Floor plan - 2013 Annual Meeting - American Association for Hand ...

Nerve Regeneration through Nerve Autografts after Local Administration of Brain Derived
Neurotrophic Factor (Bdnf) with Osmotic Pumps
Institution where the work was prepared: Clinica Universitaria. Universidad de Navarra, Pamplona, Spain
Bernardo Hontanilla, MD, PhD; Cristina Aubá; Oscar Gorria; Clínica Universitaria, Universidad de Navarra
OBJECTIVE:
To determine if administration of brain-derived neurotrophic factor (BDNF) with osmotic pumps at the site of the proximal stump of a
peripheral nerve autograft can improve the peripheral nerve regeneration.
METHODS:
Tibialis branch of sciatic nerves were transected and grafted with a 20 mm nerve autografts. Wistar rats (n=70) were divided into four
groups: a non-grafted control group (group I, n=10), a grafted but non-treated control group (group II, n=20), a grafted saline-treated
group (group III, n=20), and finally a grafted and BDNF-treated group (group IV, n=20). BDNF was delivered at a rate of 6 µg/day for 2
weeks after nerve repair, using osmotic pumps subcutaneously implanted with a connecting tube, the distal end of which faced the
proximal stump of the nerve graft. The animals were sacrificed at 6 weeks. Spinal motoneurons were quantified as well as axons at the
tibialis branch 5 mm distal to the distal nerve repair site. Neuron size was categorised as large (>25 µm) or small (0.1). Finally, there were no statistically significant differences between groups II, III and IV regarding the number of
distal axons.
CONCLUSION:
BDNF delivered through osmotic pumps demonstrates a significant capacity for improving the presence of motoneurons in the ventral
spinal horn and then the capacity to improve nerve regeneration thorough nerve autografts. However, in this study BDNF does not specially
protect from injury to motoneurons depending of the soma size.
Peripheral Nerve Surgery: Pre-Operative Variables Associated with Outcome Failures
Institution where the work was prepared: Georgetwon University Hospital, Washington, DC, USA
Ivica Ducic, MD, PhD; Emily Hartmann; Georgetown University Hospital
A wide range of outcomes in peripheral nerve surgery are reported and are linked to the type of nerve injury or neuropathy and the
type of surgery designed to address the cause. Even with proper meta-analysis of available data, it is still not possible to normalize
specifics to each reported outcome, so rather false conclusions about variables associated with post-operative failures are commonly
encountered. In order to address these issues, controlling the patient selection criteria, type of surgeries and follow-up, a single surgeon
outcome failures were analyzed identifiying what is common had patients that failed the same type of the surgery when compared
to the one with success.
Fifteen hundred consecutive patients that underwent peripheral nerve surgery by a single surgeon were identified. Patients were sent
a survey asking them about their outcome (reduction in pain, return to pre-injury daily function – sensory/motor improvement, quality
of life improvement). Only patients who had less then 50% of improvement with surgery were then analyzed (n = 425; 28.3%). Outcomes
were measured with minimum of one year follow up (range 1-3 years).
Out of 425 patients, 41 (9.6%) were on methadone, 350 (82%) had pain longer then 3 years pre-op, 429 (88.2%) had depression, 330
(77%) had workmen's compensation, 220 (52%) had surgery on more then 3 nerves at the same time. Each of 425 patients had one variable
present, 69% had two and 31% three or more variables. Complete failure of surgery for patients with three of more variables (131)
was the outcome.
Although we often present our best results, it is important to consider these findings when evaluating and consenting patients for
peripheral nerve surgery.
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