Fairbairn Neil G, Ng-Glazier Joanna, Meppelink Amanda M, Randolph Mark A, Winograd Jonathan M, Redmond Robert W
Boston, Mass. From the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital; and the Wellman Centre for Photomedicine, Massachusetts General Hospital.
Plast Reconstr Surg. 2016 Mar;137(3):887-895. doi: 10.1097/01.prs.0000479996.04255.60.
Photochemical tissue bonding uses visible light to create sutureless, watertight bonds between two apposed tissue surfaces stained with photoactive dye. When applied to nerve grafting, photochemical tissue bonding can result in superior outcomes compared with suture fixation. Our previous success has focused on immediate repair. It was the aim of this study to assess the efficacy of photochemical tissue bonding when performed following a clinically relevant delay.
Forty male Lewis rats had 15-mm left sciatic nerve gaps repaired with reversed isografts immediately (n = 20) or after a 30-day delay (n = 20). Repairs were secured using either suture or photochemical tissue bonding. Rats were killed after 150 days. Outcomes were assessed using monthly Sciatic Function Index evaluation, muscle mass retention, and nerve histomorphometry. Statistical analysis was performed using analysis of variance and the post hoc Bonferroni test.
In both immediate and delayed groups, photochemical tissue bonding showed a trend toward greater recovery of Sciatic Function Index, but these results were not significant. The Sciatic Function Index was significantly greater when performed immediately. Significantly greater muscle mass retention occurred following photochemical tissue bonding in both immediate and delayed repairs. Values did not differ significantly between immediate and delayed groups. Histomorphometric recovery was greatest in the immediate photochemical tissue bonding group and poorest in the delayed suture group. Fiber diameter, axon diameter, myelin thickness, and G-ratio were not significantly different between immediate suture and delayed photochemical tissue bonding.
Light-activated sealing of nerve grafts results in significantly better outcomes in comparison with conventional suture. The technique not only remains efficacious but may also help ameliorate the detrimental impacts of surgical delay.
光化学组织黏合利用可见光在两个用光敏染料染色的对合组织表面之间形成无缝合、防水的黏合。当应用于神经移植时，与缝合固定相比，光化学组织黏合可产生更好的效果。我们之前的成功主要集中在即时修复。本研究的目的是评估在临床相关延迟后进行光化学组织黏合的疗效。
40只雄性Lewis大鼠，15毫米的左侧坐骨神经缺损分别立即（n = 20）或延迟30天（n = 20）后用反向同基因移植物修复。修复采用缝合或光化学组织黏合固定。150天后处死大鼠。使用每月的坐骨神经功能指数评估、肌肉质量保留和神经组织形态计量学来评估结果。采用方差分析和事后Bonferroni检验进行统计分析。
在即时和延迟组中，光化学组织黏合均显示出坐骨神经功能指数恢复程度更高的趋势，但这些结果并不显著。即时进行修复时，坐骨神经功能指数显著更高。在即时和延迟修复中，光化学组织黏合后肌肉质量保留均显著更高。即时组和延迟组之间的值没有显著差异。组织形态计量学恢复在即时光化学组织黏合组中最大，在延迟缝合组中最差。即时缝合组和延迟光化学组织黏合组之间的纤维直径、轴突直径、髓鞘厚度和G比值没有显著差异。
与传统缝合相比，光激活密封神经移植物的效果显著更好。该技术不仅仍然有效，而且可能有助于减轻手术延迟的有害影响。
