Application of 2 Different Hemostatic Procedures During Microsurgical Median Nerve Reconstruction in the Rat Does Not Hinder Axonal Regeneration

• Published in: Neurosurgery Vol. 68; no. 5; pp. 1399 - 1404
• Main Authors: Sinis, Nektarios, Manoli, Theodora, Schiefer, Jennifer Lynn, Werdin, Frank, Jaminet, Patrick, Kraus, Armin, Fornaro, Michele, Raimondo, Stefania, Geuna, Stefano, Schaller, Hans-Eberhard
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Oxford University Press 01.05.2011; Lippincott Williams & Wilkins; Wolters Kluwer Health, Inc
• Subjects: Biological and medical sciences; Hospitals; Laboratory animals; Medical sciences; Neurosurgery; Plastic surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveillance; Nerve reconstruction; Blood coagulation; Hemostatic agent; Rat; Nerve regeneration; Median nerve; Nervous system diseases; Hemostatic; Rodentia; Regeneration; Vertebrata; Mammalia; Animal; Surgery; Microsurgery
• ISSN: 0148-396X; 1524-4040
• DOI: 10.1227/NEU.0b013e3182127bc4

Abstract BACKGROUND: Hemostatic procedures by means of electrical coagulation or application of topical agents are widely used to avoid postoperative bleeding during microsurgical reconstruction of peripheral nerves. It is speculated, however, that extensive hemostasis could provoke significant nerve damage. OBJECTIVE: To examine the effects of 2 intraoperative hemostatic procedures on peripheral nerve regeneration. METHODS: In 36 adult rats divided into 3 groups, the median nerve was transected and repaired by end-to-end neurorrhaphy. During surgery, bleeding was treated in groups 2 and 3 by application of either the topical hemostatic agent Floseal or routine bipolar coagulation. The degree of nerve regeneration was assessed in terms of motor function recovery using weekly grasping test evaluation for 3 months, muscle mass recovery of flexor digitorum sublimis, and stereological assessment of myelinated axon regeneration. RESULTS: Neither of the 2 applied hemostatic methods induced any negative effects on nerve regeneration as defined by grip strength, muscle mass recovery, and morphology of myelinated nerve fibers. In contrast, Floseal-treated animals showed a faster progression of motor function recovery, and animals subjected to bipolar coagulation revealed a higher muscle mass recovery compared with the control group. CONCLUSION: Controlled application of bipolar coagulation or Floseal does not exert a negative effect on the nerve regeneration outcome in rats. We propose that these methods can be applied safely to patients.