Rowley Emma K, Zamore Zachary H, Padovano William, Aslami Zohra V, Qiu Chenhu, Mantilla-Rivas Esperanza, Weitzner Aidan S, Suresh Rachana, Lee Erica B, Tuffaha Sami H
From the Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine.
University of Nevada, Reno School of Medicine.
Plast Reconstr Surg. 2025 Aug 1;156(2):198e-207e. doi: 10.1097/PRS.0000000000011945. Epub 2024 Dec 27.
Nerve wraps composed of various autologous and bioengineered materials have been used to bolster nerve repair sites. In this study, the authors describe the novel use of autologous fascia nerve wraps (AFNWs) as an adjunct to epineurial repair and evaluate their effect on inflammatory cytokine expression, intraneural collagen deposition, and end-organ reinnervation in rats, and use of AFNWs in a patient case series.
Lewis rats received sciatic transection with repair either with or without AFNWs, sciatic-to-common peroneal nerve transfer with or without AFNWs, or sham surgery ( n = 14/group). AFNWs (1 cm 2 ) were obtained from gluteal muscle fascia. Cytokine expression was assessed at both the coaptation site and L3 to L5 dorsal root ganglia at 4 weeks after repair using enzyme-linked immunosorbent assay. Intraneural scarring and end-organ reinnervation were evaluated at 12 weeks. The authors also demonstrate the clinical application of AFNWs for various potential indications in 28 patients.
AFNW-treated animals demonstrated a significant ( P < 0.001) decrease in proinflammatory cytokines (tumor necrsis factor-α and interleukin-1β) and increase in antiinflammatory cytokines (tumor necrosis factor-β and interleukin-10) within the L3 to L5 dorsal root ganglia and at the coaptation site. AFNWs also resulted in reduced intraneural collagen content and an increased mean number of retrograde labeled sensory neurons ( P < 0.01). Patients receiving AFNWs demonstrated favorable motor and sensory functional outcomes and no significant reports of neuropathic pain or other complications.
AFNWs serve as a valuable adjunct to epineurial coaptation that reduces intraneural inflammation and collagen deposition in both size-matched and size-mismatched nerve coaptations in a rodent model. Initial clinical experience with AFNWs demonstrates feasibility for various indications.
The authors' early clinical experience with AFNWs demonstrates their safety, practicality, technical feasibility, and cost-effectiveness, and serves to identify a set of potential indications for nerve wrapping that warrant further consideration.
由各种自体和生物工程材料制成的神经包裹物已被用于加强神经修复部位。在本研究中，作者描述了自体筋膜神经包裹物（AFNW）作为神经外膜修复辅助手段的新用途，并评估其对大鼠炎症细胞因子表达、神经内胶原沉积和终末器官再支配的影响，以及在一系列患者病例中AFNW的应用。
将Lewis大鼠分为坐骨神经横断后行有或无AFNW修复组、坐骨神经至腓总神经移位术有或无AFNW组或假手术组（每组n = 14）。AFNW（1平方厘米）取自臀肌筋膜。修复后4周，使用酶联免疫吸附测定法评估吻合部位和L3至L5背根神经节处的细胞因子表达。在12周时评估神经内瘢痕形成和终末器官再支配情况。作者还展示了AFNW在28例患者中针对各种潜在适应症的临床应用。
接受AFNW治疗的动物在L3至L5背根神经节和吻合部位的促炎细胞因子（肿瘤坏死因子-α和白细胞介素-1β）显著减少（P < 0.001），抗炎细胞因子（肿瘤坏死因子-β和白细胞介素-10）增加。AFNW还导致神经内胶原含量减少，逆行标记的感觉神经元平均数量增加（P < 0.01）。接受AFNW治疗的患者表现出良好的运动和感觉功能结果，且无明显的神经性疼痛或其他并发症报告。
在啮齿动物模型中，AFNW是神经外膜吻合的一种有价值的辅助手段，可减少大小匹配和大小不匹配的神经吻合中神经内的炎症和胶原沉积。AFNW的初步临床经验证明了其在各种适应症中的可行性。
作者对AFNW的早期临床经验证明了其安全性、实用性、技术可行性和成本效益，并有助于确定一系列值得进一步考虑的神经包裹潜在适应症。
