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J Reconstr Microsurg 2018; 34(06): 389-398
DOI: 10.1055/s-0038-1627472
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Development of a Device-Assisted Nerve-Regeneration Procedure in Disruptive Lesions of the Brachial Plexus

Antonio Merolli
1   New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, New Jersey
2   Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy
,
Maria Lucia Manunta
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Yong Mao
1   New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, New Jersey
,
Gerolamo Masala
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Giovanni Mario Careddu
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Francesca Cubeddu
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Maria Antonietta Evangelisti
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Maria Letizia Guida
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
,
Caroline Antonia Verardi
2   Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy
,
Claudio Proietti
2   Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy
,
Andrea Manunta
4   Department of Ortopedic Surgery, Universita' di Sassari, Sassari, Italy
,
Giuseppe Falvo D'Urso Labate
5   Department of Environmental and Chemical Engineering, Universita' della Calabria, Rende, Italy
,
Gerardo Catapano
5   Department of Environmental and Chemical Engineering, Universita' della Calabria, Rende, Italy
,
Marianne Polunas
6   Research Pathology Services, Rutgers – The State University of New Jersey, Piscataway, New Jersey
,
Pedro Louro
6   Research Pathology Services, Rutgers – The State University of New Jersey, Piscataway, New Jersey
,
Eraldo Sanna Passino
3   Department of Veterinary Surgery, University of Sassari, Sassari, Italy
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Publikationsverlauf

03. August 2017

23. Dezember 2017

Publikationsdatum:
06. März 2018 (online)

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Abstract

Background We describe the development of a new surgical procedure to be used in the treatment of disruptive brachial plexus (BP) lesions. It is centered on an artificial device designed to assist nerve regeneration by providing a confined and protected environment. Nerve fibers can repair inside the device, while the adverse massive scar-tissue formation is limited to the outside of the device.

Methods Steps in the development of the procedure were (1) definition of the rationale, (2) design of the device, (3) choice of an in vivo translational model, (4)refinement of the surgical procedure, and (5) performance of an in vivo pilot study as a proof of concept. An interdisciplinary team from several laboratories was involved in this work over a period of 6 years.

Results Results showed the absence of significant scar tissue in the regenerate and the presence of myelinated fibers aligned proximodistally between the stumps. This surgical approach can be seen not only as a definitive treatment but also as an early examination and stabilization before some different surgery will be later performed. It may also be used as additional protection for traditional surgery like end-to-end coaptation.

Conclusions We conclude that the availability of a suitable device-assisted early treatment, even if not to be considered definitive, could help in addressing the BP lesions at an earlier stage and this may improve the final outcome. Our evidence justifies further experimentation on this approach.

Keywords

biomaterials - brachial plexus - nerve regeneration
 

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