Autologous Fascia Nerve Wrap in a Rodent Primary Epineurial Repair Model and Preliminary Case Series

BACKGROUND: Nerve wraps composed of various autologous and bioengineered materials have been used to bolster nerve repair sites. In this study, we describe the novel use of autologous fascia nerve wraps (AFNW) as an adjunct to epineurial repair and evaluate their effect on inflammatory cytokine expression, intraneural collagen deposition and end-organ reinnervation in rats and use of AFNW in a patient case series. METHODS: Lewis rats received sciatic transection with repair either with or without AFNW, sciatic-to-common peroneal nerve transfer with or without AFNW, or sham surgery (n=14/group). AFNW (1 cm 2 ) were obtained from gluteal muscle fascia. Cytokine expression was assessed at both the coaptation site and L3-L5 dorsal root ganglia (DRG) at 4 weeks following repair using ELISA. Intraneural scarring and end-organ reinnervation were evaluated at 12 weeks. We also demonstrate the clinical application of AFNW for various potential indications in 28 patients. RESULTS: AFNW-treated animals demonstrated a significant (p<0.001) decrease in pro-inflammatory cytokines (TNF-α and IL-1β) and increase in anti-inflammatory cytokines (TGF-β and IL-10) within the L3-L5 DRGs and at the coaptation site. AFNW also resulted in reduced intraneural collagen content and an increased mean number of retrograde labeled sensory neurons (p<0.01). Patients receiving AFNW demonstrated favorable motor and sensory functional outcomes and no significant reports of neuropathic pain or other complications. CONCLUSION: AFNW serve as a valuable adjunct to epineurial coaptation that reduces intraneural inflammation and collagen deposition in both size-matched and size-mismatched nerve coaptations in a rodent model. Initial clinical experience with AFNW demonstrates feasibility for various indications. CLINICAL RELEVANCE: Our early clinical experience with AFNW demonstrates safety, practicality, technical feasibility, and cost-effectiveness and serves to identify a set of potential indications for nerve wrapping that warrant further consideration.