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

Antonio Merolli; Maria Lucia Manunta; Yong Mao; Gerolamo Masala; Giovanni Mario Careddu; Francesca Cubeddu; Maria Antonietta Evangelisti; Maria Letizia Guida; Caroline Antonia Verardi; Claudio Proietti; Andrea Manunta; Giuseppe Falvo D'Urso Labate; Gerardo Catapano; Marianne Polunas; Pedro Louro; Eraldo Sanna Passino

doi:10.1055/s-0038-1627472

Journal of Reconstructive Microsurgery, Table of Contents

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

¹New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, New Jersey

²Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy

,

Maria Lucia Manunta

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Yong Mao

¹New Jersey Center for Biomaterials, Rutgers – The State University of New Jersey, Piscataway, New Jersey

,

Gerolamo Masala

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Giovanni Mario Careddu

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Francesca Cubeddu

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Maria Antonietta Evangelisti

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Maria Letizia Guida

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

,

Caroline Antonia Verardi

²Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy

,

Claudio Proietti

²Department of Ortopedic Surgery, Universita' Cattolica del Sacro Cuore, Rome, Italy

,

Andrea Manunta

⁴Department of Ortopedic Surgery, Universita' di Sassari, Sassari, Italy

,

Giuseppe Falvo D'Urso Labate

⁵Department of Environmental and Chemical Engineering, Universita' della Calabria, Rende, Italy

,

Gerardo Catapano

⁵Department of Environmental and Chemical Engineering, Universita' della Calabria, Rende, Italy

,

Marianne Polunas

⁶Research Pathology Services, Rutgers – The State University of New Jersey, Piscataway, New Jersey

,

Pedro Louro

⁶Research Pathology Services, Rutgers – The State University of New Jersey, Piscataway, New Jersey

,

Eraldo Sanna Passino

³Department of Veterinary Surgery, University of Sassari, Sassari, Italy

› Author Affiliations

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

Full Text

References

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