Guided neural regeneration with autologous fat grafting and oxygen hyperbaric therapy

Abstract

The loss of continuity of the nerve structure interrupts the transmission of nerve impulses and leads to the disorganization of functional activities. Many methods, as the use of neurogenic factors, aid in the process of neural regeneration by accelerating or improving peripheral nerves neoformation. The adipose tissue is abundant in the human body, and it has presented promising results in the regeneration of peripheral nerves. We carried out a randomized controlled study in 9 months, using 45 male Wistar rats, 80 days old, and the sciatic nerve was chosen for analysis. The control animals were divided into three groups -Initial group (IG), Final group (FG), and denervated group (DG) -with seven animals each. The experimental groups, with twelve animals each, were polyethylene tube filled with fat (EGF) and polyethylene tube without filling (EGwf). All groups, except IG, were submitted to 10 sessions of hyperbaric oxygen treatment of 1h 45 min in alternating days. Functional evaluation by walking-track was assessed using the Catwalk XT ® software and tissues were harvested and stained with 1% toluidine blue for histological analysis. Quantitative data were first analyzed with the Kolmogorov Smirnov normality test. Comparison between the four groups was analyzed by ANOVA followed by Tukey Test. We concluded that hyperbaric oxygen therapy had positive results on morphometric and functional parameters. However, no significant differences were found regarding the use of autologous fat graft.

The role of hyperbaric oxygen therapy in the management of perioperative peripheral nerve injury: a scoping review of the literature

“…An additional five case reports describe a total of two female and three male patients, aged 24–50, treated with HBOT for PNI (table 2). 20 21 30–32 The remaining 40 studies, which are illustrated in table 3, describe experiments performed in a rat model,33–70 with the exception of two which used a rabbit model 71 72. Collectively, they chronicle more than 800 animal models of HBOT for the treatment of PNI.…”

“…Four human trials describe PNI of the ulnar and median nerves,24 sural and peroneal nerves,25 pudendal nerve,27 and brachial plexus,28 while the remaining human studies describe patients with variable or widespread nerve injuries such as complex regional pain syndrome or distributed peripheral neuropathies (table 1 and table 2). 20 21 26 29–32 Among animal studies (table 3) the most common nerve of interest (in 28/40 studies) is the sciatic nerve,33 37 41–44 46–56 58 60–64 66–68 70 72 while others examine the L5 spinal nerve,38 45 57 peroneal nerve,65 69 or cavernous nerve 59. Several additional animal studies describe distributed peripheral neuropathies 34–36 40 71…”

“…Among animal studies (table 3), the mechanisms of iatrogenic PNI include chronic neural constriction injury,11 37 41–44 47 49–51 53 55 crush injury,9 52 54 58 59 63 66 67 69 72 nerve transection6 33 46 48 56 60 70 chemotherapy-induced neuropathy with paclitaxel,3 34 36 40 or cisplatin,1 35 nerve ligation,3 38 45 61 diabetic neuropathy,1 62 neurotoxic injury with clioquinol,1 71 vascular embolization,1 68 burn injury,1 39 or a combination of these mechanisms 57 64 65. Most of these reports described either mechanical (12) or ischemic/compressive (10) nerve injuries, or a combination of these (10), while the remainder described chemical (5) or ischemic (2) injuries.…”

“…The average number of treatments among animal studies was 10.8, with an average duration of 71 min each. The total duration of HBOT treatment among animal studies ranged from a single day36 40 53 to 150 days 33…”

“…Mechanical and thermal thresholds were the most frequently applied measure of nerve function among animal studies, but some studies also used functional indices such as the Sciatic Function Index, nerve stimulation and conduction tests, pinch tests, gait analyses, and a variety of behavior scores. A majority of animal studies (36/40; 90%) reported a clinical benefit attributable to HBOT 33–61 63 64 67 68 70–72. Of the remaining four studies, one described short-term benefits of HBOT (ie, faster recovery) but clinical equipoise at later time points 65.…”