Sciatic nerve injury model in rabbits: What to expect.

Rabbits are commonly used for sciatic nerve injuries larger than 1.5 cm. This report provides insight into risks and benefits associated with using rabbit models in sciatic nerve injury models and proposes interventions that researchers can use to prevent experimental complications. Fifty-six rabbits from a sciatic nerve injury study that involved a 40 mm sciatic nerve injury were analyzed to examine postoperative complication rates. Autophagy of the phalanges and plantar pressure ulcer development were the most common and serious complications faced. These complications led to 23.2% (n = 13) of rabbits not being used for data in the original experiment due to euthanasia outside of intended postoperative time points. This increased the cost needed to complete the experiment by $25,038.44. It is our recommendation that alternative models be used instead of rabbits for sciatic nerve injuries. If rabbits must be used, a treatment protocol for preventing autophagy and pressure ulcers is outlined below.

Improving Strength and Quality of Epitendinous Repairs.

Background: Epitendinous sutures not only join the 2 severed tendon edges but also supply strength and support to the repair. Multiple techniques have been described, but none of them include another thread of suture. This could potentially increase the strength of the repair without affecting gliding. Methods: Caprine tendons were harvested, transected, and sutured with 6-0 Prolene. Four groups were created: single thread running (SR), single thread locking (SL), double thread running (DR), and double thread locking (DL). An Instron 5542 was used to pull the repaired tendons apart, and the energy at the break was calculated (gf/mm). For gliding resistance, we harvested a human A2 pulley. A pre- and postrepair value was obtained, and a ratio was elaborated. A single-factor analysis of variance and independent sample t tests were performed. Results: The SR group had a mean energy at break of 9339.71 ± 1630.212 gf/mm; the SL group, 9629.96 ± 1476.45 gf/mm; and the DR group, 9600.221 ± 976.087 gf/mm, with no statistical significance. The DL group was significantly higher at 14 740.664 ± 2596.586 gf/mm (P < .05). When comparing SR with DL for gliding, SR had less than half of the resistance than DL (0.018 ± 0.004 and 0.049 ± 0.015 N/mm, respectively), with statistical significance (P < .05). Conclusion: Using a single suture thread for running epitendinous repair is no different than locking with a single thread or using an extra thread in a running fashion. Performing a double suture thread with a locking technique is significantly stronger than the previously mentioned repairs, with the disadvantage of more resistance at the pulley.

Diffusion tensor tractography to visualize axonal outgrowth and regeneration in a 4-cm reverse autograft sciatic nerve rabbit injury model.

BACKGROUND: Diffusion tensor tractography (DTT) has recently been shown to accurately detect nerve injury and regeneration. This study assesses whether 7-tesla (7T) DTT imaging is a viable modality to observe axonal outgrowth in a 4 cm rabbit sciatic nerve injury model fixed by a reverse autograft (RA) surgical technique. METHODS: Transection injury of unilateral sciatic nerve (4 cm long) was performed in 25 rabbits and repaired using a RA surgical technique. Analysis of the nerve autograft was performed at 3, 6, and 11 weeks postoperatively and compared to normal contralateral sciatic nerve, used as control group. High-resolution DTT from ex vivo sciatic nerves were obtained using 3D diffusion-weighted spin-echo acquisitions at 7-T. Total axons and motor and sensory axons were counted at defined lengths along the graft. RESULTS: At 11 weeks, histologically, the total axon count of the RA group was equivalent to the contralateral uninjured nerve control group. Similarly, by qualitative DTT visualization, the 11-week RA group showed increased fiber tracts compared to the 3 and 6 weeks counterparts. Upon immunohistochemical evaluation, 11-week motor axon counts did not significantly differ between RA and control; but significantly decreased sensory axon counts remained. Nerves explanted at 3 weeks and 6 weeks showed decreased motor and sensory axon counts. DISCUSSION: 7-T DTT is an effective imaging modality that may be used qualitatively to visualize axonal outgrowth and regeneration. This has implications for the development of technology that non-invasively monitors peripheral nerve regeneration in a variety of clinical settings.

User interface paradigms for patient-specific surgical planning: lessons learned over a decade of research.

This paper covers work in virtual reality-based, patient-specific surgical planning over the past decade. It aims to comprehensively examine the user interface paradigms and system designs during that period of time and to objectively analyze their effectiveness for the task. The goal is to provide useful feedback on these interface and implementation paradigms to aid other researchers in this field. First, specialized systems for specific clinical use were produced with a limited set of visualization tools. Later, through collaboration with NASA, an immersive virtual environment was created to produce high-fidelity images for surgical simulation, but it underestimated the importance of collaboration. The next system, a networked, distributed virtual environment, provided immersion and collaboration, but the immersive paradigm was found to be of a disadvantage and the uniqueness of the framework unwieldy. A virtual model, workbench-style display was then created using a commercial package, but limitations of each were soon apparent. Finally, a specialized display, with an integrated visualization and simulation system is described and evaluated. Lessons learned include: surgical planning is an abstract process unlike surgical simulation; collaboration is important, as is stereo visualization; and that high-resolution preoperative images from standard viewpoints are desirable, but interaction is truly the key to planning.

Algorithmic tools for real-time microsurgery simulation.

Today, there is growing interest in computer surgical simulation to enhance surgeons' training. This paper presents a simulation system based on novel algorithms for animating instruments interacting with deformable tissue in real-time. The focus is on computing the deformation of a tissue subject to external forces, and detecting collisions among deformable and rigid objects. To achieve real-time performance, the algorithms take advantage of several characteristics of surgical training: (1) visual realism is more important than accurate, patient-specific simulation; (2) most tissue deformations are local; (3) human-body tissues are well damped; and (4) surgical instruments have relatively slow motions. Each key algorithm is described in detail and quantitative performance-evaluation results are given. The specific application considered in this paper is microsurgery, in which the user repairs a virtual severed blood vessel using forceps and a suture (micro-anastomosis). Microsurgery makes it possible to demonstrate several facets of the simulation algorithms, including the deformations of the blood vessel and the suture, and the collisions and interactions between the vessel, the forceps, and the suture. Validation of the overall microsurgery system is based on subjective analysis of the simulation's visual realism by different users.