Experimental repair of phrenic nerve using a polyglycolic acid and collagen tube Makoto Yoshitani, MD, Seijun Fukuda, MD, Shin-ichi Itoi, MD, Shigeyuki.

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Presentation transcript:

Experimental repair of phrenic nerve using a polyglycolic acid and collagen tube Makoto Yoshitani, MD, Seijun Fukuda, MD, Shin-ichi Itoi, MD, Shigeyuki Morino, MD, Hiroyuki Tao, MD, Akira Nakada, MD, Yuji Inada, MD, Katsuaki Endo, MD, Tatsuo Nakamura, MD The Journal of Thoracic and Cardiovascular Surgery Volume 133, Issue 3, Pages 726-732.e3 (March 2007) DOI: 10.1016/j.jtcvs.2006.08.089 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A, Overview of PGA–collagen tube filled with collagen of piled thin film structure (left, transverse section). B, Scanning electron micrograph image of a PGA–collagen nerve tube: The inner space of the tube is filled with collagen of piled thin film structure. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative view after implantation of a PGA–collagen tube: The cut ends of the phrenic nerve on both sides were inserted 5 mm into the nerve tube. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Surgical procedure for covering with a pedicled pericardial fat pad: A pedicled pericardial fat pad with a blood supply originating from the internal thoracic artery is detached from the pericardium and rotated to cover the site of tube implantation. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Still image of the maximum expiration and inspiration, obtained and traced from an x-ray film record 5 weeks (left) and 4 months (right) after implantation in the same dog: At 5 weeks after the operation, the paralyzed diaphragm (right side of the dog) is elevated and immobile, and at 4 months, both sides of the diaphragm are moving synchronously. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 A, MAPs examined on a group II dog 12 months after tube implantation (top), recorded from electrodes placed on the diaphragm by stimulating the proximal side of the phrenic nerve: The M wave is observed at 3.5 msec after the trigger point, and the amplitude is lower than the control (bottom), although the wave pattern is similar. B, MAPs examined in the same way at the left phrenic nerve (not implanted) of a group II dog: The M wave is observed 2.8 msec after the trigger point, and the MAP of the diaphragm shows a normal wave pattern. MAP, Muscle action potential. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 A, Open thorax view of the site of reconstruction 4 months after tube implantation: The regenerated nerve can be seen between the suture knots. B, Gross view of the phrenic nerve harvested en bloc with the pericardium and diaphragm showing the proximal side of the implanted/regenerated part to the diaphragm 12 months after implantation in a group II dog: Adhesive tissue is present around the area of the implanted tube, and the phrenic nerve runs continuously to the diaphragm. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 A, Light microscopic transverse section 2 cm proximal to the side of tube implantation in a group II dog, harvested 12 months after implantation. Toluidine blue stain ×400: The normal phrenic nerve composition is evident (Figures A to C were obtained from the same dog). B, Light microscopic transverse section through the center of the tube implantation site in a group II dog, harvested 12 months after implantation, Toluidine blue stain ×400: Although the number and the diameters of the fibers are smaller, the nerve fibers have clearly regenerated. C, Light microscopic transverse section 2 cm distal to the site of tube implantation in a group II dog, harvested 12 months after implantation. Toluidine blue stain ×400: Various sizes of fibers are present, suggesting that some have regenerated. The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 A, Transmission electron micrograph of the proximal phrenic nerve of a group II dog, harvested 12 months after tube implantation, 2 cm proximal to the distal side of cut end: Myelinated and unmyelinated fibers and Schwann cells are observed. (Figure E3, A, B, C is obtained from the same dog.) B, Transmission electron micrograph of a nerve tube implanted in the phrenic nerve of a group II dog, harvested 12 months after the implantation, in the center of the area where the tube was implanted: All the fibers are regenerated nerve fibers, including the myelinated and unmyelinated fibers; the wall of the nerve fibers is thinner than on the proximal side (Figure E3, A). C, Transmission electron micrograph of the distal phrenic nerve of a group II dog, harvested 12 months after tube implantation, 2 cm distal to the distal cut end: Some thin-walled and some thick-walled fibers are observed, together with myelinated and unmyelinated fibers, and the wall of the nerve fibers is thinner than on the proximal side (Figure E3, A). The Journal of Thoracic and Cardiovascular Surgery 2007 133, 726-732.e3DOI: (10.1016/j.jtcvs.2006.08.089) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions