말초신경 결손시 신경도관으로서 Gore-Tex® 도관의 유용성

The Availability of Gore-Tex® Tube as Nerve Conduit at the Peripheral Nerve Defect

  • 이기호 (충남대학교 의과대학 성형외과학교실) ;
  • 오상하 (충남대학교 의과대학 성형외과학교실) ;
  • 이승렬 (충남대학교 의과대학 성형외과학교실) ;
  • 강낙헌 (충남대학교 의과대학 성형외과학교실)
  • Lee, Ki Ho (Department of Plastic & Reconstructive Surgery, College of Medicine, Chungnam National University) ;
  • Oh, Sang Ha (Department of Plastic & Reconstructive Surgery, College of Medicine, Chungnam National University) ;
  • Lee, Seung Ryul (Department of Plastic & Reconstructive Surgery, College of Medicine, Chungnam National University) ;
  • Kang, Nak Heon (Department of Plastic & Reconstructive Surgery, College of Medicine, Chungnam National University)
  • 투고 : 2005.04.13
  • 발행 : 2005.09.10

초록

When a large peripheral nerve defect occurs, an autologous nerve graft is the most ideal method of recinstruction. But an autologous nerve graft has many limitations due to donor site morbidities. Many previous focused on finding the ideal nerve conduit. Among them, $Gore-Tex^{(R)}$ has several advantages over other conduits. It can be manipulated to a suitable size, does not collapse easily, and it is a semi- permeable material that contain pores. A round shaped nerve can be newly formed because of its smooth inner surface. The purpose of this study was to evaluate the availability of $Gore-Tex^{(R)}$ tube as a nerve conduit at the peripheral nerve defect in the rat sciatic nerve. The 10 mm nerve gap was made in each group. A $Gore-Tex^{(R)}$ tube filled with skeletal muscle was inserted and autologous nerve graft was harvested, respectively. In the experimental group, we placed a 0.5 mm thickness, $30{\mu}m$ pored, 1.8 mm in diameter and 14 mm length tube with skeletal muscle inserted inside. In the control group, the nerve gap was inserted with a rat sciatic nerve. We estimated the results electrophysiologically and histologically to 16 weeks postoperatively. Results in the nerve conduction velocity, total myelinated axon count, myelin sheath thickness and mean nerve fiber diameter, the experimental group was substantially lower than that of the control group, but the statistic difference was not significant (p<0.05). The morphology was very similar in both groups, microscopically. From the above results, We conclude that $Gore-Tex^{(R)}$ qualifies as an ideal nerve conduit. It is suggested that $Gore-Tex^{(R)}$ tube filled with skeletal muscle may, substitute for an autologous nerve graft.

키워드

참고문헌

  1. Hudson TW, Evans GD, Schmidt CE: Engineering strategies for peripheral nerve repair. Clin Plast Surg 26: 617, 1999
  2. Sandell M, Lundborg G, Kanje M: Vsacular endothelial growth factor stimulates Schwann cell invasion and neovascularization of acellular nerve grafts. Brain Res 219: 846, 1999
  3. Brunelli GA, Battiston B, Vigasio A, Brunelli G, Marocolo D: Bridging nerve defects with combined skeletal muscle and vein conduits. Microsurg 14: 247, 1993 https://doi.org/10.1002/micr.1920140407
  4. Dunnen WFAD, Lei BVD, Schakenraad JM, Stokroos I, Blaauw E, Bartels H, Pennings AJ, Robinson PH: Poly (DL-lactic-$\varepsilon$-caprolactone) nerve guides perform better than autologous nerve grafts. Microsurg 17: 348, 1996 https://doi.org/10.1002/(SICI)1098-2752(1996)17:7<348::AID-MICR2>3.0.CO;2-C
  5. Mackinnon SE, Dellon AL: Oinical nerve reconstruction with a bioabsorbable polyglycolic acid tube. Plast Reconstr Surg 85: 419, 1990 https://doi.org/10.1097/00006534-199003000-00015
  6. Danielsen N, Williams LR, Dahlin LB, Varon S, Lundborg G: Peripheral nerve regeneration in Goretex chambers. Scand J Plast Reconstr Surg 22: 207, 1988 https://doi.org/10.3109/02844318809097945
  7. Battiston B, Tos P, Cushway TR, Geuna S: Nerve repair by means of vein filled with muscle grafts I. Microsurg 20: 32, 2000 https://doi.org/10.1002/(SICI)1098-2752(2000)20:1<32::AID-MICR6>3.0.CO;2-D
  8. Tos P, Battiston B, Guena S, Giacobini-Robecchi MG, Hill MA, Lanzetta M, Owen ER: Tissue specificity in rat peripheral nerve regeneration through combined skeletal muscle and vein conduit grafts. Microsurg 20: 65, 2000 https://doi.org/10.1002/(SICI)1098-2752(2000)20:2<65::AID-MICR4>3.0.CO;2-4
  9. Soyer T, Lempinen M, Cooper P, Norton L, Eisenman B: A new venous prosthesis. Surg 72: 864, 1972
  10. Stanec S, Stanec Z: Reconstruction of upper-extremity peripheral-nerve injuries with ePTFE conduits. J Reconstr Microsurg 14: 227, 1998 https://doi.org/10.1055/s-2007-1000173