Autologous Fascia Nerve Wrap in a Rodent Primary Epineurial Repair Model and Preliminary Case Series.

Abstract

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.