Abstract   

 B. Kern, J. D. Budihardjo, S. Mermulla, A. Quan, C. Cadmi, J. Lopez, M. Khusheim, S. Xiang, J. Park, G. J. Furtmüller, K. A. Sarhane, S. Schneeberger, W. P. A. Lee, A. Hoke, S. H. Tuffaha, G. Brandacher              

Improved nerve regeneration and functional outcomes would greatly  enhance the utility of vascularized composite allotransplantation (VCA)  such as hand and upper extremity transplantation. However, research  aimed at achieving this goal has been limited by the lack of a  functional VCA animal model. We have developed a novel rat midhumeral  forelimb transplant model that allows for the characterization of upper  extremity functional recovery following transplantation. At the final  end point of 12 weeks, we found that animals with forelimb  transplantation including median, ulnar and radial nerve coaptation  demonstrated significantly improved grip strength and forelimb function  as compared to forelimb transplantation without nerve approximation  (grip strength: 1.71N ± 0.57 vs. no appreciable recovery; IBB scale: 2.6  ± 0.7? vs. 0.8 ± 0.40; p = 0.0005), and similar recovery to nerve  transection-and-repair only (grip strength: 1.71N ± 0.57 vs. 2.03 ±  0.42.6; IBB scale: 2.6 ± 0.7 vs. 2.8 ± 0.8; p = ns). Moreover, all  forelimb transplant animals with nerve coaptation displayed robust  axonal regeneration with myelination and reduced flexor muscle atrophy  when compared to forelimb transplant animals without nerve coaptation.  In conclusion, this is the first VCA small-animal model that allows for  reliable and reproducible measurement of behavioral functional recovery  in addition to histologic evaluation of nerve regeneration and graft  reinnervation.     

Karim Sarhane vanderbilt

First published: 08 August 2016
https://doi-org.proxy1.library.jhu.edu/10.1111/ajt.14007
Citations: 5