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SWH Research Marra

Axonotactic CultiGuides for Peripheral Nerve Regeneration

Kacey Marra, PhD

University of Pittsburgh

The immediate utility of our axonotactic nerve guides is in the battlefield. Soldiers can experience peripheral nerve trauma resulting from gunshot wounds, grenades, missiles and other war dangers. For example, during the Croatian War, 713 patients who suffered from wounds from firearms were examined. Single peripheral nerve lesions were present in 80% of the patients, while multiple peripheral nerve injuries were present in 20% of the patients. These wounds were inflicted by shell fragments in 80% of the patients and by projectiles in 20% of the patients. Peroneal and ulnar nerves were most often involved. In another study, injuries to 63 soldiers from January 1995 to December 1999 were examined, and it was found 11.8% of the patients had nerve injuries due to high-velocity missiles. In 1999, it was reported that three patients had undergone digital nerve repair by autogenous vein graft, due to high-velocity gunshot wounds. This grafting technique was simple and produced satisfactory results. During the period of 1991-93, there were 931 casualties with 1435 injured peripheral nerves surgically treated at the Clinic for Neurosurgery of the Military Medical Academy. The 12-36 month post-operative results of surgical treatment and found that 85% of the patients undergoing radial nerve repair had good to excellent results, while only 13.3% of the patients undergoing peroneal nerve repair had good to excellent results. In addition to direct wounds to the peripheral nerves, there are other battlefield instances that may require nerve repair, such as bilateral peroneal nerve palsy induced by prolonged squatting. Although this compression neuropathy may recover spontaneously, surgical intervention is needed for those patients with predominantly axon lesions and who do not recover for three months.

There is clearly a need for an alternative method for bridging nerve gaps. The occurrence of peripheral nerve injuries is known, and it is well known that a suitable nerve guide is still needed. We propose to develop a nerve guide that is biodegradable, inexpensive, stable at room temperature, and easily implanted. We anticipate that our guide will have the ability to regenerate peripheral nerves over long gaps, which is not possible with the current nerve guides.