Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany.
PLoS One. 2023 Aug 4;18(8):e0289677. doi: 10.1371/journal.pone.0289677. eCollection 2023.
Extensive scar tissue formation after peripheral nerve injury or surgery is a common problem. To avoid perineural scarring, implanting a mechanical barrier protecting the nerve from inflammation processes in the perineural environment has shown promising results for functional recovery. This study investigates the potential of an acellular collagen-elastin matrix wrapped around a peripheral nerve after induction of scar tissue formation.
In the present study, 30 Lewis rats were separated into three groups and sciatic nerve scarring was induced with 2.5% glutaraldehyde (GA-CM) or 2.5% glutaraldehyde with a supplemental FDA-approved acellular collagen-elastin matrix application (GA+CM). Additionally, a sham group was included for control. Nerve regeneration was assessed by functional analysis using the Visual Statisc Sciatic Index (SSI) and MR neurography during the 12-week regeneration period. Histological and histomorphometry analysis were performed to evaluate the degree of postoperative scar tissue formation.
Histological analysis showed an extensive scar tissue formation for GA-CM. Connective tissue ratio was significantly (p < 0.009) reduced for GA+CM (1.347 ± 0.017) compared to GA-CM (1.518 ± 0.057). Similarly, compared to GA+CM, MR-Neurography revealed extensive scar tissue formation for GA-CM with a direct connection between nerve and paraneural environment. Distal to the injury site, quantitative analysis presented significantly higher axon density (p = 0.0145), thicker axon diameter (p = 0.0002) and thicker myelinated fiber thickness (p = 0.0008) for GA+CM compared to GA-CM. Evaluation of functional recovery revealed a significantly faster regeneration for GA+CM.
The supplemental application of an acellular collagen-elastin matrix showed beneficial effects in histological, radiological, and functional analysis. Therefore, applying a collagen-elastin matrix around the nerve after peripheral nerve injury or surgery may have beneficial effects on preventing scar tissue formation in the long run. This represents a feasible approach to avoid scar tissue formation in peripheral nerve surgery.
周围神经损伤或手术后广泛的瘢痕组织形成是一个常见的问题。为了避免神经周围的瘢痕形成，在神经周围环境中植入一种机械屏障来保护神经免受炎症过程的影响，这已经显示出对功能恢复有很好的效果。本研究调查了在诱导瘢痕组织形成后，将无细胞胶原-弹性蛋白基质包裹在周围神经周围的潜在应用。
在本研究中，将 30 只 Lewis 大鼠分为三组，用 2.5%戊二醛（GA-CM）或 2.5%戊二醛加补充 FDA 批准的无细胞胶原-弹性蛋白基质（GA+CM）诱导坐骨神经瘢痕形成。此外，还包括一个假手术组作为对照。在 12 周的再生期内，通过视觉统计坐骨神经指数（SSI）和磁共振神经成像进行功能分析来评估神经再生情况。进行组织学和组织形态学分析以评估术后瘢痕组织形成的程度。
组织学分析显示 GA-CM 有广泛的瘢痕组织形成。GA+CM 的结缔组织比（1.347±0.017）明显低于 GA-CM（1.518±0.057）（p<0.009）。同样，与 GA+CM 相比，GA-CM 的磁共振神经成像显示广泛的瘢痕组织形成，神经与神经周围环境之间有直接连接。在损伤部位远端，GA+CM 的轴突密度（p=0.0145）、轴突直径（p=0.0002）和有髓纤维厚度（p=0.0008）明显高于 GA-CM，定量分析结果也更高。功能恢复评估显示 GA+CM 的再生速度更快。
补充应用无细胞胶原-弹性蛋白基质在组织学、影像学和功能分析方面均显示出有益的效果。因此，在周围神经损伤或手术后将胶原-弹性蛋白基质包裹在神经周围可能从长远来看对预防瘢痕组织形成有有益的效果。这代表了一种可行的方法，可以避免周围神经手术中的瘢痕形成。
