The Short- and Long-Term Effects of Seprafilm^®on Peripheral Nerves: A Histological and Functional Study

Abstract

Extraneural scar reduction is an important goal in peripheral nerve microsurgery. The use of biosynthetic materials, such as Seprafilm , reduces postoperative adhesions in abdominopelvic gynecologic and orthopedic surgery. The study evaluates the safety of Seprafilm in proximity to nerve tissue in a noninjury (phase 1) and injury (phase 2) model. Phase 1 groups were: (1) sciatic nerve exposure and neurolysis (n = 15), (2) Seprafilm placement superficial to the nerve (n = 15), and (3) circumferentially wrapping Seprafilm around the nerve (n = 15). Outcome measures at 45 and 90 days included wound inspection, histomorphometry, and stereological analysis of vascularity. Phase II groups were: (1) sciatic nerve cut and repair alone (n = 15) or (2) nerve wrapped with Seprafilm (n = 15). Nerves were evaluated at 18, 32, and 42 days postoperatively, and animals underwent biweekly functional walking tracks. In phase I, no significant differences were detected between groups. In phase II, fewer perineural scar bands were seen with Seprafilm . Histomorphometric differences favoring Seprafilm at 18 days and favoring control at 42 days were noted ( P < 0.05), though no differences in functional outcomes were detected. Qualitatively less perineural scar tissue was seen when using Seprafilm . No functional or histological deleterious effects were noted from placing Seprafilm on intact nerves or cut and repaired nerves.

Reduction of neural scarring after peripheral nerve suture: An experimental study about collagen membrane and autologous vein wrapping

“…It limits the difficulties of dissection that cause additional nerve trauma, which generate inflammation, edema and ischemia leading to increased extraneural fibrosis [3]. Different biomaterials have been studied for their anti-adherent characteristics in peripheral nerve surgery: a carbohydrate polymer gel (ADCON-T/N) [3,19], hyaluronic acid [1,8], aprotinin, protease inhibitor [2], Seprafilm 1 [9] and even human amniotic fluid [18]. These studies have shown an effect of reducing perineural adhesions for each of these substances, but clinical applications are still scarce, because these are expensive materials with limited availability.…”

“…Different biosynthetic materials designed to limit postoperative adhesions have been experimentally studied in the field of abdominal, gynaecological or spinal surgery [4][5][6][7]. These materials were then tested to limit scarring after peripheral nerve surgery, often with conclusive results [1,2,8,9]. Collagen polymers are currently used as conduits for nerve regeneration [10,11], but no studies were specifically dedicated to their anti-adherent characteristics.…”

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

“…Other pharmacologic agents for reducing scar formation are HA and its derivates, which have the effect of optimizing the extracellular matrix 13,14). HA is a major component of the extracellular matrix and it plays an important role in the early wound healing process 3).…”

“…The demonstration of the prowess of Seprafilm for the prevention of abdominal adhesion after surgery12) has led to the widespread use of the HA-CMC membrane experimentally as well as clinically to prevent adhesion in abdominal surgeries, pelvic surgeries, tendon surgery in the hand and spinal surgery. However, there have been only a few reports on the use of the HA-CMC membrane for the prevention of peripheral nerve adhesion 13,14). The solid, film-like HA-CMC membrane is relatively rigid compared to nerves, which confers some physical restrictions on its use with nerves 7,15)…”

Nerve Transfer to the Triceps After Brachial Plexus Injury: Report of Four Cases

“…The redundant FCU donor fascicle was divided distally, then coapted to the medial triceps branch in an end-to-end fashion using 9-0 nylon microsuture and standard microsurgical technique. Seprafilm (Genzyme; Cambridge, MA) was placed above and below the nerve repair to reduce extraneural scar 41 …”