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Treatment of a Segmental Nerve Defect in the Rat with Use of Bioabsorbable Synthetic Nerve Conduits: A Comparison of Commercially Available Conduits
Richard H. Shin, BS1; Patricia F. Friedrich, AAS1; Brian A. Crum, MD1; Allen T. Bishop, MD1; Alexander Y. Shin, MD1
1 Microvascular Research Laboratory (R.H.S., P.F.F., A.T.B., and A.Y.S.) and the Departments of Neurology (B.A.C.) and Orthopedic Surgery (A.T.B and A.Y.S.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for A.Y. Shin: shin.alexander@mayo.edu
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Mayo Foundation Research Grant (CR-20). Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Microvascular Research Laboratory and the Departments of Neurology and Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2194-2204. doi: 10.2106/JBJS.H.01301
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Background: The use of biodegradable synthetic nerve conduits for the reconstruction of segmental nerve defects has been extensively reported in both animal and human studies, with a majority of studies evaluating sensory nerve recovery. However, few studies have compared these nerve conduits for functional motor recovery. The purpose of this study was to compare three commercially available, synthetic, bioabsorbable nerve conduits and autograft with respect to compound muscle action potentials, maximum isometric tetanic force, wet muscle weight, and nerve histomorphometry.

Methods: Eighty Lewis rats were divided into four groups according to the type of repair of a 10-mm excision of the sciatic nerve: group I had a reversed autograft; group II, a poly-DL-lactide-e-caprolactone conduit; group III, a type-I collagen conduit; and group IV, a polyglycolic acid conduit. All results were compared with the contralateral side. At twelve weeks, the rats underwent bilateral measurements of the compound muscle action potentials of the tibialis anterior and flexor digiti quinti brevis muscles, isometric tetanic force and muscle weight of the tibialis anterior, and peroneal nerve histomorphometry.

Results: At twelve weeks, no difference in the percentage of recovery between the autograft and the poly-DL-lactide-e-caprolactone conduit was observed with respect to compound muscle action potentials, isometric muscle force, muscle weight, and axon count measurements. The poly-DL-lactide-e-caprolactone and collagen conduits remained structurally stable at twelve weeks, while the polyglycolic acid conduits had completely collapsed. The polyglycolic acid conduit had the poorest results, with a recovery rate of 15% for compound muscle action potentials and 29% for muscle force.

Conclusions: The functional outcome in this rat model was similar for the autograft and the poly-DL-lactide-e-caprolactone conduits when they were used to reconstruct a 10-mm sciatic nerve defect. Functional recovery following the use of the polyglycolic acid conduit was the poorest.

Clinical Relevance: Differences were demonstrated between commercially available conduits in this rat model. These results will allow surgeons to choose the optimal bioabsorbable synthetic conduit for human segmental nerve defect reconstruction.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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