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Comparison of collagen biomatrix and omentum effectiveness on peripheral nerve regeneration

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Abstract

Despite the presence of various nerve coaptation materials and techniques, achievement of the functional nerve regeneration is still inadequate. This study was aimed to compare the effectiveness of conduit composed of collagen biomatrix and omentum graft on peripheral nerve regeneration. Thirty-five male Wistar rats were divided into four groups. In the control group, the right sciatic nerve was skeletonized from the sciatic notch till the point of bifurcation. In the primary epineural repair group, the nerve was transected 1 cm proximal to the bifurcation with a sharp pair of micro scissors and then repaired with four epineural sutures. In the collagen biomatrix group, the epineural repaired nerve was wrapped with collagen biomatrix. In the collagen group, the epineural repaired nerve was wrapped with the nonpediculated omentum. Assessment of the nerve regeneration was based on functional (Walking Track Analysis, Electrophysiological Measurements), histological, and morphometric criteria. Light and electron microscopic examinations showed that collagen-biomatrix-wrapped specimens have the best regeneration. The electrophysiological study confirmed the recovery of electrical activity in the regenerated axons.

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Authors and Affiliations

  1. Department of Neurosurgery, Gazi University School of Medicine, Beşevler, 06500, Ankara, Turkey

    Berker Cemil & Memduh Kaymaz

  2. Departments of Physical Medicine and Rehabilitation, Gazi University School of Medicine, Beşevler, 06500, Ankara, Turkey

    Durukan Ture

  3. Department of Histology and Embryology, Medical University of Hacettepe, Sihiye, 06550, Ankara, Turkey

    Figen Kaymaz

  4. Department of Statistics, Middle East Technical University, 06531, Ankara, Turkey

    Banu Cevirgen

  5. Fazilet Mahallesi, Muvazi Sokak, 3/2, Diskapi, 06100, Ankara, Turkey

    Berker Cemil

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  1. Berker Cemil
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  2. Durukan Ture
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  3. Banu Cevirgen
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  4. Figen Kaymaz
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Correspondence to Berker Cemil.

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Comments

Ugur Türe, Istanbul, Turkey

The authors have provided a clear and concise experimental study that assessed peripheral nerve regeneration in Wistar rats. The authors transected the sciatic nerve and compared the effectiveness of a conduit composed of a collagen biomatrix and omentum graft on peripheral nerve regeneration. They made a functional assessment of the regeneration with the Walking Track Analysis and electrophysiological measurements. The authors have supported their findings with a histological assessment and electron microscopy.

A comparison of the thickness of myelin between the test groups showed that the collagen biomatrix group had greater scores, and the nerve velocity values of this group were also greater. The authors noted that the collagen biomatrix minimizes the foreign-body reaction and provides a properly aligned matrix scaffold that allows regular Schwann cell proliferation and blocks fewer axons.

Interesting findings of the study are the results of the Omentum Group. The results in this group were even worse than those of patients undergoing primary epineural repair. These findings are not in accordance with the regeneration-activating character of the omentum. The authors associate this worse alignment with a poorer quality of nourishment of the omentum cells. Another interesting finding is the average number of myelinated fibers. In all groups, this number is higher than in the control group. The authors believe this result is from multiple aberrant axonal sprouting from the proximal nerve fiber and that the regenerated nerve fibers had not matured completely in the regenerated segment by a 12-week period.

The results of this study have implications for neurosurgeons who perform peripheral nerve surgery. The take-home message is that the biological and mechanical structure of the graft material is very important in achieving an effective nerve regeneration and the collagen biomatrix may really support nerve regeneration. We may have further information to contribute. Dubey et al. (1) noted that, in repairing transected nerves, a solution could be to find bioresorbable collagen nerve guides with magnetically aligned collagen gel implanted in the surgical gaps. This procedure might stimulate the correct orientation and fasten both the speed and functional success of the regeneration.

Reference

1. Dubey N, Letourneau PC, Tranquillo RT. Guided neurite elongation and Schwann cell invasion into magnetically aligned collagen in simulated peripheral nerve regeneration. Exp Neurol. 1999 Aug;158(2):338-50.

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Cemil, B., Ture, D., Cevirgen, B. et al. Comparison of collagen biomatrix and omentum effectiveness on peripheral nerve regeneration. Neurosurg Rev 32, 355–362 (2009). https://doi.org/10.1007/s10143-009-0193-5

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  • DOI: https://doi.org/10.1007/s10143-009-0193-5

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