis revealed nerve alignment with no tissue trauma for the polymer-assisted repair, unlike microsutures. Conclusions The mechanical performance of the polymer-assisted coaptation system is suitable for peripheral nerve repair. The achieved fixation forces are equivalent to those of microsutures and superior to fibrin glue, minimizing stress concentration at the repair site and avoiding trauma to the severed nerve ends.
Collapse
Affiliation(s)
| | | | | | - Randy Bindra
- Griffith University School of Medicine and Dentistry, Gold Coast, Australia
| | - Dominic M Power
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| |
Collapse
|
4
|
Zabbia G, Toia F, Coppola F, Cassata G, Cicero L, Giglia G, Puleio R, Cordova A. Nerve Regeneration after a Nerve Graft in a Rat Model: The Effectiveness of Fibrin Glue. J Pers Med 2024; 14:445. [PMID: 38793027 PMCID: PMC11121836 DOI: 10.3390/jpm14050445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/11/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Simulating the post-traumatic continuity defect of small human peripheral nerves, we compared the effectiveness of fibrin glue with neurorrhaphy for nerve gap restoration. METHODS In twenty-four male Wistar rats, a fifteen mm defect in one sciatic nerve only was made and immediately repaired with an inverted polarity autograft. According to the used technique, rats were divided into Group A (Control), using traditional neurorrhaphy, and Group B (Study), using fibrine glue sealing; in total, 50% of rats were sacrificed at 16 weeks and 50% at 21 weeks. Before sacrifice, an assessment of motor function was done through Walking Track Analysis and an electroneurophysiological evaluation. After sacrifice, selected muscle mass indexes and the histology of the regenerated nerves were assessed. All data were evaluated by Student's t test for unpaired data. RESULTS No significant differences were found between the two groups, with only the exception of a relative improvement in the tibialis anterior muscle's number of motor units in the study group. CONCLUSION Despite the fact that the use of fibrin glue as a nerve sealant is not superior in terms of functional recovery, its effectiveness is comparable to that of microsurgical repair. Hence, the faster and technically easier glueing technique could deserve broader clinical application.
Collapse
Affiliation(s)
- Giovanni Zabbia
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Francesca Toia
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Federico Coppola
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| | - Giovanni Cassata
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T), Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy; (G.C.); (L.C.)
| | - Luca Cicero
- Centro Mediterraneo Ricerca e Training (Ce.Me.Ri.T), Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy; (G.C.); (L.C.)
| | - Giuseppe Giglia
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), Section of Human Physiology, University of Palermo, 90127 Palermo, Italy;
| | - Roberto Puleio
- Laboratorio Istopatologia e Immunoistochimica, Dipartimento Ricerca Biotecnologica e Diagnostica Specialistica, Istituto Zooprofilattico Sperimentale della Sicilia “A. Mirri”, 90129 Palermo, Italy;
| | - Adriana Cordova
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy; (G.Z.); (F.T.); (A.C.)
| |
Collapse
|
5
|
Bendale G, Smith M, Daniel L, deBruler I, Fernandes Gragnani M, Clement R, McNeice J, Griffitts F, Sonntag M, Griffis J, Clements I, Isaacs J. In Vivo Efficacy of a Novel, Sutureless Coaptation Device for Repairing Peripheral Nerve Defects. Tissue Eng Part A 2023; 29:461-470. [PMID: 37114683 PMCID: PMC10517328 DOI: 10.1089/ten.tea.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 04/26/2023] [Indexed: 04/29/2023] Open
Abstract
Although microsuture neurorrhaphy is the accepted clinical standard treatment for severed peripheral nerves, this technique requires microsurgical proficiency and still often fails to provide adequate nerve approximation for effective regeneration. Entubulation utilizing commercially available conduits may enhance the technical quality of the nerve coaptation and potentially provide a proregenerative microenvironment, but still requires precise suture placement. We developed a sutureless nerve coaptation device, Nerve Tape®, that utilizes Nitinol microhooks embedded within a porcine small intestinal submucosa backing. These tiny microhooks engage the outer epineurium of the nerve, while the backing wraps the coaptation to provide a stable, entubulated repair. In this study, we examine the impact of Nerve Tape on nerve tissue and axonal regeneration, compared with repairs performed with commercially available conduit-assisted or microsuture-only repairs. Eighteen male New Zealand white rabbits underwent a tibial nerve transection, immediately repaired with (1) Nerve Tape, (2) conduit plus anchoring sutures, or (3) four 9-0 nylon epineurial microsutures. At 16 weeks postinjury, the nerves were re-exposed to test sensory and motor nerve conduction, measure target muscle weight and girth, and perform nerve tissue histology. Nerve conduction velocities in the Nerve Tape group were significantly better than both the microsuture and conduit groups, while nerve compound action potential amplitudes in the Nerve Tape group were significantly better than the conduit group only. Gross morphology, muscle characteristics, and axon histomorphometry were not statistically different between the three repair groups. In the rabbit tibial nerve repair model, Nerve Tape offers similar regeneration efficacy compared with conduit-assisted and microsuture-only repairs, suggesting minimal impact of microhooks on nerve tissue.
Collapse
Affiliation(s)
- Geetanjali Bendale
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Matt Smith
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lida Daniel
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Isabelle deBruler
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | | | | | | | | | | | - Jonathan Isaacs
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| |
Collapse
|
6
|
Han GY, Hwang SK, Cho KH, Kim HJ, Cho CS. Progress of tissue adhesives based on proteins and synthetic polymers. Biomater Res 2023; 27:57. [PMID: 37287042 DOI: 10.1186/s40824-023-00397-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
In recent years, polymer-based tissue adhesives (TAs) have been developed as an alternative to sutures to close and seal incisions or wounds owing to their ease of use, rapid application time, low cost, and minimal tissue damage. Although significant research is being conducted to develop new TAs with improved performances using different strategies, the applications of TAs are limited by several factors, such as weak adhesion strength and poor mechanical properties. Therefore, the next-generation advanced TAs with biomimetic and multifunctional properties should be developed. Herein, we review the requirements, adhesive performances, characteristics, adhesive mechanisms, applications, commercial products, and advantages and disadvantages of proteins- and synthetic polymer-based TAs. Furthermore, future perspectives in the field of TA-based research have been discussed.
Collapse
Affiliation(s)
- Gi-Yeon Han
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Korea
| | - Soo-Kyung Hwang
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea
| | - Ki-Hyun Cho
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, 03080, Korea
| | - Hyun-Joong Kim
- Program in Environmental Materials Science, Department of Agriculture, Forestry and Bioresources, Seoul National University, Seoul, 08826, Korea.
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea.
| | - Chong-Su Cho
- Research Institute of Agriculture and Life Sciences, Seoul National University, Seoul, 08826, Korea.
| |
Collapse
|
7
|
Advances of Direct Peripheral Nerve Repair Techniques: Do We Already Have Enough Scientific Evidence? Indian J Orthop 2022; 57:189-202. [PMID: 36777121 PMCID: PMC9880092 DOI: 10.1007/s43465-022-00791-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
Purpose To systematically review the evidence of direct peripheral nerve repair techniques and to determine any differences in outcomes that would guide rational treatment. Additionally, we compare the results and outcomes of these studies and find future directions for peripheral nerve repair techniques. Methods We searched PubMed, Virtual Health Library, and Embase databases to identify articles involving direct peripheral nerve techniques. We analyzed and compared the results and outcomes of these techniques. We also aimed to look for the differences in outcomes that would guide the current and future treatments. Results We identified 1390 articles, and 19 met our criteria with evidence ranging from level I to level IV. The nerve repair techniques included direct repair, epineural repair, fascicular repair, and group fascicular repair. These nerve techniques are based on the surgeons' personal experience. The results and the outcome of these studies were based on prognostic factors and not on surgical techniques. Few studies compared the surgical techniques and found no significant difference in nerve repair techniques. Conclusions Analyzing all direct peripheral nerve techniques and literature of all levels of evidence, our data show no significant difference between different suturing techniques. Currently, there is a lack of scientific evidence on the best direct peripheral nerve repair techniques. Therefore, we need more research to understand the rational treatment methods for peripheral nerve injuries. Level of evidence IV.
Collapse
|
8
|
Li M, Shi X, Yang B, Qin J, Han X, Peng W, He Y, Mao H, Kong D, Gu Z. Single-component hyaluronic acid hydrogel adhesive based on phenylboronic ester bonds for hemostasis and wound closure. Carbohydr Polym 2022; 296:119953. [DOI: 10.1016/j.carbpol.2022.119953] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/15/2022] [Accepted: 08/01/2022] [Indexed: 11/30/2022]
|
9
|
Epineural Neurorrhaphy of a Large Nerve Defect Due to IatroGenic Sciatic Nerve Injury in a Maltese Dog. Vet Sci 2022; 9:vetsci9070361. [PMID: 35878378 PMCID: PMC9324001 DOI: 10.3390/vetsci9070361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Sciatic nerve injury could occur due to mistake of surgery and called as ‘iatrogenic injury’. This type of injury is rare in dogs. Historically, this injury is treated through physiotherapy. However, if the nerve is completely transected, surgery such as nerve repair could be addressed. Unfortunately, if there is a large gap between transected sciatic nerve, it is very difficult to treat. Sometimes amputation is recommended because of permanent problem with dog’s hind leg. By the way, it is not known how long the gap can be treated in dogs before the important decision of whether to amputate the leg or not. Therefore, we would like to described a good result of treating an iatrogenic sciatic nerve injury with a large defect measuring 20 mm in length in a small Maltese dog. The dog suffered nerve injury after hip joint surgery and could not be walking himself for 2 months. So, we decided to treat him by nerve repair despite of large gap. Sensation and walking function of his hind leg was recovered almost completely after 2.5 years. Although sciatic nerve injury with large gap is a concern, it could be treated through surgery, even in small Maltese. Abstract Epineural neurorrhaphy is a standard nerve repair method, but it is rarely reported in veterinary literature. Epineural neurorrhaphy in canine sciatic nerve injury are described in this report. An 11-month-old, castrated male Maltese dog, presented with an one-month history of non-weight bearing lameness and knuckling of the right pelvic limb. The dog showed absence of superficial and deep pain perception on the dorsal and lateral surfaces below the stifle joint. The dog had undergone femoral head and neck osteotomy in the right pelvic limb one month prior to referral at a local hospital. Based on physical and neurological examinations, peripheral nerve injury of the right pelvic limb was suspected. Radiography showed irregular bony proliferation around the excised femoral neck. Magnetic resonance imaging revealed sciatic nerve injury with inconspicuous continuity at the greater trochanter level. A sciatic nerve neurotmesis was suspected and surgical repair was decided. During surgery, non-viable tissue of the sciatic nerve was debrided, and epineural neurorrhaphy was performed to bridge a large, 20-mm defect. The superficial and deep pain perception was progressively improved and restored at 3 weeks postoperatively, and the dog exhibited a gradual improvement in motor function. At 10 weeks postoperatively, the dog showed no neurological deficit including knuckling but the tarsal joint hyperextension did not improve due to ankylosis. The dog had undergone tarsal arthrodesis and exhibited almost normal limb function without any neurologic sequela until the last follow-up at 2.5 years postoperatively.
Collapse
|
10
|
Pinkiewicz M, Dorobisz K, Zatoński T. A Comprehensive Approach to Facial Reanimation: A Systematic Review. J Clin Med 2022; 11:jcm11102890. [PMID: 35629016 PMCID: PMC9143601 DOI: 10.3390/jcm11102890] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/08/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: To create a systematic overview of the available reconstructive techniques, facial nerve grading scales, physical evaluation, the reversibility of paralysis, non-reconstructive procedures and medical therapy, physical therapy, the psychological aspect of facial paralysis, and the prevention of facial nerve injury in order to elucidate the gaps in the knowledge and discuss potential research aims in this area. A further aim was to propose an algorithm simplifying the selection of reconstructive strategies, given the variety of available reconstructive methods and the abundance of factors influencing the selection. Methodological approach: A total of 2439 papers were retrieved from the Medline/Pubmed and Cochrane databases and Google Scholar. Additional research added 21 articles. The primary selection had no limitations regarding the publication date. We considered only papers written in English. Single-case reports were excluded. Screening for duplicates and their removal resulted in a total of 1980 articles. Subsequently, we excluded 778 articles due to the language and study design. The titles or abstracts of 1068 articles were screened, and 134 papers not meeting any exclusion criterion were obtained. After a full-text evaluation, we excluded 15 papers due to the lack of information on preoperative facial nerve function and the follow-up period. This led to the inclusion of 119 articles. Conclusions: A thorough clinical examination supported by advanced imaging modalities and electromyographic examination provides sufficient information to determine the cause of facial palsy. Considering the abundance of facial nerve grading scales, there is an evident need for clear guidelines regarding which scale is recommended, as well as when the postoperative evaluation should be carried out. Static procedures allow the restoral of facial symmetry at rest, whereas dynamic reanimation aims to restore facial movement. The modern approach to facial paralysis involves neurotization procedures (nerve transfers and cross-facial nerve grafts), muscle transpositions, and microsurgical free muscle transfers. Rehabilitation provides patients with the possibility of effectively controlling their symptoms and improving their facial function, even in cases of longstanding paresis. Considering the mental health problems and significant social impediments, more attention should be devoted to the role of psychological interventions. Given that each technique has its advantages and pitfalls, the selection of the treatment approach should be individualized in the case of each patient.
Collapse
|
11
|
Hamedi H, Moradi S, Hudson SM, Tonelli AE, King MW. Chitosan based bioadhesives for biomedical applications: A review. Carbohydr Polym 2022; 282:119100. [DOI: 10.1016/j.carbpol.2022.119100] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 11/02/2022]
|
12
|
González García LE, Ninan N, Simon J, Madathiparambil Visalakshan R, Bright R, Wahono SK, Ostrikov K, Mailänder V, Landfester K, Goswami N, Vasilev K. Ultra-small gold nanoclusters assembled on plasma polymer-modified zeolites: a multifunctional nanohybrid with anti-haemorrhagic and anti-inflammatory properties. NANOSCALE 2021; 13:19936-19945. [PMID: 34820678 DOI: 10.1039/d1nr06591b] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Hemostatic agents are pivotal for managing clinical and traumatic bleeding during emergency and domestic circumstances. Herein, a novel functional hybrid nanocomposite material consisting of plasma polymer-modified zeolite 13X and ultra-small gold nanoclusters (AuNCs) was fabricated as an efficient hemostatic agent. The surface of zeolite 13X was functionalised with amine groups which served as binding sites for carboxylate terminated AuNCs. Protein corona studies revealed the enhanced adsorption of two proteins, namely, coagulation factors and plasminogen as a result of AuNCs immobilization on the zeolite surface. The immune response studies showed that the hybrid nanocomposites are effective in reducing inflammation, which combined with a greater attachment of vitronectin, may promote wound healing. The hemostatic potential of the nanocomposite could be directly correlated with their immunomodulatory and anti-haemorrhagic properties. Together, the hybrid nanoengineered material developed in this work could provide a new avenue to tackle life-threatening injuries in civilian and other emergencies.
Collapse
Affiliation(s)
- Laura E González García
- Academic Unit of STEM, The University of South Australia, Mawson Lakes, SA 5095, Australia.
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - Neethu Ninan
- Academic Unit of STEM, The University of South Australia, Mawson Lakes, SA 5095, Australia.
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - Johanna Simon
- Max-Planck-Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
- Dermatology Clinic, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | | | - Richard Bright
- Academic Unit of STEM, The University of South Australia, Mawson Lakes, SA 5095, Australia.
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
| | - Satriyo K Wahono
- Research Division for Natural Product Technology, Indonesian Institutes of Sciences, Jl. Jogja-Wonosari km 32, Gading, Playen, Gunungkidul, Yogyakarta 55861, Indonesia
| | - Kostya Ostrikov
- School of Chemistry and Physics, Centre for Materials Science, Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, QLD 4000, Australia
| | - Volker Mailänder
- Max-Planck-Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
- Dermatology Clinic, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Katharina Landfester
- Max-Planck-Institute for Polymer Research, Ackermannweg 10, 55128 Mainz, Germany
- Dermatology Clinic, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Nirmal Goswami
- Academic Unit of STEM, The University of South Australia, Mawson Lakes, SA 5095, Australia.
- Materials Chemistry Department, CSIR-Institute of Minerals and Materials Technology, Acharya Vihar, Bhubaneswar-751013, India
- Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, 201 002, India
| | - Krasimir Vasilev
- Academic Unit of STEM, The University of South Australia, Mawson Lakes, SA 5095, Australia.
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
| |
Collapse
|
13
|
A Novel Alaska Pollock Gelatin Sealant Shows Higher Bonding Strength and Nerve Regeneration Comparable to That of Fibrin Sealant in a Cadaveric Model and a Rat Model. Plast Reconstr Surg 2021; 148:742e-752e. [PMID: 34705777 DOI: 10.1097/prs.0000000000008489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A novel biocompatible sealant composed of Alaska pollock-derived gelatin (ApGltn) has recently shown good burst strength and biocompatibility in a porcine aorta. The purpose of this study was to investigate the bonding strength and biocompatibility of the ApGltn sealant in transected digital nerves of fresh frozen cadavers and in the sciatic nerves of a rat model. METHODS Eighty human digital nerves of fresh frozen cadavers were transected for biomechanical traction testing. They were treated with four surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; and (4) fibrin sealant. Forty-three sciatic nerves of male Wistar rats were used for functional and histopathologic evaluation. They were treated with six surgical interventions: (1) suture plus ApGltn sealant; (2) suture; (3) ApGltn sealant; (4) fibrin sealant; (5) resection with a 5-mm gap (10 rats per group); and (6) sham operation (three rats). Macroscopic confirmation, muscle weight measurement, and histopathologic findings including G-ratio were examined 8 weeks after the procedure. RESULTS The maximum failure load of the ApGltn sealant was significantly higher than that of a fibrin sealant (0.22 ± 0.05 N versus 0.06 ± 0.04 N). The maximum failure load of the ApGltn sealant was significantly lower that of suture plus ApGltn sealant (1.37 N) and suture (1.27 N). Functional evaluation and histologic examination showed that sciatic nerves repaired with ApGltn sealant showed similar nerve recovery compared to repair with the suture and fibrin sealant. CONCLUSION The ApGltn sealant showed higher bonding strength and equal effect of nerve regeneration when compared with the fibrin sealant.
Collapse
|
14
|
Chen S, Gil CJ, Ning L, Jin L, Perez L, Kabboul G, Tomov ML, Serpooshan V. Adhesive Tissue Engineered Scaffolds: Mechanisms and Applications. Front Bioeng Biotechnol 2021; 9:683079. [PMID: 34354985 PMCID: PMC8329531 DOI: 10.3389/fbioe.2021.683079] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/15/2021] [Indexed: 11/13/2022] Open
Abstract
A variety of suture and bioglue techniques are conventionally used to secure engineered scaffold systems onto the target tissues. These techniques, however, confront several obstacles including secondary damages, cytotoxicity, insufficient adhesion strength, improper degradation rate, and possible allergic reactions. Adhesive tissue engineering scaffolds (ATESs) can circumvent these limitations by introducing their intrinsic tissue adhesion ability. This article highlights the significance of ATESs, reviews their key characteristics and requirements, and explores various mechanisms of action to secure the scaffold onto the tissue. We discuss the current applications of advanced ATES products in various fields of tissue engineering, together with some of the key challenges for each specific field. Strategies for qualitative and quantitative assessment of adhesive properties of scaffolds are presented. Furthermore, we highlight the future prospective in the development of advanced ATES systems for regenerative medicine therapies.
Collapse
Affiliation(s)
- Shuai Chen
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Carmen J. Gil
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Liqun Ning
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Linqi Jin
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Lilanni Perez
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Gabriella Kabboul
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Martin L. Tomov
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
| | - Vahid Serpooshan
- Department of Biomedical Engineering, Emory University School of Medicine, Georgia Institute of Technology, Atlanta, GA, United States
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
- Children’s Healthcare of Atlanta, Atlanta, GA, United States
| |
Collapse
|
15
|
Rossi F, Magni G, Colasanti R, Banchelli M, Iacoangeli M, Carrassi E, Aiudi D, Di Rienzo A, Giannoni L, Pieri L, Dallari S, Pini R, Matteini P. Characterization and Ex Vivo Application of Indocyanine Green Chitosan Patches in Dura Mater Laser Bonding. Polymers (Basel) 2021; 13:polym13132130. [PMID: 34209537 PMCID: PMC8271756 DOI: 10.3390/polym13132130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/26/2021] [Accepted: 06/21/2021] [Indexed: 12/26/2022] Open
Abstract
Dura mater repair represents a final and crucial step in neurosurgery: an inadequate dural reconstruction determines dreadful consequences that significantly increase morbidity and mortality rates. Different dural substitutes have been used with suboptimal results. To overcome this issue, in previous studies, we proposed a laser-based approach to the bonding of porcine dura mater, evidencing the feasibility of the laser-assisted procedure. In this work, we present the optimization of this approach in ex vivo experiments performed on porcine dura mater. An 810-nm continuous-wave AlGaAs (Aluminium Gallium Arsenide) diode laser was used for welding Indocyanine Green-loaded patches (ICG patches) to the dura. The ICG-loaded patches were fabricated using chitosan, a resistant, pliable and stable in the physiological environment biopolymer; moreover, their absorption peak was very close to the laser emission wavelength. Histology, thermal imaging and leak pressure tests were used to evaluate the bonding effect. We demonstrated that the application of 3 watts (W), pulsed mode (Ton 30 ms, Toff 3.5 ms) laser light induces optimal welding of the ICG patch to the dura mater, ensuring an average fluid leakage pressure of 216 ± 105 mmHg, falling within the range of physiological parameters. This study demonstrated that the thermal effect is limited and spatially confined and that the laser bonding procedure can be used to close the dura mater. Our results showed the effectiveness of this approach and encourage further experiments in in vivo models.
Collapse
Affiliation(s)
- Francesca Rossi
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche, Sesto Fiorentino, 50019 Florence, Italy; (F.R.); (R.P.); (P.M.)
| | - Giada Magni
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche, Sesto Fiorentino, 50019 Florence, Italy; (F.R.); (R.P.); (P.M.)
- Correspondence: (G.M.); (R.C.); (M.B.)
| | - Roberto Colasanti
- Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy; (M.I.); (E.C.); (D.A.); (A.D.R.)
- Department of Neurosurgery, Padua University Hospital, 35128 Padua, Italy
- Correspondence: (G.M.); (R.C.); (M.B.)
| | - Martina Banchelli
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche, Sesto Fiorentino, 50019 Florence, Italy; (F.R.); (R.P.); (P.M.)
- Correspondence: (G.M.); (R.C.); (M.B.)
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy; (M.I.); (E.C.); (D.A.); (A.D.R.)
| | - Erika Carrassi
- Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy; (M.I.); (E.C.); (D.A.); (A.D.R.)
| | - Denis Aiudi
- Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy; (M.I.); (E.C.); (D.A.); (A.D.R.)
| | - Alessandro Di Rienzo
- Department of Neurosurgery, Università Politecnica delle Marche, 60121 Ancona, Italy; (M.I.); (E.C.); (D.A.); (A.D.R.)
| | - Luca Giannoni
- El.En. S.p.A., Calenzano, 50041 Florence, Italy; (L.G.); (L.P.)
| | - Laura Pieri
- El.En. S.p.A., Calenzano, 50041 Florence, Italy; (L.G.); (L.P.)
| | | | - Roberto Pini
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche, Sesto Fiorentino, 50019 Florence, Italy; (F.R.); (R.P.); (P.M.)
| | - Paolo Matteini
- Istituto di Fisica Applicata “Nello Carrara”, Consiglio Nazionale delle Ricerche, Sesto Fiorentino, 50019 Florence, Italy; (F.R.); (R.P.); (P.M.)
| |
Collapse
|
16
|
Towne J, Carter N, Neivandt DJ. COMSOL Multiphysics® modelling of oxygen diffusion through a cellulose nanofibril conduit employed for peripheral nerve repair. Biomed Eng Online 2021; 20:60. [PMID: 34130690 PMCID: PMC8204471 DOI: 10.1186/s12938-021-00897-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Peripheral nerve injury can cause significant impairment, and the current methods for facilitating repair, particularly over distances greater than approximately 1 mm, are not entirely effective. Allografts, autografts, and synthetic conduits are three of the most common surgical interventions for peripheral nerve repair; however, each has limitations including poor biocompatibility, adverse immune responses, and the need for successive surgeries. A potential new method for promoting peripheral nerve repair that addresses the shortcomings of current interventions is a biocompatible cellulose nanofibril (CNF) conduit that degrades in-vivo over time. Preliminary testing in multiple animal models has yielded positive results, but more information is needed regarding how the CNF conduit facilitates nutrient and gas flow. RESULTS The current work employs 3D modelling and analysis via COMSOL Multiphysics® to determine how the CNF conduit facilitates oxygen movement both radially through the conduit walls and axially along the length of the conduit. Various CNF wall permeabilities, conduit lengths, and nerve-to-conduit diameter ratios have been examined; all of which were shown to have an impact on the resultant oxygen profile within the conduit. When the walls of the CNF conduit were modeled to have significant oxygen permeability, oxygen diffusion across the conduit was shown to dominate relative to axial diffusion of oxygen along the length of the conduit, which was otherwise the controlling diffusion mechanism. CONCLUSIONS The results of this study suggest that there is a complex relationship between axial and radial diffusion as the properties of the conduit such as length, diameter, and permeability are altered and when investigating various locations within the model. At low wall permeabilities the axial diffusion is dominant for all configurations, while for higher wall permeabilities the radial diffusion became dominant for smaller diameters. The length of the conduit did not alter the mechanism of diffusion, but rather had an inverse relationship with the magnitude of the overall concentration profile. As such the modeling results may be employed to predict and control the amount and distribution of oxygenation throughout the conduit, and hence to guide experimental conduit design.
Collapse
Affiliation(s)
- Julia Towne
- Department of Chemical and Biomedical Engineering, University of Maine, Orono, ME, 04469, USA
| | - Nicklaus Carter
- Department of Chemical and Biomedical Engineering, University of Maine, Orono, ME, 04469, USA
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, 04469, USA
| | - David J Neivandt
- Department of Chemical and Biomedical Engineering, University of Maine, Orono, ME, 04469, USA.
- Graduate School of Biomedical Science and Engineering, University of Maine, Orono, ME, 04469, USA.
- Forest Bioproduct Research Institute, University of Maine, Orono, ME, 04469, USA.
| |
Collapse
|
17
|
Patil NA, Kandasubramanian B. Functionalized polylysine biomaterials for advanced medical applications: A review. Eur Polym J 2021. [DOI: 10.1016/j.eurpolymj.2020.110248] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
18
|
Carter N, Towne J, Neivandt DJ. Finite Element Analysis of Glucose Diffusivity in Cellulose Nanofibril Peripheral Nerve Conduits. CELLULOSE (LONDON, ENGLAND) 2021; 28:2791-2803. [PMID: 35382433 PMCID: PMC8979350 DOI: 10.1007/s10570-021-03724-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/23/2021] [Indexed: 06/14/2023]
Abstract
Peripheral neuropathy arising from physical trauma is estimated to afflict 20 million people in the United States alone. In one common surgical intervention, neural conduits are placed over the nerve stumps to bridge the gap and create a microenvironment conducive to regeneration. It has been proposed that a biocompatible material such as cellulose nanofiber may serve as a viable conduit material, providing a non-inflammatory and mechanically stable system. Preliminary studies have shown that cellulose nanofiber conduits successfully aid neural regeneration and further, that the dimensions of the conduit relative to the nerve gap have an impact on efficacy in murine models. It has been hypothesized that the reliance of regeneration upon the physical dimensions of the conduit may be related to modified modes of diffusion and/or distances of key cellular nutrients and waste metabolites to/from the injury site. The present work investigates the concentration profile of glucose within the conduit via finite element analysis as a function of the physical dimensions of the conduit. It was determined that the magnitude of glucose diffusion was greater through the conduit walls than through the luminal space between the nerve and the inner wall of the conduit, and that as such radial diffusion is dominant over axial diffusion.
Collapse
Affiliation(s)
- Nicklaus Carter
- Department of Chemical and Biomedical Engineering, University of Maine
- Graduate School of Biomedical Science and Engineering, University of Maine
| | - Julia Towne
- Department of Chemical and Biomedical Engineering, University of Maine
| | - David J. Neivandt
- Department of Chemical and Biomedical Engineering, University of Maine
- Graduate School of Biomedical Science and Engineering, University of Maine
| |
Collapse
|
19
|
Molotkovets VY, Medvediev VV, Korsak AV, Chaikovsky YB, Marynsky GS, Tsymbaliuk VI. Restoration of the Integrity of a Transected Peripheral Nerve with the Use of an Electric Welding Technology. NEUROPHYSIOLOGY+ 2020. [DOI: 10.1007/s11062-020-09848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
20
|
Wei SM, Pei MY, Pan WL, Thissen H, Tsai SW. Gelatin Hydrogels Reinforced by Absorbable Nanoparticles and Fibrils Cured In Situ by Visible Light for Tissue Adhesive Applications. Polymers (Basel) 2020; 12:E1113. [PMID: 32414044 PMCID: PMC7285276 DOI: 10.3390/polym12051113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 12/21/2022] Open
Abstract
Most gelatin hydrogels used in regenerative medicine applications today are fabricated by photocrosslinking due to the convenience and speed of this method. However, in most cases photoinitiators are used, which require UV light, which, in turn, can cause cell and tissue damage, or using functionalized gelatin. Recently, ruthenium (II) tris-bipyridyl chloride has been studied as an initiator that can induce dityrosine bond formation using visible light. In addition, continuous fibrils and small particles are often used to reinforce composite materials. Therefore, this study investigated the visible-light-induced photocrosslinking of native gelatin molecules via dityrosine bonds formation as well as gel reinforcement by collagen fibrils and mesoporous bioactive glass (MBG) particles. The results show that collagen and MBG exerted a synergistic effect on maintaining gel integrity with a dental LED curing light when the irradiation time was shortened to 30 s. Without the two reinforcing components, the gel could not form a geometric shape stable gel even when the exposure time was 120 s. The shear strength increased by 62% with the collagen and MBG compared with the blank control. Furthermore, our results demonstrate that the addition of collagen and MBG enhanced gel stability in an artificial saliva solution. These results demonstrate the considerable advantages of using tyrosine-containing biomolecules, and using a dental LED curing light for the crosslinking of hydrogels in terms of their suitability and feasibility for use as bioadhesives in confined clinical working space, such as the oral cavity, and in application as in situ-crosslinked injectable hydrogels.
Collapse
Affiliation(s)
- Shih-Min Wei
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ming-Ying Pei
- Department of Biomedical Sciences, Chang Gung University, Taoyuan 333, Taiwan;
| | - Whei-Lin Pan
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan;
| | - Helmut Thissen
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Clayton, VIC 3168, Australia;
| | - Shiao-Wen Tsai
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Periodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan;
| |
Collapse
|
21
|
Suryavanshi JR, Cox C, Osemwengie BO, Jones HB, MacKay BJ. Sutureless repair of a partially transected median nerve using Tisseel glue and Axoguard nerve protector: A case report. Microsurgery 2020; 40:896-900. [PMID: 32333694 DOI: 10.1002/micr.30593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 03/11/2020] [Accepted: 04/10/2020] [Indexed: 12/15/2022]
Abstract
Peripheral nerve injuries in which the nerve is not completely severed often result in neuromas-in-continuity. These can cause sensory and functional deficits and must be resected and reconstructed. In defects greater than 5 mm in length, nerve graft is indicated, and suture neurorrhaphy is typically used to secure the nerve ends. However, sutures may negatively impact nerve regeneration. Fibrin glue has recently been used to mitigate the inflammatory response associated with suture neurorrhaphy. Most of the literature regarding fibrin glue covers animal models and supports its use for nerve reconstruction. Tisseel, a fibrin sealant developed as an adjunct to hemostasis, has recently shown utility in peripheral nerve repair by increasing tensile strength without additional sutures. We present the successful use of Tisseel sealant in a neuroma resection and reconstruction. In this case, a 35-year-old female presented with persistent neuropathic pain and neurologic dysfunction related to the median nerve in her hand with a history of distal forearm laceration and prior carpal tunnel release. Upon exploration, a neuroma-in-continuity involving 75% of the nerve was identified, resected, and reconstructed using processed human nerve allograft, as well as Tisseel sealant and Axoguard nerve protector to secure the repair and offload tension. At 1-year follow-up, pain was resolved, with ≤8 mm static 2-point discrimination in the median nerve distribution, and excellent improvement in hand strength compared with preoperative conditions. The outcome of this case indicates that fibrin glue may be useful to avoid excess sutures in cases of neuroma-in-continuity not involving the entire cross-section of the nerve.
Collapse
Affiliation(s)
- Joash R Suryavanshi
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Cameron Cox
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Bradley O Osemwengie
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Hunter B Jones
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Brendan J MacKay
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.,Division of Orthopaedic Surgery, University Medical Center, Lubbock, Texas, USA
| |
Collapse
|
22
|
Zhu H, Mei X, He Y, Mao H, Tang W, Liu R, Yang J, Luo K, Gu Z, Zhou L. Fast and High Strength Soft Tissue Bioadhesives Based on a Peptide Dendrimer with Antimicrobial Properties and Hemostatic Ability. ACS APPLIED MATERIALS & INTERFACES 2019; 12:4241-4253. [PMID: 31859475 DOI: 10.1021/acsami.9b18720] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Haofang Zhu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Xingheng Mei
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Yiyan He
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Hongli Mao
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| | - Wenbo Tang
- The Second Department of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, P.R. China
| | - Rong Liu
- The Second Department of Hepato-Pancreato-Biliary Surgery, Chinese People’s Liberation Army (PLA) General Hospital, Beijing 100853, P.R. China
| | - Jun Yang
- The Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Science, Nankai University, Tianjin 300071, P.R. China
| | - Kui Luo
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and molecular imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhongwei Gu
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
- Huaxi MR Research Center (HMRRC), Department of Radiology, Functional and molecular imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Lian Zhou
- College of Materials Science and Engineering, Nanjing Tech University, Nanjing 211816, P.R. China
| |
Collapse
|
23
|
Bhatt NK, Faddis BT, Paniello RC. Laryngeal adductor function following potassium titanyl phosphate laser welding of the recurrent laryngeal nerve. Laryngoscope 2019; 130:1764-1769. [PMID: 31566750 DOI: 10.1002/lary.28295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve (RLN) transection injuries may occur during thyroidectomy and other surgical procedures. Laser nerve welding has been shown to cause less technique-related axonal damage than the traditional suture method. We compared functional adductor results using these two methods of RLN repair. STUDY DESIGN Animal model. METHODS Canine hemilarynges underwent pretreatment testing of laryngeal adductor function, followed by RLN transection and repair using potassium titanyl phosphate (KTP) laser welding (n = 8) or microneural suture (n = 16) techniques. Six months later, adductor function was measured again and expressed as a proportion of the pretreatment value. RESULTS The mean laryngeal adductor pressure ratios were 82.4% (95% confidence interval [CI]: 72.8%-92.0%) for the laser repair group and 55.5% (95% CI: 49.4%-61.6%) for the suture control group, with a difference of 26.9% (95% CI: 15.3%-38.5%). Both spontaneous and stimulated glottic closure was observed in the laser welding and microsuture repair groups. CONCLUSIONS Laser nerve welding resulted in greater strength of adduction than suture repair of an acutely transected RLN. Suture anastomosis may traumatize more axons than the laser. Stronger vocal fold adduction is associated clinically with better protection from aspiration and improved voice outcomes. KTP laser welding should be considered for anastomosis of the RLN and other nerves. LEVEL OF EVIDENCE NA Laryngoscope, 130:1764-1769, 2020.
Collapse
Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Brian T Faddis
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| |
Collapse
|
24
|
Jahromi M, Razavi S, Bakhtiari A. The advances in nerve tissue engineering: From fabrication of nerve conduit to in vivo nerve regeneration assays. J Tissue Eng Regen Med 2019; 13:2077-2100. [PMID: 31350868 DOI: 10.1002/term.2945] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 12/14/2022]
Abstract
Peripheral nerve damage is a common clinical complication of traumatic injury occurring after accident, tumorous outgrowth, or surgical side effects. Although the new methods and biomaterials have been improved recently, regeneration of peripheral nerve gaps is still a challenge. These injuries affect the quality of life of the patients negatively. In the recent years, many efforts have been made to develop innovative nerve tissue engineering approaches aiming to improve peripheral nerve treatment following nerve injuries. Herein, we will not only outline what we know about the peripheral nerve regeneration but also offer our insight regarding the types of nerve conduits, their fabrication process, and factors associated with conduits as well as types of animal and nerve models for evaluating conduit function. Finally, nerve regeneration in a rat sciatic nerve injury model by nerve conduits has been considered, and the main aspects that may affect the preclinical outcome have been discussed.
Collapse
Affiliation(s)
- Maliheh Jahromi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Razavi
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Bakhtiari
- Department of Anatomical Science, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
25
|
Kramer EA, Rentschler ME. Energy-Based Tissue Fusion for Sutureless Closure: Applications, Mechanisms, and Potential for Functional Recovery. Annu Rev Biomed Eng 2019; 20:1-20. [PMID: 29865874 DOI: 10.1146/annurev-bioeng-071516-044702] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
As minimally invasive surgical techniques progress, the demand for efficient, reliable methods for vascular ligation and tissue closure becomes pronounced. The surgical advantages of energy-based vessel sealing exceed those of traditional, compression-based ligatures in procedures sensitive to duration, foreign bodies, and recovery time alike. Although the use of energy-based devices to seal or transect vasculature and connective tissue bundles is widespread, the breadth of heating strategies and energy dosimetry used across devices underscores an uncertainty as to the molecular nature of the sealing mechanism and induced tissue effect. Furthermore, energy-based techniques exhibit promise for the closure and functional repair of soft and connective tissues in the nervous, enteral, and dermal tissue domains. A constitutive theory of molecular bonding forces that arise in response to supraphysiological temperatures is required in order to optimize and progress the use of energy-based tissue fusion. While rapid tissue bonding has been suggested to arise from dehydration, dipole interactions, molecular cross-links, or the coagulation of cellular proteins, long-term functional tissue repair across fusion boundaries requires that the reaction to thermal damage be tailored to catalyze the onset of biological healing and remodeling. In this review, we compile and contrast findings from published thermal fusion research in an effort to encourage a molecular approach to characterization of the prevalent and promising energy-based tissue bond.
Collapse
Affiliation(s)
- Eric A Kramer
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado 80309, USA;
| | - Mark E Rentschler
- Department of Mechanical Engineering, University of Colorado, Boulder, Colorado 80309, USA; .,Departments of Surgery and Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045, USA
| |
Collapse
|
26
|
Overview on the Evolution of Laser Welding of Vascular and Nervous Tissues. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9102157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Laser welding presents a core position in the health sector. This process has had an outstanding impact on the surgical procedures from many medical areas, such as on vascular and nervous surgeries. The aim of the present research is to present an overview on the evolution of laser welding of vascular and nervous tissues. These surgeries present many advantages, such as an absence of foreign-body reactions and aneurysms and good tensile strengths. However, despite the sutureless nature of the process, complementary sutures have been applied to support the procedure success. An important concern in vascular and nervous laser welding is the thermal damage. The development of temperature-controlled feedback systems has reduced this concern with a very precise control of the laser parameters. The bonding strength of vascular and nerve laser welds can be enhanced with the application of solder solutions, bonding materials, and laser-activated dyes. Alternative techniques to laser welding, such as photochemical tissue bonding and electrosurgical high-frequency technologies, have also been tested for vascular and nervous repairs.
Collapse
|
27
|
Wang W, Degrugillier L, Tremp M, Prautsch K, Sottaz L, Schaefer DJ, Madduri S, Kalbermatten D. Nerve Repair With Fibrin Nerve Conduit and Modified Suture Placement. Anat Rec (Hoboken) 2018; 301:1690-1696. [PMID: 30353694 DOI: 10.1002/ar.23921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 03/21/2018] [Accepted: 04/05/2018] [Indexed: 12/15/2022]
Abstract
Sutureless nerve repair has been regarded as a promising technique for nerve repair as the suture materials often results in neuroma formation and scar tissue that impede nerve regeneration. The aim of this study was to analyze the mechanical stability and morphological outcome of sutureless repair using fibrin glue conduit and an alternative approach of modified suture placement. Using rat sciatic nerve, we tested the following experimental conditions: conventional suture repair; single suture combined with fibrin glue repair, and fibrin conduit reinforced with modified suture or fibrin glue. Nerve detachment anatomical measures such as axon density, myelin, and fiber caliber were analyzed for evaluation of nerve regeneration. Muscle atrophy were evaluated by muscle wet weight and H&E staining. All animals in sutureless repair group exhibited complete detachment or elongation by two or four weeks after repair. No detachment was found in any other groups. Animals treated with fibrin conduit reinforced with modified suture showed better axonal regeneration with good alignment. There were no significant differences in axon caliber among the groups. Muscle atrophy was found in all groups and there was no significant difference in muscle wet-weight among the groups. In summary, sutureless nerve repair with fibrin glue was mechanically unstable for resistance of mechanical stretches, fibrin glue conduit with modified suture placement is mechanically stable and resulted in better morphological outcome. Anat Rec, 301:1690-1696, 2018. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Wenjin Wang
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland.,Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai, 200011, China
| | - Lucas Degrugillier
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| | - Mathias Tremp
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| | - Katharina Prautsch
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| | - Lima Sottaz
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| | - Srinivas Madduri
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland.,Department of Biomedicine, University of Basel, CH-4031, Basel, Switzerland.,Department of Biomedical Engineering, University of Basel, CH-4123, Allschwil, Switzerland
| | - Daniel Kalbermatten
- Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital Basel, CH-4031, Basel, Switzerland
| |
Collapse
|
28
|
Trejo JL. Advances in the Ongoing Battle against the Consequences of Peripheral Nerve Injuries. Anat Rec (Hoboken) 2018; 301:1606-1613. [DOI: 10.1002/ar.23936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 02/06/2023]
Affiliation(s)
- JosÉ L. Trejo
- Department of Translational Neuroscience; Cajal Institute, CSIC; Madrid Spain
| |
Collapse
|
29
|
Soucy JR, Shirzaei Sani E, Portillo Lara R, Diaz D, Dias F, Weiss AS, Koppes AN, Koppes RA, Annabi N. Photocrosslinkable Gelatin/Tropoelastin Hydrogel Adhesives for Peripheral Nerve Repair. Tissue Eng Part A 2018; 24:1393-1405. [PMID: 29580168 PMCID: PMC6150941 DOI: 10.1089/ten.tea.2017.0502] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/21/2018] [Indexed: 12/29/2022] Open
Abstract
Suturing peripheral nerve transections is the predominant therapeutic strategy for nerve repair. However, the use of sutures leads to scar tissue formation, hinders nerve regeneration, and prevents functional recovery. Fibrin-based adhesives have been widely used for nerve reconstruction, but their limited adhesive and mechanical strength and inability to promote nerve regeneration hamper their utility as a stand-alone intervention. To overcome these challenges, we engineered composite hydrogels that are neurosupportive and possess strong tissue adhesion. These composites were synthesized by photocrosslinking two naturally derived polymers, gelatin-methacryloyl (GelMA) and methacryloyl-substituted tropoelastin (MeTro). The engineered materials exhibited tunable mechanical properties by varying the GelMA/MeTro ratio. In addition, GelMA/MeTro hydrogels exhibited 15-fold higher adhesive strength to nerve tissue ex vivo compared to fibrin control. Furthermore, the composites were shown to support Schwann cell (SC) viability and proliferation, as well as neurite extension and glial cell participation in vitro, which are essential cellular components for nerve regeneration. Finally, subcutaneously implanted GelMA/MeTro hydrogels exhibited slower degradation in vivo compared with pure GelMA, indicating its potential to support the growth of slowly regenerating nerves. Thus, GelMA/MeTro composites may be used as clinically relevant biomaterials to regenerate nerves and reduce the need for microsurgical suturing during nerve reconstruction.
Collapse
Affiliation(s)
- Jonathan R. Soucy
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
| | - Ehsan Shirzaei Sani
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
| | - Roberto Portillo Lara
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
- Tecnológico de Monterrey, Escuela de IngenierÍa y Ciencias, Zapopan, JAL, Mexico
| | - David Diaz
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
| | - Felipe Dias
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
| | - Anthony S. Weiss
- Charles Perkins Centre, School of Life and Environmental Sciences and Bosch Institute, University of Sydney, Sydney, Australia
| | - Abigail N. Koppes
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
- Department of Biology, Northeastern University, Boston, Massachusetts
| | - Ryan A. Koppes
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
| | - Nasim Annabi
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Chemical and Biomolecular Engineering, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
30
|
Fu F, Zhu X, Qin Z, Wang JJ, Xu C, Wang LN, Tu Y, Zhang S, Li RX, Li XH, Zhao ML. Differential degradation rate and underlying mechanism of a collagen/chitosan complex in subcutis, spinal cord and brain tissues of rat. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:35. [PMID: 29556804 DOI: 10.1007/s10856-018-6033-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 02/03/2018] [Indexed: 06/08/2023]
Abstract
Degradation rate is an important index for evaluating biomaterials. The authors' aim was to determine whether the degradation rate of biomaterials is different in distinct tissues and to clarify the underlying mechanism of degradation. The collagen-chitosan (CG-CS) composite scaffolds were prepared using freeze-drying technology. The porosity, water absorption and swelling ratio of the scaffolds were tested in vitro. The scaffolds were implanted into the subcutis, spinal cord and brain tissues of SD rats, the rate of degradation was assessed by continuous monitoring of weight loss, the pathological changes of target areas were observed by histological staining, and matrix metalloproteinase 9 (MMP-9) and lysozyme were detected at the rapid stage of degradation of the scaffolds. Physical and chemical property testing confirmed that CG-CS composite scaffold components can meet the biological requirements of in vivo transplantation. The in vivo experimental results showed that the scaffolds were completely absorbed in the subcutis at 12 days, the scaffolds in the spinal cord and brain groups exhibited progressive mass loss starting from the 3rd week, and a substantial fraction of the scaffold was degraded at 12 weeks. HE staining found that compared with the spinal cord and brain groups, macrophages and capillaries appeared earlier in the subcutis group, and the number was significantly higher (P < 0.05). Western blot analysis showed that the MMP-9 and lysozyme levels in the subcutis were higher than those in the spinal cord and brain (P < 0.05). The results of in vivo experiments demonstrated that the CG-CS scaffold has good biocompatibility and biodegradability, while the rate of degradation was significantly different between the three tissues at the same time point. Macrophage behavior and vascularization in different parts of the body may result in control over the balance of degradation and reconstruction.
Collapse
Affiliation(s)
- Feng Fu
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Xiang Zhu
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
- The First Traditional Chinese Medicine Hospital of Luoyang City, Luoyang, 471000, China
| | - Zhe Qin
- Chinese People' s Armed Police Forces General Hospital, Beijing, 100039, China
| | - Jing-Jing Wang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Chao Xu
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Li-Na Wang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Yue Tu
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Sai Zhang
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China
| | - Rui-Xin Li
- Central Laboratory, Tianjin Stomatological Hospital, Tianjin, 300041, China.
| | - Xiao-Hong Li
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China.
| | - Ming-Liang Zhao
- Tianjin Key Laboratory of Neurotrauma Repair, Pingjin Hospital Brain Center, Logistics University of PAP, Tianjin, 300162, China.
| |
Collapse
|
31
|
Eren A, Atalar H, Seymen CM, Alpaslan Pınarlı F, Take Kaplanoglu G, Turanlı S. Sutureless approach with vein grafts and mesenchymal stem cells in primary nerve repair: Functional and immunohistological results. Microsurgery 2018; 38:780-789. [DOI: 10.1002/micr.30315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 02/02/2018] [Accepted: 02/16/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Ali Eren
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Hakan Atalar
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Cemile Merve Seymen
- Department of Histology and Embryology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Ferda Alpaslan Pınarlı
- Center of Cell Research and Genetic Diagnosis; Dıskapı Yıldırım Beyazıt Research Hospital; Etlik Ankara 06010 Turkey
| | - Gulnur Take Kaplanoglu
- Department of Histology and Embryology, Faculty of Medicine; Gazi University; Ankara Turkey
| | - Sacit Turanlı
- Department of Orthopedics and Traumatology, Faculty of Medicine; Gazi University; Ankara Turkey
| |
Collapse
|
32
|
Suchyta MA, Sabbagh MD, Morsy M, Mardini S, Moran SL. Advances in peripheral nerve regeneration as it relates to VCA. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/23723505.2017.1344347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - M. Diya Sabbagh
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamed Morsy
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Assiut University Hospital, Assiut University, Assiut, Egypt
| | - Samir Mardini
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Steven L. Moran
- Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
33
|
Turner NJ, Johnson SA, Foster LJR, Badylak SF. Sutureless nerve repair with ECM bioscaffolds and laser-activated chitosan adhesive. J Biomed Mater Res B Appl Biomater 2017; 106:1698-1711. [DOI: 10.1002/jbm.b.33975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/21/2017] [Accepted: 07/29/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Neill J. Turner
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Scott A. Johnson
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
| | - Leslie J. R. Foster
- Biopolymer Research Group; School of Biotechnology and Bimolecular Sciences, The University of New South Wales; Sydney Australia
- Save Sight Institute, Faculty of Medicine, University of Sydney; Sydney Australia
| | - Stephen F. Badylak
- McGowan Institute for Regenerative Medicine, University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Surgery; University of Pittsburgh; Pittsburgh Pennsylvania 15219
- Department of Bioengineering; University of Pittsburgh; Pittsburgh Pennsylvania 15260
| |
Collapse
|
34
|
Bhatt NK, Khan TR, Mejias C, Paniello RC. Nerve transection repair using laser-activated chitosan in a rat model. Laryngoscope 2017; 127:E253-E257. [PMID: 28349572 DOI: 10.1002/lary.26583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/03/2017] [Accepted: 02/20/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES/HYPOTHESIS Cranial nerve transection during head and neck surgery is conventionally repaired with microsuture. Previous studies have demonstrated recovery with laser nerve welding (LNW), a novel alternative to microsuture. LNW has been reported to have poorer tensile strength, however. Laser-activated chitosan, an adhesive biopolymer, may promote nerve recovery while enhancing the tensile strength of the repair. Using a rat posterior tibial nerve injury model, we compared four different methods of nerve repair in this pilot study. STUDY DESIGN Animal study. DESIGN Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by potassium titanyl phosphate (KTP) laser alone (n = 20), KTP + chitosan (n = 12), microsuture + chitosan (n = 12), and chitosan alone (n = 14). Weekly walking tracks were conducted to measure functional recovery (FR). Tensile strength (TS) was measured at 6 weeks. RESULTS At 6 weeks, KTP laser alone had the best recovery (FR = 93.4% ± 8.3%). Microsuture + chitosan, KTP + chitosan, and chitosan alone all showed good FR (87.4% ± 13.5%, 84.6% ± 13.0%, and 84.1% ± 10.0%, respectively). One-way analysis of variance was performed (F(3,56) = 2.6, P = .061). A TS threshold of 3.8 N was selected as a control mean recovery. Three groups-KTP alone, KTP + chitosan, and microsuture + chitosan-were found to meet threshold 60% (95% confidence interval [CI]: 23.1%-88.3%), 75% (95% CI: 46.8%-91.1%), and 100% (95% CI: 75.8%-100.0%), respectively. CONCLUSIONS In the posterior tibial nerve model, all repair methods promoted nerve recovery. Laser-activated chitosan as a biopolymer anchor provided good TS and appears to be a novel alternative to microsuture. This repair method may have surgical utility following cranial nerve injury during head and neck surgery. LEVEL OF EVIDENCE NA Laryngoscope, 127:E253-E257, 2017.
Collapse
Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Taleef R Khan
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Christopher Mejias
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| |
Collapse
|
35
|
Barton MJ, John JS, Clarke M, Wright A, Ekberg J. The Glia Response after Peripheral Nerve Injury: A Comparison between Schwann Cells and Olfactory Ensheathing Cells and Their Uses for Neural Regenerative Therapies. Int J Mol Sci 2017; 18:E287. [PMID: 28146061 PMCID: PMC5343823 DOI: 10.3390/ijms18020287] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 01/04/2023] Open
Abstract
The peripheral nervous system (PNS) exhibits a much larger capacity for regeneration than the central nervous system (CNS). One reason for this difference is the difference in glial cell types between the two systems. PNS glia respond rapidly to nerve injury by clearing debris from the injury site, supplying essential growth factors and providing structural support; all of which enhances neuronal regeneration. Thus, transplantation of glial cells from the PNS is a very promising therapy for injuries to both the PNS and the CNS. There are two key types of PNS glia: olfactory ensheathing cells (OECs), which populate the olfactory nerve, and Schwann cells (SCs), which are present in the rest of the PNS. These two glial types share many similar morphological and functional characteristics but also exhibit key differences. The olfactory nerve is constantly turning over throughout life, which means OECs are continuously stimulating neural regeneration, whilst SCs only promote regeneration after direct injury to the PNS. This review presents a comparison between these two PNS systems in respect to normal physiology, developmental anatomy, glial functions and their responses to injury. A thorough understanding of the mechanisms and differences between the two systems is crucial for the development of future therapies using transplantation of peripheral glia to treat neural injuries and/or disease.
Collapse
Affiliation(s)
- Matthew J Barton
- Menzies Health Institute Queensland, Griffith University, Nathan QLD 4111, Australia.
- Clem Jones Centre for Neurobiology & Stem Cell Research, Griffith University, Nathan QLD 4111, Australia.
| | - James St John
- Menzies Health Institute Queensland, Griffith University, Nathan QLD 4111, Australia.
- Clem Jones Centre for Neurobiology & Stem Cell Research, Griffith University, Nathan QLD 4111, Australia.
- Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD 4111, Australia.
| | - Mary Clarke
- Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD 4111, Australia.
| | - Alison Wright
- Faculty of Health and Medical Science, Bond University, Robina, QLD 4226, Australia.
| | - Jenny Ekberg
- Clem Jones Centre for Neurobiology & Stem Cell Research, Griffith University, Nathan QLD 4111, Australia.
- Faculty of Health and Medical Science, Bond University, Robina, QLD 4226, Australia.
| |
Collapse
|
36
|
Bhatt NK, Mejias C, Kallogjeri D, Gale DC, Park AM, Paniello RC. Potassium titanyl phosphate laser welding following complete nerve transection. Laryngoscope 2016; 127:1525-1530. [DOI: 10.1002/lary.26383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/04/2016] [Accepted: 09/27/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Neel K. Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Christopher Mejias
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Derrick C. Gale
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Andrea M. Park
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University in Saint Louis; St. Louis Missouri U.S.A
| |
Collapse
|
37
|
Shaikh S, Shortland P, Lauto A, Barton M, Morley JW, Mahns DA. Sensory perturbations using suture and sutureless repair of transected median nerve in rats. Somatosens Mot Res 2016; 33:20-8. [PMID: 26899181 DOI: 10.3109/08990220.2016.1142438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effects of changes to cold, mechanical, and heat thresholds following median nerve transection with repair by sutures (Su) or Rose Bengal adhesion (RA) were compared to sham-operated animals. Both nerve-injured groups showed a transient, ipsilateral hyposensitivity to mechanical and heat stimuli followed by a robust and long-lasting hypersensitivity (6-7 weeks) with gradual recovery towards pre-injury levels by 90 days post-repair. Both tactile and thermal hypersensitivity were seen in the contralateral limb that was similar in onset but differed in magnitude and resolved more rapidly compared to the injured limb. Prior to injury, no animals showed any signs of aversion to cold plate temperatures of 4-16 °C. After injury, animals showed cold allodynia, lasting for 7 weeks in RA-repaired rats before recovering towards pre-injury levels, but were still present at 12 weeks in Su-repaired rats. Additionally, sensory recovery in the RA group was faster compared to the Su group in all behavioural tests. Surprisingly, sham-operated rats showed similar bilateral behavioural changes to all sensory stimuli that were comparable in onset and magnitude to the nerve-injured groups but resolved more quickly compared to nerve-injured rats. These results suggest that nerve repair using a sutureless approach produces an accelerated recovery with reduced sensorimotor disturbances compared to direct suturing. They also describe, for the first time, that unilateral forelimb nerve injury produces mirror-image-like sensory perturbations in the contralateral limb, suggesting that the contralateral side is not a true control for sensory testing. The potential mechanisms involved in this altered behaviour are discussed.
Collapse
Affiliation(s)
- Sumaiya Shaikh
- a School of Medicine, Western Sydney University , NSW , Australia
| | - Peter Shortland
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Antonio Lauto
- b School of Science and Health, Western Sydney University , NSW , Australia
| | - Matthew Barton
- a School of Medicine, Western Sydney University , NSW , Australia
| | - John W Morley
- a School of Medicine, Western Sydney University , NSW , Australia
| | - David A Mahns
- a School of Medicine, Western Sydney University , NSW , Australia
| |
Collapse
|
38
|
Zhou Y, Zhao J, Sun X, Li S, Hou X, Yuan X, Yuan X. Rapid Gelling Chitosan/Polylysine Hydrogel with Enhanced Bulk Cohesive and Interfacial Adhesive Force: Mimicking Features of Epineurial Matrix for Peripheral Nerve Anastomosis. Biomacromolecules 2016; 17:622-30. [DOI: 10.1021/acs.biomac.5b01550] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Yalin Zhou
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| | - Jin Zhao
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| | - Xiaolei Sun
- Department
of Orthopedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Sidi Li
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| | - Xin Hou
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| | - Xubo Yuan
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| | - Xiaoyan Yuan
- School
of Materials Science and Engineering, and Tianjin Key Laboratory of
Composite and Functional Materials, Tianjin University, Tianjin 300072, China
| |
Collapse
|
39
|
Altun I, Çıralık H. Histopathological Effects of Tissue Adhesives on Experimental Peripheral Nerve Transection Model in Rats. J Korean Neurosurg Soc 2015; 58:504-7. [PMID: 26819683 PMCID: PMC4728086 DOI: 10.3340/jkns.2015.58.6.504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Our aim was to evaluate the histopathological effects of tissue adhesives on peripheral nerve regeneration after experimental sciatic nerve transection in rats and to search whether these tissue adhesives may possess a therapeutic potential in peripheral nerve injuries. METHODS This experimental study was performed using 42 female Wistar-Albino rats distributed in 6 groups subsequent to transection of right sciatic nerves. Group I underwent external circumferential neurolysis; Group II received suture repair; Group III had local polymeric hydrogel based tissue adhesive administration; Group IV received suture repair and polymeric hydrogel based tissue adhesive application together; Group V had gelatin based tissue adhesive application and Group VI had suture repair and gelatin based tissue adhesive together. After a 6-week follow-up period, biopsies were obtained from site of neural injury and groups were compared with respect to histopathological scoring based on inflammatory, degenerative, necrotic and fibrotic changes. RESULTS There were remarkable differences between control group and study groups with respect to inflammation (p=0.001), degeneration (p=0.002), necrosis (p=0.007), fibrosis (p<0.001) and vascularity (p=0.001). Histopathological scores were similar between study groups and the only noteworthy difference was that Group V displayed a lower score for necrosis and higher score in terms of vascularization. CONCLUSION Our results imply that tissue adhesives can be useful in repair of peripheral nerve injuries by decreasing the surgical trauma and shortening the duration of intervention. Results with gelatin based tissue adhesive are especially promising since more intense vascularity was observed in tissue after application. However, trials on larger series with longer durations of follow-up are essential for reaching more reliable conclusions.
Collapse
Affiliation(s)
- Idiris Altun
- Department of Neurosurgery, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Harun Çıralık
- Department of Pathology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| |
Collapse
|