Development of New Nerve Guide Tube for Repair of Long Nerve Defects

A novel nerve guide tube (poly (L-lactic) acid (PLLA)/polyglycolic acid (PGA)-c-tube) capable of repairing long peripheral nerve injuries in a canine model has been developed. The tube was created by braiding together PLLA and PGA and then coating it with collagen. PLLA was newly added to the formulation to achieve higher sustainability. The tube was compared with a PGA-collagen tube in clinical use since 2002 having the same structure with a collagen coating but composed of PGA alone (PGA-c-tube). When tested for repair of a 40-mm gap in the left peroneal nerve, using PLLA/PGA-c-tube (n = 15), PGA-c-tube (n = 15), and a negative control group where the cut stump was capped using a silicone cap (n = 15), the lumen structure essential for securing the space for nerve regeneration was maintained in PLLA/PGA-c-tube for over 12 months with a higher number of axons both within the tube and at the distal nerve end. Electrophysiological evaluation revealed that the amplitude of compound muscle action potentials and sensory nerve action potentials after nerve regeneration with PLLA/PGA-c-tube were significantly higher. When assessed using magnetic resonance imaging (MRI), the volume of the tibialis anterior (TA) muscle in dogs that had undergone nerve repair using PLLA/PGA-c-tube was approximately 80% that of the positive control at 12 months. Functional analysis conducted by assessing the ankle angle revealed faster recovery in the PLLA/PGA-c-tube group. Better regeneration was achieved using a PLLA/PGA-c-tube that contains the slowly decomposing fiber material, PLLA. This indicates potential for repair of even longer nerve gaps or defects located near joints, and also clinical application.