Antonio Lauto

Laser-activated solid protein bands for peripheral nerve repair: An in vivo study

Severed tibial nerves in rats were repaired using a novel technique, utilizing a semiconductor diode‐laser‐activated protein solder applied longitudinally across the join. Welding was produced by selective laser denaturation of solid solder bands containing the dye indocyanine green.

LASER NERVE REPAIR BY SOLID PROTEIN BAND TECHNIQUE. I: IDENTIFICATION OF OPTIMAL LASER DOSE, POWER, AND SOLDER SURFACE AREA

Thirty‐four tibial nerves in 17 adult male wistar rats were repaired by applying protein bands longitudinally across the nerve join. The bands were then irradiated with a fibre‐coupled diode laser (λ = 810 nm). The relations among the laser weld breaking force, the power, and the solder surface area were investigated, while maintaining a consistent ratio between the total mass of protein solder in a band and total laser energy delivered (the laser energy dose). When this laser energy dose was held constant, the average breaking force of the laser welds irradiated by 72 mW laser output power was weaker than that reached after 90 mW laser radiation. There is a linear relation between the solder breaking force and the solder surface area when band thickness, laser power, and laser dose are unvaried.

Laser nerve repair by solid protein band technique. II : Assessment of long-term nerve regeneration

A total of 18 adult male Wistar rats had left tibial nerve repaired by either the laser‐solder technique or a more conventional microsuture technique. The diode laser power was 90 mW and the radiation dose 16 J/mg. Three months postoperatively electrophysiology showed that the average compound muscle action potential (CMAP) of the laser repair group was not significantly different from the CMAP of the sutured nerves. Light microscopy confirmed regeneration of myelinated axons in both groups of animals. The laser‐solder technique, when used with such parameters, proved to be a reliable method to achieve satisfactory peripheral nerve anastomosis and nerve regeneration.

Laser-activated protein bands for peripheral nerve repair

A 100 micrometer core optical fiber-coupled 75 mW diode laser operating at a wavelength of 800 nm has been used in conjunction with a protein solder to stripe weld severed rat tibial nerves, reducing the long operating time required for microsurgical nerve repair. Welding is produced by selective laser denaturation of the protein based solder which contains the dye indocyanine green. Operating time for laser soldering was 10 plus or minus 5 min. (n equals 24) compared to 23 plus or minus 9 min (n equals 13) for microsuturing. The laser solder technique resulted in patent welds with a tensile strength of 15 plus or minus 5 g, while microsutured nerves had a tensile strength of 40 plus or minus 10 g. Histopathology of the laser soldered nerves, conducted immediately after surgery, displayed solder adhesion to the outer membrane with minimal damage to the inner axons of the nerves. An in vivo study, with a total of fifty-seven adult male wistar rats, compared laser solder repaired tibial nerves to conventional microsuture repair. Twenty-four laser soldered nerves and thirteen sutured nerves were characterized at three months and showed successful regeneration with average compound muscle action potentials (CMAP) of 2.4 plus or minus 0.7 mV and 2.7 plus or minus 0.8 mV respectively. Histopathology of the in vivo study, confirmed the comparable regeneration of axons in laser and suture operated nerves. A faster, less damaging and long lasting laser based anastomotic technique is presented.

Laser-activated protein solder for peripheral nerve repair

A 100 micrometers core optical fiber-coupled 75 mW diode laser operating at a wavelength of 800 nm has been used in conjunction with a protein solder to stripe weld severed rat tibial nerves, reducing the long operating time required for microsurgical nerve repair. Welding is produced by selective laser denaturation of the albumin based solder which contains the dye indocyanine green. Operating time for laser soldering was 10 +/- 5 min. (n equals 20) compared to 23 +/- 9 min. (n equals 10) for microsuturing. The laser solder technique resulted in patent welds with a tensile strength of 15 +/- 5 g, while microsutured nerves had a tensile strength of 40 +/- 10 g. Histopathology of the laser soldered nerves, conducted immediately after surgery, displayed solder adhesion to the outer membrane with minimal damage to the inner axons of the nerves. An in vivo study is under way comparing laser solder repaired tibial nerves to conventional microsuture repair. At the time of submission 15 laser soldered nerves and 7 sutured nerves were characterized at 3 months and showed successful regeneration with compound muscle action potentials of 27 +/- 8 mV and 29 +/- 8 mW respectively. A faster, less damaging and long lasting laser based anastomotic technique is presented.

Laser-Activated Solid Protein Solder for Nerve Repair: In Vitro Studies of Tensile Strength and Solder/Tissue Temperature

Abstract. Laser-activated solid protein solder strips have been developed for peripheral nerve repair. Indocyanine green dye added to the solder strongly absorbs diode wavelengths (∼800u2009nm) and causes localised heating and coagulation of the albumin protein solder. The protein strengthens the tissue join, particularly during the acute healing phase postoperative, while shielding the underlying axons from excessive thermal damage.In this investigation of the solid protein solder technique for nerve repair, the effect of laser irradiance on weld strength and solder and tissue temperature were studied. The tensile strength of repaired nerves rose steadily with increased irradiance reaching a maximum of 105±10u2009N/cm2 at 12.7u2009W/cm2. At higher irradiances, tensile strength fell. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fibre optic radiometer and thermocouple, respectively, also rose steadily with laser irradiance. At 12.7u2009W/cm2, the temperatures reached at the surface and at the interface were 88±5°C and 71±4°C, respectively.This in vitro investigation demonstrates the feasibility of the laser-activated solid protein solder strips for peripheral nerve repair. The laser irradiance and the corresponding solder surface temperature for optimal tensile strength have been identified.

Laser-solder repair technique for nerve anastomosis: temperatures required for optimal tensile strength

Laser-assisted repair of nerves is often unsatisfactory and has a high failure rate. Two disadvantages of laser assisted procedures are low initial strength of the resulting anastomosis and thermal damage of tissue by laser heating. Temporary or permanent stay sutures are used and fluid solders have been proposed to increase the strength of the repair. These techniques, however, have their own disadvantages including foreign body reaction and difficulty of application. To address these problems solid protein solder strips have been developed for use in conjunction with a diode laser for nerve anastomosis. The protein helps to supplement the bond, especially in the acute healing phase up to five days post- operative. Indocyanine green dye is added to the protein solder to absorb a laser wavelength (approximately 800 nm) that is poorly absorbed by water and other bodily tissues. This reduces the collateral thermal damage typically associated with other laser techniques. An investigation of the feasibility of the laser-solder repair technique in terms of required laser irradiance, tensile strength of the repair, and solder and tissue temperature is reported here. The tensile strength of repaired nerves rose steadily with laser irradiance reaching a maximum of 105 plus or minus 10 N.cm-2 at 12.7 W.cm-2. When higher laser irradiances were used the tensile strength of the resulting bonds dropped. Histopathological analysis of the laser- soldered nerves, conducted immediately after surgery, showed the solder to have adhered well to the perineurial membrane, with minimal damage to the inner axons of the nerve. The maximum temperature reached at the solder surface and at the solder/nerve interface, measured using a non-contact fiber optic radiometer and thermocouple respectively, also rose steadily with laser irradiance. At 12.7 W.cm-2, the temperatures reached at the surface and at the interface were 85 plus or minus 4 and 68 plus or minus 4 degrees Celsius respectively. This study demonstrates the feasibility of the laser-solder repair technique for nerve anastomosis resulting in improved tensile strength. The welding temperature required to achieve optimal tensile strength has been identified.

Laser-activated solder weld repair of the inferior alveolar nerve in rats

A new laser activated solder weld technique is described for the microsurgical repair of the inferior alveolar nerve in rats. The laser weld technique used an albumin based solder, containing indocyanine cardiogreen, plus an infrared diode laser. Seven animals had inferior alveolar nerve repairs performed using the laser weld technique and these were compared against corresponding unoperated controls plus three cases of nerve section without repair. Histochemical analysis was performed utilizing neuron counts and horseradish peroxidase tracer (HRP) uptake in the trigeminal ganglion following sacrifice and staining of frozen sections with cresyl violet and diaminobenzidene. The results of this analysis showed comparable mean neuron counts and mean HRP uptake by neurons for the unoperated control and laser weld groups with considerable reduction of mean values in cases of nerve section with no repair. Sections of the repaired inferior alveolar nerves, stained with Massons trichrome, showed no adverse reactions by axons or epineurium to the coagulative repair with the solder and demonstrated regeneration of myelinated axons at the time of sacrifice. In summary a new technique of laser weld repair of the inferior alveolar nerve is described which, on initial analysis, appears to be a reliable alternative to traditional techniques.