ABSTRACTsurgical techniques have been developed to reduce and prevent epineural scar formation (microsurgical techniques, endoscopic techniques, nerve transposition, dermofascial fat grafts, and muscle flap) (34). Daunorubicin or daunomycin (DNR) is a chemotherapeutic agent that is a member of the anthracycline family. It is used for some types of cancer treatment. Mostly, it is used for the treatment of specific types of leukemia (acute myeloid leukemia and acute lymphocytic leukemia). Daunorubicin usage is recommended locally after pterygium surgery, glaucoma surgery and strabismus surgery due to █
INTRODUCTIONThe main reason for the failure of peripheral nerve surgery is post-operative adhesion after surgery. Intraoperative nerve injury, bleeding or a simple manipulation of the nerve can result formation of scar tissue via thickening of the epineurium. Nerve compression that is caused by postoperative scarring may result in functional impairment and pain. Strong and prolonged adhesion of nerves to adjacent structures can give rise to ischemia and further nerve injury (22,27,33,39). Many AIM: Epineural adhesion after peripheral nerve surgery is common. The purpose of this study was to evaluate the macroscopic and histopathologic effects of topical mitomycin C and daunorubicin on epineural scar formation.
MATERIAl and METhODS:In this study, we used 15 rats (30 nerves). Two test groups and one control group were created. Sciatic nerve exposure was created bilaterally in each group (30 nerve examinations in total). In experimental group 1, cotton pads that had absorbed mitomycin C (0.5 mg/ml) were placed onto the nerves for 5 minutes while in experimental group 2, cotton pads that had absorbed daunorubicin (0.2 mg/ml) were placed onto the nerves for 5 minutes and cotton pads that had absorbed saline were applied to the control group. Eight weeks after the first surgery, surgical dissection was performed for the evaluation of neurolysis sites. Epineural adhesions were classified utilizing a numerical grading layout.
RESUlTS:We did not find any adverse effect with topically applied mitomycin C and daunorubicin. Within the 3 groups, no significant difference was seen in skin and fascia-muscle cavity closure (p>0.05). Macroscopically, mitomycin C and daunorubicin decreased the adhesion of sciatic nerve to adjacent structures. There was intensive epineural scar formation in the control group. Scar tissue thickness and fibroblast/fibrocyte cell number were less in the two test groups compared with the control group (p<0.001). There was no statistical difference between the two test groups.CONClUSION: Epineural scar formation after peripheral nerve surgery may be reduced by using topical application of mitomycin C and daunorubicin.