Title

Laser or Razor? A Novel Experimental Peripheral Nerve Repair Technique

Document Type

Article

Department

Brain and Mind Institute

Abstract

An operative repair technique for crushed sciatic nerve in the rat was used to examine whether removal of the damaged tissue could be better achieved with a low wattage CO2 laser or a blade. This approach was compared to results in rats undergoing conventional end-to-end nerve anastomosis using a microsurgical approach. Crushed sciatic nerves were exposed bilaterally 24 hours after injury and treated as follows. A longitudinally split polyethylene catheter was placed under the nerve, which was fixed to the catheter with 9-0 stitches placed away from lesion area; the nerve was bathed in ice-cold polyvinyl alcohol/chlorpromazine (PVA/CPZ) solution. After the nerve was crushed, the lesioned tissue was removed using laser pulses or a thin blade. A collagen matrix was used to fill the gap, and the preparation was covered and allowed to recover for 6 weeks. End-to-end anastomosis was done following same parameters, but with omission of the nerve catheter, PVA/CPZ solution, and collagen matrix; these nerves were reunited using epineurial stitches. High performance liquid chromotography (HPLC) analysis of each group showed that the laser approach reduced the levels of norepinephrine distal to the lesion, least, suggesting better regeneration of proximal axonal growth. Morphological and neuroelectric findings, although suggestive, showed no significant differences between laser and blade repair, a finding that reinforces the idea that such endpoints are not as sensitive as chemical assays of tissue transmitter levels such as HPLC. Laser or blade repair using nerve-catheter fixation and collagen bridge matrix was superior to end-to-end nerve anastomosis when morphological, neuroelectric, and HPLC values were compared in this model.

Comments

This work was published before the author joined Aga Khan University.

Publication

Neurosurgery

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