Improving Outcomes in Immediate and Delayed Nerve Grafting of Peripheral Nerve Gaps Using Light-Activated Sealing of Neurorrhaphy Sites with Human Amnion Wraps

Neil G. Fairbairn, Joanna Ng-Glazier, Amanda M. Meppelink, Mark A. Randolph, Jonathan M. Winograd, Robert W. Redmond

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

Original languageEnglish
Pages (from-to)887-895
Number of pages9
JournalPlastic and reconstructive surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2016

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