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Peg-fusion To Restore Electrophysiological Continuity And Function After Nerve Transection
Suvethavarshini Ketheeswaran, MD, John D. Luck, MD, Cameron L. Ghergherehchi, PhD, Jaimie T. Shores, MD.
Johns Hopkins, Baltimore, MD, USA.

PURPOSE: In this study, we tested whether Polyethylene glycol (PEG)-fusion repair of peripheral nerves could improve electrophysiological and behavioral functions in a large animal (swine) model of nerve repair.
METHODS: The median and ulnar nerves were both sharply transected above the elbow in Yorkshire pigs (n=2). The median nerve was irrigated with hypotonic calcium-free saline and methylene blue , then repaired with 9-0 sutures in standard fashion. PEG was applied directly to the coaptation site for 1-2min, followed by a final wash with Lactated Ringers solution. Electrophysiological testing of compound action potentials (CAPs) and compound muscle action potentials (CMAPs) was performed to measure if PEG resulted in the re-establishment of electrical connectivity between proximal and distal nerve segments.
RESULTS: Electrophysiological testing demonstrated the absence of CAPs or CMAPs after the nerve was repaired with sutures and re-establishment of CAP and CMAPs after application of PEG. Follow up studies 14 days post-operatively showed continual maintenance of CAPs in both pigs, and CMAPs in 1 of 2 pigs, suggesting axonal survival and maintenance of neuromuscular innervation.
CONCLUSION: PEG-fusion successfully re-established electrophysiological function after median nerve transection in swine, showing that PEG-fusion can be accomplished in larger animal models. Swine could be a particularly useful model for PEG-fusion of long nerve defects (>3cm) that are not possible in small animal models.


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