Use of human fat grafting in the prevention of perineural adherence: Experimental study in athymic mouse

Abstract

Perineural adherences represent a problem after surgery involving peripheral neural system. Fat-grafting with adipose derived stem cells (ASCs) with their pro-regenerative characteristics can be important to prevent the neural damage or to facilitate the neural regeneration. Our idea was to use the fat-grafting as an anti-adherence device and test its efficacy on a postsurgical scar animal model and comparing to an antiadhesive gel. 32 athymic mice were operated under magnification, we exposed both sciatic nerves. We randomly divided all sciatic nerves into four experimental groups: burning (1), burning + carboxy-methylcellulose and poly- ethylene oxide (CMC-PEO) (2) + human adipose fat tissue (3), control group (4). Bio-mechanical evaluation was performed to measure the peak force required to pull out the nerve from the muscular bed. Results: in the CMC-PEO group the peak pull out force was 0.37 Newton. In the fat grafted group we registered a peak pull out force of 0.35 N (t Student 0.913). In burning group the force necessary to tear the nerve apart was markedly superior (0.46 N). In control group, we reported the minimal strength (0.31 N) to slide the nerve from the tissue. Histologically, in the group treated with fat-grating, a thinner scar layer was highlighted. Considering the results of this study we can support the efficacy in animal experimental model of fat graft as an anti-adherence device in peripheral nerve surgery.

Adipose tissue stem cells in peripheral nerve regeneration—In vitro and in vivo

“…The injection of fat grafts around a coapted sciatic nerve in rats leads to reduced perineural adherence and minor scar formation (Cherubino et al., 2017). Furthermore, ASCs have been solely investigated for peripheral nerve regeneration (for an overview, see Table 1).…”

Medial Sural Perforator “Nerve through Flap”: Anatomical Study and Clinical Application

“…One of the main complications in nerve surgery is perineural adherence involving the peripheral nerve system and this is more evident in mangled limbs [24]. In spite of the numerous anti-adherence devices and techniques have been developed in the last years to prevent the physiologic onset of perineural fibrosis after a surgical trauma, few reports are available in literature regarding the efficacy of these types of barriers in the peripheral neural system [15]. In some cases, ALT flap with femoral cutaneous nerve has been used in order to transfer a composite flap restoring both skin and nervous continuity, but in most cases this flap is quite thick compared to hand skin [1,2].…”

“…Perineural adherences can become a major problem after any surgery involving the peripheral nerve system, independently from vascularization of the nerve transfer and this is more evident in mangled limbs. Despite the numerous anti-adherence devices and techniques employing autologous tissues that have been developed in the last years to prevent the physiologic onset of perineural fibrosis after a surgical trauma, few reports are available in literature regarding the efficacy of these types of barriers in the peripheral neural system [15,16].…”

Experimental Methods to Simulate and Evaluate Postsurgical Peripheral Nerve Scarring

“…Finally, some recent papers have described a simple and cheap method that consists of connecting the nerve to a plastic can that is gradually filled with water at a constant flow of 100 mL/min. The adhesion force is obtained from the grams of water at the break moment [ 20 , 70 , 71 ].…”

“…The use of fat grafting in the prevention of peripheral scar tissue formation has had different results: it produces nerve stiffness reduction in biomechanical testing [ 66 ], but no significant differences were reported when compared to other antiadhesion devices. Moreover, in microscopical analysis, it appears to be able to reduce scar thickness [ 70 ].…”