Department of Orthopaedic Surgery, Hand and Upper Extremity Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania 15212, USA.
J Reconstr Microsurg. 2011 Jan;27(1):19-28. doi: 10.1055/s-0030-1267379. Epub 2010 Oct 13.
Nerve wrapping can improve outcomes by protecting nerves in a scarred tissue bed. Autologous tissue wraps have shown good results, but there are limitations associated with harvesting and availability. Extracellular matrix (ECM) derived from porcine small intestinal submucosa offers an attractive off-the-shelf option. This study evaluated this material as a nerve wrap. The sciatic nerves of 18 New Zealand rabbits were exposed and then wrapped, while the contralateral side served as sham control. Presence and quality of adhesions, motor conduction velocity (MCV), and histology were evaluated at 1, 2, and 6 months ( N = 6 animals per time point). The quality, extent, tenacity, and overall impression of adhesions were not different from control at any time point ( P = 0.18 to 0.99). MCV was also not statistically different from control (1 month, P = 0.35; 2 months, P = 0.20; 6 months, P = 0.83). Histology demonstrated that wrapped nerves were healthy in terms of myelination, density, and vascularity compared with controls. Vascularization and incorporation of the ECM material could be visualized at explants. All assessments supported the feasibility and safety of this material as a nerve wrap. Its ability to function as a protective barrier has strong implications for clinical use in trauma and/or recurrent compression neuropathies.
神经包裹术通过保护瘢痕组织床中的神经来改善预后。自体组织包裹已显示出良好的效果，但在取材和可用性方面存在局限性。源自猪小肠黏膜下层的细胞外基质 (ECM) 提供了一种有吸引力的现成选择。本研究评估了这种材料作为神经包裹物的效果。18 只新西兰兔的坐骨神经暴露后进行包裹，对侧作为假手术对照。在 1、2 和 6 个月时评估粘连的存在和质量、运动传导速度 (MCV) 和组织学（N = 每组 6 只动物）。在任何时间点，粘连的质量、程度、韧性和总体印象与对照组均无差异（P = 0.18 至 0.99）。MCV 与对照组也无统计学差异（1 个月，P = 0.35；2 个月，P = 0.20；6 个月，P = 0.83）。组织学显示，与对照组相比，包裹的神经在髓鞘形成、密度和血管生成方面是健康的。在植入物中可以观察到血管化和 ECM 材料的整合。所有评估均支持该材料作为神经包裹物的可行性和安全性。其作为保护屏障的功能对创伤和/或复发性压迫性神经病的临床应用具有重要意义。
