Prevention of Peripheral Nerve Entrapment Following Extensive Soft Tissue Injury, Using Silicone Cuffing

Finsterbush, Alex; Porat, Shlomo; Rousso, M; Ashur, H

doi:10.1097/00003086-198201000-00043

Cited by 13 publications

(7 citation statements)

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“…This makes it indispensable to have a robust and authentic model that simulates the most important clinical characteristics in order to assess the efficacy of urgently needed anti-adhesive and pro-regenerative therapeutic approaches for scarred peripheral nerves. The hitherto existing animal models either induce a direct or an indirect lesion to the nerve, such as irritating the nerve ( Crosio et al, 2014 ; Görgülü et al, 2003 ) or burning the muscular bed ( Abe et al, 2005 ; Albayrak et al, 2010 ; Crosio et al, 2014 ; Dam-Hieu et al, 2005 ; Finsterbush and Porat, 1982 ; Görgülü et al, 2003 ; Park et al, 2011 ; Smit et al, 2004 ; Tos et al, 2016 ; Zanjani et al, 2013 ; Zuijdendorp et al, 2008 ). The resulting pathological processes, mainly macroscopic and histological modifications, were described, but often no assessable functional impairment ( Abe et al, 2005 ; Crosio et al, 2014 ; Dam-Hieu et al, 2005 ; Palatinsky et al, 1997 ; Smit et al, 2004 ; Tos et al, 2016 ; Yamamoto et al, 2010 ; Zanjani et al, 2013 ) – a significant clinical characteristic – was shown.…”

Section: Discussionmentioning

confidence: 99%

A novel experimental rat model of peripheral nerve scarring: reliably mimicking post-surgical complications and recurring adhesions

Lemke

Penzenstadler

Ferguson

et al. 2017

Disease Models &Amp; Mechanisms

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Inflammation, fibrosis and perineural adhesions with the surrounding tissue are common pathological processes following nerve injury and surgical interventions on peripheral nerves in human patients. These features can reoccur following external neurolysis, currently the most common surgical treatment for peripheral nerve scarring, thus leading to renewed nerve function impairment and chronic pain. To enable a successful evaluation of new therapeutic approaches, it is crucial to use a reproducible animal model that mimics the main clinical symptoms occurring in human patients. However, a clinically relevant model combining both histological and functional alterations has not been published to date. We therefore developed a reliable rat model that exhibits the essential pathological processes of peripheral nerve scarring. In our study, we present a novel method for the induction of nerve scarring by applying glutaraldehyde-containing glue that is known to cause nerve injury in humans. After a 3-week contact period with the sciatic nerve in female Sprague Dawley rats, we could demonstrate severe intra- and perineural scarring that resulted in grade 3 adhesions and major impairments in the electrophysiological peak amplitude compared with sham control (P=0.0478). Immunohistochemical analysis of the nerve structure revealed vigorous nerve inflammation and recruitment of T cells and macrophages. Also, distinct nerve degeneration was determined by immunostaining. These pathological alterations were further reflected in significant functional deficiencies, as determined by the analysis of relevant gait parameters as well as the quantification of the sciatic functional index starting at week 1 post-operation (P<0.01). Moreover, with this model we could, for the first time, demonstrate not only the primary formation, but also the recurrence, of severe adhesions 1 week after glue removal, imitating a major clinical challenge. As a comparison, we tested a published model for generating perineural fibrotic adhesions, which did not result in significant pathological changes. Taken together, we established an easily reproducible and reliable rat model for peripheral nerve scarring that allows for the effective testing of new therapeutic strategies.

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Section: Discussionmentioning

confidence: 99%

A novel experimental rat model of peripheral nerve scarring: reliably mimicking post-surgical complications and recurring adhesions

Lemke

Penzenstadler

Ferguson

et al. 2017

Disease Models &Amp; Mechanisms

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show abstract

“…There have been various surgical techniques to prevent perineural scarring and adhesion, such as the microsurgical technique, flap,18) free fat graft,19) vein wrapping20) and silicone cuffing 21). Postoperative perineural scarring and adhesion are inevitable, even when using meticulous surgical techniques, including microsurgical techniques.…”

Section: Discussionmentioning

confidence: 99%

Effect of Hyaluronic Acid-Carboxymethylcellulose Solution on Perineural Scar Formation after Sciatic Nerve Repair in Rats

et al. 2011

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BackgroundScar tissue formation is the major cause of failure in peripheral nerve surgery. Use of a hyaluronic acid-carboxymethylcellulose (HA-CMC) membrane (Seprafilm) as a solid anti-adhesion barrier agent is one of the therapeutic approaches to reduce postoperative scar tissue formation. However, a solid membrane may not be suitable for repair of a weak peripheral nerve site. This study examined the effect of HA-CMC solution on perineural scar formation after peripheral nerve repair in rats.MethodsThe sciatic nerves of 40 rats were transected and then immediately repaired using 10-0 nylon. The nerves were divided randomly into two groups. Saline and HA-CMC solution were applied topically to the nerve repair sites in the control and experimental groups, respectively. Reoperation was performed at 3, 6, 9, and 12 weeks to assess scar tissue formation. The assessment included the quality of wound healing, presence of perinueral adhesion, cellular components of the scar tissue, thickness of the scar tissue and histomorphological organization of the repair site.ResultsTopical application of the HA-CMC solution significantly decreased the macroscopic nerve adherence score and the numbers of the cellular components such as fibroblasts and inflammatory cells (p < 0.05, Mann-Whitney U-test). The scar tissue formation index was significantly lower in the experimental group at 12 weeks than that in the control group (p < 0.05, Mann-Whitney U-test). The grading scores of the histomorphological axonal organization at the repair site were significantly higher in the experimental group than those in the control group at 12 weeks (p < 0.05, Mann-Whitney U-test). No evidence of wound dehiscence or inflammatory reactions against the HA-CMC solution was noted.ConclusionsTopical application of a HA-CMC solution is effective in reducing the perineural scar formation and adhesion after sciatic nerve repair in rats, and is effective in promoting peripheral nerve regeneration at the repair site.

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“…Electrophysiological and histopathological results were consistent and parallel in both groups. The results were summarized in Table III. dISCuSSIon Peripheral nerve trauma, with an estimated incidence of 1/1000 in population per year, remains a major cause of morbidity and social disruption (4 (2,6,7,8,23,24,25,26,37). To the best of our knowledge no study has been reported on preventing intraneural scarring by radiation.…”

Section: Latency Measurementsmentioning

confidence: 99%

The effects of low-dose radiation in the treatment of sciatic nerve injury in rats

Göçmen¹,

Şirin²,

Oysul³

et al. 2011

Turkish Neurosurgery

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AIm: Peripheral nerve regeneration is often blocked by scar formation and misdirection of axon sprouts. The aim of this study is to evaluate electrophysiological and histopathological effects of low-dose radiation therapy on the prevention of intraneural scar formation in peripheral nerve injury. mAterIAl and methOds: In this experimental study, twenty rats were randomly divided into two groups. Left sciatic nerves were exposed and clipped by temporary aneurysm clip for 5 minutes in both groups. In all animals, electrophysiological recordings were performed between 22-24 hours after sciatic nerve injury. The control group was not given any treatment. In the experimental group, 700 cGy low-dose radiation was administered on the left sciatic nerves 24 hours after clipping. Six weeks after injury, electrophysiological recordings were performed in both groups and animals were sacrificed to evaluate the injured nerves histopathologically. results:We observed that low-dose radiotherapy increased the amplitude and improved latency measurements in electrophysiological examinations. Histopathologically, more axonal degeneration and vacuolization was observed in the control group comparing with the experimental group. Endoneural space increased slightly more in the control group than the experimental group.COnClusIOn: It was observed that low-dose radiotherapy may prevent intraneural scar formation and may improve electrophysiological recovery in sciatic nerve injury performed in rats.

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Prevention of Peripheral Nerve Entrapment Following Extensive Soft Tissue Injury, Using Silicone Cuffing

Cited by 13 publications

References 0 publications

A novel experimental rat model of peripheral nerve scarring: reliably mimicking post-surgical complications and recurring adhesions

A novel experimental rat model of peripheral nerve scarring: reliably mimicking post-surgical complications and recurring adhesions

Effect of Hyaluronic Acid-Carboxymethylcellulose Solution on Perineural Scar Formation after Sciatic Nerve Repair in Rats

The effects of low-dose radiation in the treatment of sciatic nerve injury in rats

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