A New Synthetic Conduit for the Treatment of Peripheral Nerve Injuries
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ORIGINAL SCIENTIFIC REPORT
A New Synthetic Conduit for the Treatment of Peripheral Nerve Injuries Selman Uranues1 • Georg Bretthauer2 • Gordana Tomasch1 • Dietmar Rafolt3 Doris Nagele-Moser1 • Andrea Berghold4 • Reinhold Kleinert5 • Ivo Justich6 • Jo¨rg Waldert7 • Horst Koch6
•
Ó The Author(s) 2020
Abstract Background Peripheral nerve defects (PND) often cause lifelong physical disability, and the available treatment options are often not satisfactory. PND are usually bridged with an autologous nerve transplant or a nerve guidance conduit (NGC), when coaptation as preferred technique is not possible. The aim of this experimental study was to determine the effectiveness of a novel NGC for regeneration in the treatment of PND. Materials and methods A conduit made of gelatin with an innovative interior structure was tested for the repair of a 6-mm gap versus direct microsurgical suture repair without gap. Results We found that bridging the defect with this conduit was as effective as direct microsurgical coaptation without a defect. Conclusions This nerve conduit, effective in bridging neural defects, appears as an alternative to autologous nerve grafts, avoiding the problems related to nerve graft harvesting, host–donor differences in diameter, mismatches in number and pattern of fascicles, cross-sectional shape and area, and morbidity of the donor area.
Introduction & Selman Uranues [email protected] 1
Section for Surgical Research, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria
2
Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, 76344 Eggenstein-Leopoldshafen, Germany
3
Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria
4
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria
5
Institute of Pathology, Medical University of Graz, 8036 Graz, Austria
6
Clinical Division of Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, 8036 Graz, Austria
7
State Hospital for Neurology and Psychiatrics, 8055 Graz, Austria
Peripheral nerve defects are most often due to trauma and have a high potential for major disability [1]. Annually more than 200,000 nerve injuries are treated surgically in the USA [2]. Younger men are the most prone to these injuries (male/female ratio 3:1, mean age 32–35 years) [3–5]. Thus, people in the most productive phase of their lives are affected leading to high treatment and socioeconomic costs [6]. Coaptation with direct suture repair is optimal for a good functional result but is only possible for defects of less than 5 mm in length, as larger gaps may cause tension on the suture line leading to poorer results [7, 8]. In this setting, autologous nerve grafts are being used serving as scaffolds supplying nutrients, while the basal lamina, endoneural tubes, and Schwann cells guide the regenerating axons to the distal stump [9, 10]. However, nerve grafting can res
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