ABSTRACT
Healing of a transected nerve is not always optimal even if it is repaired with an ideal microsurgical technique. We studied the effects of solitary and combined usage of amniotic membrane (AM) wrapping and granulocyte-colony-stimulating factor (GCSF) injections after primary repairs of transected sciatic nerves of Wistar rats. No repair was performed in group 1, primary nerve repairs were performed in group 2, AMs were wrapped around repair sites in group 3, in addition to AM wrapping G-CSF injections were performed in group 4, and only G-CSF injections were performed in group 5. Nerve regeneration was assessed by clinical tests at the 4th, 8th, and 12th weeks and by electrophysiological studies and histological evaluations at the end of the 12th week. Group 4 rats gave earlier responses to clinical tests that showed a stable increase throughout the study. In electrophysiological studies, the mean amplitude values were higher in group 4 whereas mean latency and duration values were higher in group 1. At the end of the 12th week, the morphology of the distal nerve segment was similar to healthy nerves in the absence of fibrosis in group 4. The comparison of mean scores of axonal counting under the light microscope revealed that scores of group 4 were higher than the other groups in a statistically significant manner. Electron microscopy revealed that samples from groups 3 and 4 had high numbers of axons possessing myelin sheaths of normal thickness, as well as less inter-axonal fibrosis. In terms of both axonal diameter and myelin thickness, groups 2, 3, and 4 had higher values than groups 1 and 5. As a conclusion, both AM wrapping and G-CSF injection have a supportive effect on nerve regeneration, and this effect is further potentialized by their combined use.
Subject(s)
Amnion , Granulocyte Colony-Stimulating Factor/pharmacology , Nerve Regeneration/drug effects , Peripheral Nerve Injuries/drug therapy , Sciatic Neuropathy/drug therapy , Animals , Bandages , Combined Modality Therapy , Disease Models, Animal , Electromyography , Injections, Intralesional , Likelihood Functions , Male , Nerve Regeneration/physiology , Neurosurgical Procedures/methods , Peripheral Nerve Injuries/diagnosis , Peripheral Nerve Injuries/surgery , Random Allocation , Rats , Rats, Wistar , Recovery of Function , Sciatic Neuropathy/surgeryABSTRACT
UNLABELLED:  This study evaluates the efficacy of a vacuum-assisted closure (V.A.C.® Therapy, KCI, San Antonio, Tex) device in the comparative management of clean and infected wounds. Vacuum-assisted closure was applied to 57 wounds of 51 patients. METHODS: Our protocol consisted of debridement of all necrotic tissue followed by vacuum-assisted closure therapy along with appropriate antibiotic administration. In 5 cases with peripheral circulation impairment, vacuum-assisted closure therapy was terminated due to a poor tissue response. In the remaining 52 wounds, healthy granulation tissue generation was observed. Wound cultures obtained from these patients prior to the start of vacuum-assisted closure proved the presence of infection in 31 wounds, while the other 21 wounds were free of infection. RESULTS: The average sizes of the infected and non-infected wounds were 55.77 cm2 and 57.94 cm2 prior to the start of vacuum-assisted closure, respectively, while they were reduced to 48.28 cm2 and 45.70 cm2 after the last session. At the conclusion of vacuum-assisted closure therapy, 42 wounds were skin grafted and 10 wounds were covered with skin/muscle flaps. CONCLUSION: Vacuum-assisted closure therapy is a reliable tool in the management of almost any type of wound, whether infected or not infected, unless major circulatory impairment interferes and acted as a contributory factor in wound formation. .
