Abstract
Defects of the peripheral nervous system are extremely frequent in trauma and surgeries and have high socioeconomic costs. If the direct suture of a lesion is not possible, i.e., nerve gap > 2 cm, it is necessary to use grafts. While the gold standard is the autograft, it has disadvantages related to its harvesting, with an inevitable functional deficit and further morbidity. An alternative to autografting is represented by the acellular nerve allograft (ANA), which avoids disadvantages of autograft harvesting and fresh allograft rejection. In this research, the authors intend to transfer to human nerves a novel technique, previously implemented in animal models, to decellularize nerves. The new method is based on soaking the nerve tissues in decellularizing solutions while associating ultrasounds and freeze–thaw cycles. It is performed without interrupting the sterility chain, so that the new graft may not require post-production γ-ray irradiation, which is suspected to affect the structural and functional quality of tissues. The new method is rapid, safe, and inexpensive if compared with available commercial ANAs. Histology and immunohistochemistry have been adopted to evaluate the new decellularized nerves. The study shows that the new method can be applied to human nerve samples, obtaining similar, and, sometimes better, results compared with the chosen control method, the Hudson technique.
Highlights
IntroductionCharacterizing up to 3.3% of traumatic injuries [2], peripheral nerve injuries (PNI) are common in several conditions requiring replacement of nerve defects, such as oncologic and orthopedic surgeries, as well as in many other conditions requiring replacement of nerve defects in several other surgical specialties [3,4,5]
The annual incidence of peripheral nerve injuries (PNI) is 1:1000, with a related cost of about 150 billion dollars [1], in addition to the socio-economic costs derived from absence from work.Characterizing up to 3.3% of traumatic injuries [2], PNI are common in several conditions requiring replacement of nerve defects, such as oncologic and orthopedic surgeries, as well as in many other conditions requiring replacement of nerve defects in several other surgical specialties [3,4,5]
This study aims to evaluate the outcomes of the new decellularization method on human nerves, in terms of histology, immunohistochemistry and microbiology, in order to prepare the field for its clinical translation
Summary
Characterizing up to 3.3% of traumatic injuries [2], PNI are common in several conditions requiring replacement of nerve defects, such as oncologic and orthopedic surgeries, as well as in many other conditions requiring replacement of nerve defects in several other surgical specialties [3,4,5]. In the case of PNI, the first approach is primary neurorrhaphy, which is a direct nerve repair with epineural micro-sutures of two stumps. This is not feasible in the case of stump retraction or in the case of loss of tissue (gap > 2 cm) [7], where the main surgical options are autologous grafts, allogenic grafts, or nerve conduits [8]
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