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Schwann Cell Strip for Peripheral Nerve Repair

From the Department of Hand, Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basel, Switzerland, the Plastic and Reconstructive Research, Blond McIndoe Research Laboratories, University of Manchester, Manchester, UK, the Department of Hand, Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Lausanne, Lausanne, Switzerland and the Department of Hand and Plastic Surgery, Umeå University, Umeå, Sweden

Correspondence: PD Dr Daniel F. Kalbermatten, Department of Plastic, Reconstructive and Aesthetic Surgery, University of Basel, CH-4031 Basel, Switzerland and Department of Hand and Plastic Surgery, Umea University, Umea, Sweden. Tel.: +41 61 265 2525; fax: +41 61 265 7301. E-mail: daniel.kalbermatten{at}bluewin.ch

Many strategies have been investigated to provide an ideal substitute to treat a nerve gap injury. Initially, silicone conduits were used and more recently conduits fabricated from natural materials such as poly-3-hydroxybutyrate (PHB) showed good results but still have their limitations. Surgically, a new concept optimising harvested autologous nerve graft has been introduced as the single fascicle method. It has been shown that a single fascicle repair of nerve grafting is successful. We investigated a new approach using a PHB strip seeded with Schwann cells to mimic a small nerve fascicle. Schwann cells were attached to the PHB strip using diluted fibrin glue and used to bridge a 10-mm sciatic nerve gap in rats. Comparison was made with a group using conventional PHB conduit tubes filled with Schwann cells and fibrin glue. After 2 weeks, the nerve samples were harvested and investigated for axonal and Schwann cell markers. PGP9.5 immunohistochemistry showed a superior nerve regeneration distance in the PHB strip group versus the PHB tube group (> 10 mm, crossed versus 3.17± 0.32 mm respectively, P<0.05) as well as superior Schwann cell intrusion (S100 staining) from proximal (> 10 mm, crossed versus 3.40± 0.36 mm, P<0.01) and distal (> 10 mm, crossed versus 2.91± 0.31 mm, P<0.001) ends. These findings suggest a significant advantage of a strip in rapidly connecting a nerve gap lesion and imply that single fascicle nerve grafting is advantageous for nerve repair in rats.

Key Words: PHB • nerve scaffold • fibrin glue • tisseel®

Journal of Hand Surgery (European Volume), Vol. 33, No. 5, 587-594 (2008)
DOI: 10.1177/1753193408090755


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