Electrical welding technology in restoring the integrity of the injured peripheral nerve: review of literature and own experimental research
Keywords:peripheral nerve injury, neurorrhaphy, weld biological tissue, peripheral nerve regeneration
Mechanical damage to the peripheral nerve is a disabling type of trauma with high cumulative potential, treatment and rehabilitation of which remains an important medical problem. At present, neurorrhaphy is a ubiquitous means of connecting stumps of a crossed nerve. The disadvantages of the method are the manual complexity and prolongation of local inflammatory reactions by persistent suture material. Alternatively, methods of glue, laser, photochemical, nanocomposite or, least studied, electric welding compounds are considered.
A series of studies performed on adult white outbred male rats evaluated the efficacy and safety of multiple point-welded epineural joints of the sciatic nerve stump after crossing it. In particular, it was found that the tested type of connection provides a fast and reliable fixation of the stump of the crossed nerve, which by Sciatic Functional Index values is 2 months faster, but ultimately does not differ from neurorrhaphy. Instead, the amplitude of the electrical M-response of the paretic calf muscle and the density of nerve fibers in the regeneration neuroma thickness are significantly higher after 5 months after the weld, and the angle of deviation of the fibers from the nerve axis is substantially smaller than after neurorrhaphy.
In general, the effectiveness of a welded joint is no worse than an epineural surgical suture, in some respects better, as it requires less time and resources. The study also attempts to pathophysiologically interpret the data and compare them with the results of testing other seamless means of restoring the integrity of the crossed nerve.
In our opinion, the obtained experimental data against the background of the results of other research groups motivate the clinical validation of the proposed method.
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