ABSTRACT
The inside-out vein graft is a vein conduit pulled through itself to invert the normal orientation and place the adventitial layer within the lumen of the conduit. Our study compares regeneration of peripheral nerves in the rat through two conduits: inside-out graft of the jugular vein and autogenous nerve graft. In 10 rats, the right jugular vein was harvested, turned inside out, and used to bridge a 10 mm defect created in the right sciatic nerve. The 10 mm nerve segment from the right was then used as a standard nerve graft to bridge a 10 mm gap created in the left sciatic nerve. Rats were sacrificed at 8 and 12 weeks. Regeneration on the inside-out vein graft side showed superior functional results (faster conduction velocities) and improved histological results (greater axon counts) compared with the nerve grafted side. We feel the adventitial surface of the wall of the vein promotes nerve regeneration by providing an environment rich with collagen, laminin, and Schwann cells and promotes increased vascularization of the new nerve.
Subject(s)
Jugular Veins/transplantation , Nerve Regeneration , Sciatic Nerve/surgery , Sciatic Nerve/transplantation , Action Potentials/physiology , Amidines , Animals , Axons/ultrastructure , Benzofurans , Electromyography , Fluorescent Dyes , Ganglia, Spinal/ultrastructure , Jugular Veins/pathology , Microsurgery , Neural Conduction/physiology , Rats , Rats, Sprague-Dawley , Reaction Time/physiology , Sciatic Nerve/physiology , Sciatic Nerve/ultrastructure , Transplantation, AutologousABSTRACT
This study was designed to evaluate the feasibility of CO2 laser-assisted repair of esophageal injuries. Nine-millimeter longitudinal incisions were made in the cervical esophagus of 40 Sprague-Dawley rats. The rats were divided into two groups. Twenty rats in Group 1 had their incisions closed in two layers (mucosa and muscularis) with the I.L. Med Unilase microsurgical CO2 laser (LAREL), using 80 mW of power with a spot size of 200 mu (power density = 255). Twenty rats in Group 2 had their incisions closed in two layers using 8-0 Vicryl conventional suture technique (CST). Postoperatively, an intraluminal methylene blue injection evaluated patency and leakage. Histologic analysis was performed at 3 days, 2 weeks, 1 month, and 6 months. Patency rates of LAREL and CST were comparable. No fistulas or strictures were found with either technique. Laser-assisted repair of esophageal lacerations (LAREL) was found to be faster and easier than CST. The question arises whether small esophageal tears can be safely repaired through the endoscope. This study demonstrates the feasibility of tissue welding the esophagus. Further research is mandatory to study the applicability of this technique in the clinical setting.
