Grants Funded

Abstract
Achieving successful results after nerve grafting remains a challenge. Nerve grafting is often done via end to end (ETE) technique, where one end of the graft is sutured to the proximal nerve while the other end is sutured to the distal nerve. Recently, a new technique called ‘Helicoid Weave Technique' (HWT) has been described in which a large perineural window was created in the donor nerve and the recipient nerve was trimmed diagonally and wrapped around it. Only two studies have been done on the HWT, but they suggest superior results as compared to ETE technique.

We propose a modification of HWT technique (MHWT), where we pass the graft through, instead of around, the proximal and distal nerves. The rationale being that more cross sectional area for nerve–to–nerve contact would translate into higher axonal crossover. Also, there will be multiple perineural windows with controlled injury, each potential site for spontaneous axonal sprouting. We will compare MHWT to ETE repair in a rat sciatic nerve model using a rat autograft and rat processed nerve allografts (PNA). PNA are another recent advancement in nerve injury literature. PNAs are decellularized cadaver nerve tissue with maintained microarchitecture. PNAs have been found to have comparable outcomes with fewer limitations. Additionally, the MHWT requires a longer graft, making the off-the-shelf processed allograft more practical in a clinical setting.

The study will be conducted in a rat sciatic nerve model. After obtaining IACUC approval, 24 rats will be divided into 4 groups of 6 rats each. Group 1: ETE with autograft, Group 2: MHWT with autograft, Group 3: ETE with PNA and Group 4: MHWT using PNA. In the first surgery, a 2 cm segment of the rat sciatic nerve will be resected and reconstruction will be done either by ETE or MHWT technique using either rat autograft or rat processed nerve allograft. After a 6-months, all rats will be reanesthetized and following assessments will be done- (1) Mean action potential amplitude at Extensor Digitrum longus (EDL) when sciatic nerve stimulated proximally by EMG machine, (2) Tetanic Force of the EDL Muscle by tetanic force machine, (3) wet weight of the EDL Muscle and (4) nerve fiber counting distal to repair site by histopathologic study. Data will be gathered and statistical analysis done using SPSS software to find out statistically significant difference between the four groups.

Biography
I am currently doing my fellowship in Hand and microsurgery at Christine M Kleinert Institute .I completed my medical school in 2007 and went on to complet residencies in General Surgery and Plastic Surgery. I have received honours both during my Medical school and residency. Throughout my Medical career, I had keen interest in research. As PI, I had obtained national level grant during my third year as a medical student. I have presented my research in various national and international fora and have won numerous awards including those received at - Research Louisville 2016, Leiden International Medical Students Conference (LIMSC) 2011, Indo- US International emergency Medicine Summit 2006, National Medical Student Research Conference 2006, Annual conference of Association of Plastic Surgeons (Kerala), 2014. In addition I have produced 10 peer-reviewed publications. I have proposed a new classification for intracranial melanoma, A novel test for malaria diagnosis and a novel device of esophageal anastomosis. I have more than six years of training in microsurgery and have experience of over a thousand microsurgical repairs. I have successfully completed multiple microsurgical courses in Rat model and am well versed with the surgical approaches and anesthesia in rat model. I have the expertise, experience, training and motivation necessary to successfully carry out the proposed research project.