PDF herunterladen
J Reconstr Microsurg 2014; 30(09): 617-626
DOI: 10.1055/s-0034-1372483
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

An Autologously Generated Platelet-Rich Plasma Suturable Membrane May Enhance Peripheral Nerve Regeneration after Neurorraphy in an Acute Injury Model of Sciatic Nerve Neurotmesis

Elisabetta Giannessi
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Alessandra Coli
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Maria Rita Stornelli
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Vincenzo Miragliotta
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Andrea Pirone
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Carla Lenzi
1   Department of Veterinary Sciences, University of Pisa, Pisa, Italy
,
Silvia Burchielli
2   Gabriele Monasterio Foundation, Institute of Clinical Physiology, National Research Council, Pisa, Italy
,
Giovanni Vozzi
3   Department of Information Engineering, Center “E. Piaggio,” University of Pisa, Pisa, Italy
,
Carmelo De Maria
3   Department of Information Engineering, Center “E. Piaggio,” University of Pisa, Pisa, Italy
,
Margherita Giorgetti
4   Department of Musculoskeletal and Skin Diseases, and Hand Surgery, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

20. November 2013

01. Februar 2014

Publikationsdatum:
16. Mai 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Background The aim of this study was to investigate the ability of suturable platelet-rich plasma (PRP) membrane to promote peripheral nerve regeneration after neurotmesis and neurorraphy.

Methods A total of 36 rats were used: 32 animals underwent surgery and were split in two groups. An interim sacrifice was performed at 6 weeks postsurgery and final sacrifice at 12 weeks; four animals did not sustain nerve injury and served as control. Clinical, electromyographic (EMG), gross, and histological changes were assessed. The EMG signal was evaluated for its amplitude and frequency spectrum. Number of regenerating fibers, their diameter, and myelin thickness were histologically analyzed.

Results Both EMG parameters showed a significant (p < 0.05) effect of treatment at 6 and 12 weeks postsurgery. At 6 weeks, the fiber density was statistically different between treated and untreated animals with a higher observed density in treated nerves. No difference in fiber density was observed at 12 weeks postsurgery. The distribution of fiber diameters showed an effect at 12 weeks when only the sections of the nerves sutured with PRP showed fibers with diameters greater than 6 µm.

Discussion Our data show that the application of a PRP fibrin membrane around the neurorraphy improves the nerve regeneration process in a rat sciatic nerve model. The use of PRP as a suturable membrane could perform an action not only as a source of bioactive proteins but also as a nerve guide to hold the scar reaction and thus improve axonal regeneration.

Keywords

platelet-rich plasma - peripheral nerve surgery - sciatic nerve - electromyography - histology - rat
 

  • References

  • 1 Siemionow M, Brzezicki G. Chapter 8: current techniques and concepts in peripheral nerve repair. Int Rev Neurobiol 2009; 87: 141-172
    PubMedGoogle Scholar
  • 2 Yu W, Wang J, Yin J. Platelet-rich plasma: a promising product for treatment of peripheral nerve regeneration after nerve injury. Int J Neurosci 2011; 121 (4) 176-180
    CrossrefPubMedGoogle Scholar
  • 3 Marx RE. Platelet-rich plasma: evidence to support its use. J Oral Maxillofac Surg 2004; 62 (4) 489-496
    CrossrefPubMedGoogle Scholar
  • 4 Cervelli V, Lucarini L, Spallone D, Brinci L, de Angelis B. Use of platelet rich plasma and hyaluronic acid on exposed tendons of the foot and ankle. J Wound Care 2010; 19 (5) 186-, 188–190
    CrossrefPubMedGoogle Scholar
  • 5 Lacci KM, Dardik A. Platelet-rich plasma: support for its use in wound healing. Yale J Biol Med 2010; 83 (1) 1-9
    PubMedGoogle Scholar
  • 6 Lacoste E, Martineau I, Gagnon G. Platelet concentrates: effects of calcium and thrombin on endothelial cell proliferation and growth factor release. J Periodontol 2003; 74 (10) 1498-1507
    CrossrefPubMedGoogle Scholar
  • 7 Christgau M, Moder D, Hiller KA, Dada A, Schmitz G, Schmalz G. Growth factors and cytokines in autologous platelet concentrate and their correlation to periodontal regeneration outcomes. J Clin Periodontol 2006; 33 (11) 837-845
    CrossrefPubMedGoogle Scholar
  • 8 Whitman DH, Berry RL, Green DM. Platelet gel: an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery. J Oral Maxillofac Surg 1997; 55 (11) 1294-1299
    CrossrefPubMedGoogle Scholar
  • 9 Everts PA, Knape JT, Weibrich G , et al. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 2006; 38 (2) 174-187
    CrossrefPubMedGoogle Scholar
  • 10 Nurden AT. Platelets, inflammation and tissue regeneration. Thromb Haemost 2011; 105 (Suppl. 01) S13-S33
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Froum SJ, Wallace SS, Tarnow DP, Cho SC. Effect of platelet-rich plasma on bone growth and osseointegration in human maxillary sinus grafts: three bilateral case reports. Int J Periodontics Restorative Dent 2002; 22 (1) 45-53
    PubMedGoogle Scholar
  • 12 Molloy T, Wang Y, Murrell G. The roles of growth factors in tendon and ligament healing. Sports Med 2003; 33 (5) 381-394
    CrossrefPubMedGoogle Scholar
  • 13 Ranly DM, Lohmann CH, Andreacchio D, Boyan BD, Schwartz Z. Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice. J Bone Joint Surg Am 2007; 89 (1) 139-147
    CrossrefPubMedGoogle Scholar
  • 14 Shen YX, Fan ZH, Zhao JG, Zhang P. The application of platelet-rich plasma may be a novel treatment for central nervous system diseases. Med Hypotheses 2009; 73 (6) 1038-1040
    CrossrefPubMedGoogle Scholar
  • 15 Cho HH, Jang S, Lee SC , et al. Effect of neural-induced mesenchymal stem cells and platelet-rich plasma on facial nerve regeneration in an acute nerve injury model. Laryngoscope 2010; 120 (5) 907-913
    Google Scholar
  • 16 Elgazzar RF, Mutabagani MA, Abdelaal SE, Sadakah AA. Platelet rich plasma may enhance peripheral nerve regeneration after cyanoacrylate reanastomosis: a controlled blind study on rats. Int J Oral Maxillofac Surg 2008; 37 (8) 748-755
    CrossrefPubMedGoogle Scholar
  • 17 Emel E, Ergün SS, Kotan D , et al. Effects of insulin-like growth factor-I and platelet-rich plasma on sciatic nerve crush injury in a rat model. J Neurosurg 2011; 114 (2) 522-528
    CrossrefPubMedGoogle Scholar
  • 18 Farrag TY, Lehar M, Verhaegen P, Carson KA, Byrne PJ. Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model. Laryngoscope 2007; 117 (1) 157-165
    CrossrefPubMedGoogle Scholar
  • 19 Sariguney Y, Yavuzer R, Elmas C, Yenicesu I, Bolay H, Atabay K. Effect of platelet-rich plasma on peripheral nerve regeneration. J Reconstr Microsurg 2008; 24 (3) 159-167
    Google Scholar
  • 20 Ding XG, Li SW, Zheng XM, Hu LQ, Hu WL, Luo Y. The effect of platelet-rich plasma on cavernous nerve regeneration in a rat model. Asian J Androl 2009; 11 (2) 215-221
    CrossrefPubMedGoogle Scholar
  • 21 Piskin A, Kaplan S, Aktaş A , et al. Platelet gel does not improve peripheral nerve regeneration: an electrophysiological, stereological, and electron microscopic study. Microsurgery 2009; 29 (2) 144-153
    CrossrefPubMedGoogle Scholar
  • 22 Vozzi G, Dini F, Burchielli S , et al. Melt extruded PU hollow fibers for nerve regeneration: in vivo study. Veterinary Res 2011; 4 (4) 109-116
    PubMedGoogle Scholar
  • 23 Lundborg G. A 25-year perspective of peripheral nerve surgery: evolving neuroscientific concepts and clinical significance. J Hand Surg Am 2000; 25 (3) 391-414
    CrossrefPubMedGoogle Scholar
  • 24 Gigante A, Del Torto M, Manzotti S , et al. Platelet rich fibrin matrix effects on skeletal muscle lesions: an experimental study. J Biol Regul Homeost Agents 2012; 26 (3) 475-484
    PubMedGoogle Scholar
  • 25 Monteiro SO, Lepage OM, Theoret CL. Effects of platelet-rich plasma on the repair of wounds on the distal aspect of the forelimb in horses. Am J Vet Res 2009; 70 (2) 277-282
    CrossrefPubMedGoogle Scholar
  • 26 Dionyssiou D, Demiri E, Foroglou P , et al. The effectiveness of intralesional injection of platelet-rich plasma in accelerating the healing of chronic ulcers. An experimental and clinical study. Int Wound J 2013; 10 (4) 397-406
    CrossrefPubMedGoogle Scholar
  • 27 De Angelis B, Lucarini L, Orlandi F , et al. Regenerative surgery of the complications with Morton's neuroma surgery: use of platelet rich plasma and hyaluronic acid. Int Wound J 2013; 10 (4) 372-376
    CrossrefPubMedGoogle Scholar
  • 28 Li H, Han Z, Liu D, Zhao P, Liang S, Xu K. Autologous platelet-rich plasma promotes neurogenic differentiation of human adipose-derived stem cells in vitro. Int J Neurosci 2013; 123 (3) 184-190
    CrossrefPubMedGoogle Scholar