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2013 Harvard - Neurorrhaphy, Graft and Nerve Regeneration

6/20/2013
by

Andrew Yee

on 8 July 2013

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Transcript of 2013 Harvard - Neurorrhaphy, Graft and Nerve Regeneration

Schwann Cell Senescence
Immunohistochemistry
"Cellular Growth Arrest in Response to Over-Proliferation or Stress"
Schwann Cells
Axons
Day 5
Day 10
Day 15
Axonal Regeneration and Schwann Cell Migration
Schwann cells migrate prior to axonal regeneration.
Mechanism of Senescence
Schwann Cell Morphology
Myelinated Axon with Schwann Cell
Schwann Cell "Senescence"
Dispersed Chromatin
Long Nerve Graft Model
Proximal End
6cm ANA Nerve Graft
Distal End
Control
Proximal Graft
(Regeneration)
Distal Graft
Distal End
Dispersed Chromatin
Dispersed Chromatin
Co-Localization Fluorescence
Normal Nerve (Control)
Isograft (Regeneration)
ANA (Senescence)
S100 (Schwann Cells) - Red
p16 (Senescence)- Green
B-Galactosidase
p16
Proximal
ANA Graft
Distal
Isograft
ANA Graft
p16
p53
SAHFs - Senescence-associated Herterochromatin Foci
SASP - Senescence-associated Secretory Profile
B-Galactosidase
The Repair
Fibrin Glue
Suture
Reduced nerve fibers with naive surgeons suturing...
...no difference between glue and sutures with experienced surgeons.
Suturing takes significant time in naive surgeons...
Nerve Repair Time
Histomorphometry
Regeneration Distance
Vascularity
Inosculation
Nerve Gap
Nerve Isograft
Acellularized Nerve Allograft
Angiogenesis
~3 days for revascularization...
Nerve Capillary Growth
Few mm/day
Blood Vessel with Cells
+ VEGF
Vascular Endothelial Growth Factor
Flourescent Microscopy
Isograft
Acellularized Nerve Allograft
Acellularized Nerve Allograft + VEGF
3 Days - Midgraft
10 Days - Midgraft
5 Days - Midgraft
Immunohistochemistry
Evans Blue Albumin
Acellularized Nerve Allograft
Acellularized Nerve Allograft + VEGF
20 Days
CD31
- Vascular Endothelial Cells
S100
- Schwann Cells
DAPI
- General Nucleus
Increased Schwann Cell (
S100
) Migration
60mm Graft
Senescence
Schwann Cells
Conduit
Negative Effects on Regeneration
Distal Nerve
Conduit
Senescence
SCs
Reduced myelinated axons
Fluorescence Markers for Senescence and SCs
Colocalization
Isograft
Acellularized Allograft
2cm
4cm
2cm
4cm
Long Nerve Graft Model
Isograft
ANA
4cm
6cm
Histomorphometry
10 Weeks
NERVE GRAFTING
Effects of Distal Nerve
Neurorrhaphy, Grafting and Nerve Regeneration
Susan E. Mackinnon, MD

Plastic and Reconstructive Surgery
Washington University School of Medicine
St. Louis, MO
I, Susan E. Mackinnon, MD, am the co-inventor of the PGA Neurotube and have received research funding from AxoGen Inc.
NIH - 5R01 NS 033406-17
Nerve Allotransplantation for Traumatic Nerve Injury
NIH - 2R01NS05170606A1
The Effects of GDNF on Peripheral Nerve Regeneration
NERVE REPAIR
6cm
6cm
DISTAL NERVE
PROXIMAL NERVE
Sural Nerve Graft
Cross-Facial Nerve
Sural Nerve Graft
Subcutaneous
Position
No Distal Hook-up

Cross-facial Hook-up

Normal SCs
~10 days
~5 days
Nerve Surgery
Credits
Andrew Yee, BS
Peripherial Nerve Surgery Education
nervesurgery.wustl.edu

Surgical Video Library
https://vimeo.com/user6062882

Prezi Presentation
http://prezi.com/user/yeeandrew/
Full transcript