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DOI: 10.1055/s-0043-1772670
Photochemical Tissue Bonding of Amnion Allograft Membranes for Peripheral Nerve Repair: A Biomechanical Analysis
Funding Funding for this project was provided by the Walter Reed Army Institute of Research.
Abstract
Background Photochemical tissue bonding (PTB) is a technique for peripheral nerve repair in which a collagenous membrane is bonded around approximated nerve ends. Studies using PTB with cryopreserved human amnion have shown promising results in a rat sciatic nerve transection model including a more rapid and complete return of function, larger axon size, and thicker myelination than suture repair. Commercial collagen membranes, such as dehydrated amnion allograft, are readily available, offer ease of storage, and have no risk of disease transmission or tissue rejection. However, the biomechanical properties of these membranes using PTB are currently unknown in comparison to PTB of cryopreserved human amnion and suture neurorrhaphy.
Methods Rat sciatic nerves (n = 10 per group) were transected and repaired using either suture neurorrhaphy or PTB with one of the following membranes: cryopreserved human amnion, monolayer human amnion allograft (crosslinked and noncrosslinked), trilayer human amnion/chorion allograft (crosslinked and noncrosslinked), or swine submucosa. Repaired nerves were subjected to mechanical testing.
Results During ultimate stress testing, the repair groups that withstood the greatest strain increases were suture neurorrhaphy (69 ± 14%), PTB with crosslinked trilayer amnion (52 ± 10%), and PTB with cryopreserved human amnion (46 ± 20%), although the differences between these groups were not statistically significant. Neurorrhaphy repairs had a maximum load (0.98 ± 0.30 N) significantly greater than all other repair groups except for noncrosslinked trilayer amnion (0.51 ± 0.27 N). During fatigue testing, all samples repaired with suture, or PTBs with either crosslinked or noncrosslinked trilayer amnion were able to withstand strain increases of at least 50%.
Conclusion PTB repairs with commercial noncrosslinked amnion allograft membranes can withstand physiological strain and have comparable performance to repairs with human amnion, which has demonstrated efficacy in vivo. These results indicate the need for further testing of these membranes using in vivo animal model repairs.
Financial Disclosures
J.M.W. and M.A.R. are patent holders on Photochemical Tissue Bonding technology, with no royalties or commercial income received at this point.
Publication History
Received: 02 May 2023
Accepted: 14 July 2023
Article published online:
11 September 2023
© 2023. Thieme. All rights reserved.
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References
- 1 Lad SP, Nathan JK, Schubert RD, Boakye M. Trends in median, ulnar, radial, and brachioplexus nerve injuries in the United States. Neurosurgery 2010; 66 (05) 953-960
- 2 Stonner MM, Mackinnon SE, Kaskutas V. Predictors of functional outcome after peripheral nerve injury and compression. J Hand Ther 2021; 34 (03) 369-375
- 3 Kamegaya Y, Farinelli WA, Vila Echague AV. et al. Evaluation of photochemical tissue bonding for closure of skin incisions and excisions. Lasers Surg Med 2005; 37 (04) 264-270
- 4 O'Neill AC, Winograd JM, Zeballos JL. et al. Microvascular anastomosis using a photochemical tissue bonding technique. Lasers Surg Med 2007; 39 (09) 716-722
- 5 Ding B, Wang X, Yao M. Photochemical tissue bonding technique for improving healing of hand tendon injury. Surg Innov 2019; 26 (02) 153-161
- 6 Scott BB, Wang Y, Wu RC, Randolph MA, Redmond RW. Light-activated photosealing with human amniotic membrane strengthens bowel anastomosis in a hypotensive, trauma-relevant swine model. Lasers Surg Med 2022; 54 (03) 407-417
- 7 Fairbairn NG, Ng-Glazier J, Meppelink AM. et al. Light-activated sealing of acellular nerve allografts following nerve gap injury. J Reconstr Microsurg 2016; 32 (06) 421-430
- 8 Johnson TS, O'Neill AC, Motarjem PM. et al. Photochemical tissue bonding: a promising technique for peripheral nerve repair. J Surg Res 2007; 143 (02) 224-229
- 9 Kim SS, Sohn SK, Lee KY, Lee MJ, Roh MS, Kim CH. Use of human amniotic membrane wrap in reducing perineural adhesions in a rabbit model of ulnar nerve neurorrhaphy. J Hand Surg Eur Vol 2010; 35 (03) 214-219
- 10 Fairbairn NG, Ng-Glazier J, Meppelink AM, Randolph MA, Winograd JM, Redmond RW. Improving outcomes in immediate and delayed nerve grafting of peripheral nerve gaps using light-activated sealing of neurorrhaphy sites with human amnion wraps. Plast Reconstr Surg 2016; 137 (03) 887-895
- 11 Topp KS, Boyd BS. Structure and biomechanics of peripheral nerves: nerve responses to physical stresses and implications for physical therapist practice. Phys Ther 2006; 86 (01) 92-109
- 12 Grover CN, Gwynne JH, Pugh N. et al. Crosslinking and composition influence the surface properties, mechanical stiffness and cell reactivity of collagen-based films. Acta Biomater 2012; 8 (08) 3080-3090
- 13 Kang AH, Gross J. Relationship between the intra and intermolecular cross-links of collagen. Proc Natl Acad Sci U S A 1970; 67 (03) 1307-1314
- 14 Temple CL, Ross DC, Dunning CE, Johnson JA, King GJ. Tensile strength of healing peripheral nerves. J Reconstr Microsurg 2003; 19 (07) 483-488
- 15 Scott BB, Wu RC, Nietlispach V, Randolph MA, Redmond RW. A photosealed cap prevents disorganized axonal regeneration and neuroma following nerve transection in rats. Plast Reconstr Surg Glob Open 2022; 10 (03) e4168
- 16 Flores AJ, Lavernia CJ, Owens PW. Anatomy and physiology of peripheral nerve injury and repair. Am J Orthop 2000; 29 (03) 167-173
- 17 M F G, M M, S H, Khan WS. Peripheral nerve injury: principles for repair and regeneration. Open Orthop J 2014; 8: 199-203
- 18 Millesi H. Reappraisal of nerve repair. Surg Clin North Am 1981; 61 (02) 321-340
- 19 Temple CLF, Ross DC, Dunning CE, Johnson JA. Resistance to disruption and gapping of peripheral nerve repairs: an in vitro biomechanical assessment of techniques. J Reconstr Microsurg 2004; 20 (08) 645-650