Effects of Hyaluronic Acid-Carboxymethylcellulose Membrane on Extraneural Adhesion Formation and Peripheral Nerve Regeneration

Abstract

The goal of nerve repair in the peripheral nervous system is to increase the number of axons passing from proximal to distal stump, and to enable the regenerated axons to reach the end organ as soon as possible. In the present study, the effect of the membrane formed by a mixture of hyaluronic acid and carboxymethylcellulose (HA-CMC) on nerve regeneration and perineurial scar formation was investigated. Eighteen New Zealand rabbits were allocated into control (n = 9) and experimental groups (n = 9). In the control group, conventional nerve repair was carried out following the transection of the sciatic nerve, while in the experimental group, following repair of the nerve, the repair line was covered by HA-CMC membrane extending 1 cm beyond the distal and proximal ends. Nerve regeneration and extraneurial adhesion formation were compared between the two groups 3 months later. It was observed that adhesion in the surrounding tissues was significantly less in the experimental group than in the control group. Furthermore, morphometric analysis of specimens obtained from the distal parts of nerves showed that the number of axons with myelin was higher in the experimental group than in the control group, with a statistically significant difference. Histologic sections obtained from the nerve repair line demonstrated that extraneural and intraneural fibrosis was significantly lower in the experimental group. It was concluded that HA-CMC membrane had a favorable effect on nerve regeneration, as well as extraneural scar formation, encouraging the clinical application of HA-CMC following nerve injuries.

Use of a Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier on the Neurovascular Bundle and Prostatic Bed to Facilitate Earlier Recovery of Erectile Function After Robot-Assisted Prostatectomy: An Initial Experience

“…7,8,[17][18][19] The role of HACM may be therapeutic as well as protective. The 2003 study by Adanali and colleagues 9 concluded that HACM use with concurrent repair of sciatic nerve injuries in rabbits resulted in a statistically significant improvement in the number of viable axons 3 months after surgery and a reduction in perineural fibrosis. 9 The introduction of a locally active agent as a physical barrier around the NVBs to separate them from adjacent inflammatory tissue and reduce fibrosis is a novel concept.…”

“…The 2003 study by Adanali and colleagues 9 concluded that HACM use with concurrent repair of sciatic nerve injuries in rabbits resulted in a statistically significant improvement in the number of viable axons 3 months after surgery and a reduction in perineural fibrosis. 9 The introduction of a locally active agent as a physical barrier around the NVBs to separate them from adjacent inflammatory tissue and reduce fibrosis is a novel concept. Unlike an individual's surgical technique, HACM use can be standardized in its dosage, delivery, and target area to improve early potency outcomes after RARP.…”

“…More interestingly, it has been demonstrated in rabbits that HACM improves peripheral nerve regeneration. 9 We hypothesized that placing HACM gel around the anatomic location of the NVBs intraoperatively limits local inflammatory response and reduces fibrosis, thus hastening return of neural activity and potency. We present our initial experience with HACM use in RARP.…”

Peripheral Nerve Reconstruction Using Enriched Chitosan Conduits

“…In the peripheral nerves, HA is one of the prominent components of the Bunger band formed during Wallerian degeneration, and the ablation of HA receptors can reduce cell adhesion and migration [15]. Several studies showed that HA has a positive effects on peripheral nerve regeneration [16,17].…”

Clinical evaluation of a hyaluronan‐based gel following microsurgical reconstruction of peripheral nerves of the hand

“…2 An HA-carboxymethylcellulose membrane has also been shown to decrease the formation of both intraand extraneural fibrosis in rabbits. 3 Hyaloglide 1 (Fidia Advanced Biopolymers, Abano Terme, Italy) is a crosslinked hyaluronan gel that is both biocompatible and bioreabsorbable, with a degradation pathway equivalent to HA. It also has improved viscoelastic properties compared to unmodified HA solutions of the same molecular weight.…”