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Brain-Derived Neurotrophic Factor–Enriched Collagen Tubule as a Substitute for Autologous Nerve Grafts
David J. Terris, MD;
Kenneth M. Toft, MD;
Melinda Moir, MD;
Joanne Lum, BS;
Michelle Wang, BS
Arch Otolaryngol Head Neck Surg. 2001;127:294-298.
Background Autologous nerve interposition grafts are frequently harvested by head
and neck surgeons. The sacrifice of these donor nerves guarantees some degree
of morbidity, including sensory loss, additional incision sites with associated
potential complications, and prolonged operative time. An alternative to autologous
nerve grafting is, therefore, desirable.
Objective To determine if a collagen tubule (CT) filled with either a plain collagen
gel or a brain-derived neurotrophic factor (BDNF)–enriched collagen
gel could be used to achieve functional and histologic outcomes equivalent
to an autologous nerve graft in bridging a 15-mm nerve gap in the rabbit facial
nerve.
Design A prospective, randomized, blinded animal study with a control group.
Methods Thirty rabbit facial nerves were resected (15-mm segments) to create
nerve gaps. The gaps were bridged using 1 of 3 methods, assigned randomly:
a reversed facial nerve (control), a collagen gel–filled CT, or a BDNF-enriched
collagen gel–filled CT. The animals were evaluated after 6 weeks in
a blinded fashion for functional nerve recovery, axon count, and axonal diameter.
Results There were no significant differences between the autologous nerve graft
group, the collagen gel–filled CT group, or the BDNF-enriched collagen
gel–filled CT group (n = 10 for each group) for functional nerve recovery
(P = .94). The mean axon count and the mean axonal
diameter were highest in the BDNF-enriched collagen gel–filled CT group,
but these differences failed to reach statistical significance (P = .18 and .96, respectively).
Conclusions Collagen tubules filled with BDNF-enriched collagen gel appear to be
at least as good as autologous nerve grafts for bridging short facial nerve
gaps. Larger experimental studies are warranted to determine if clinical trials
are justified.
From the Division of Otolaryngology/Head and Neck Surgery, Stanford
University Medical Center, Stanford, Calif.
Corresponding author and reprints: David J. Terris, MD, Division
of Otolaryngology/Head and Neck Surgery, Stanford University Medical Center,
Edwards Bldg, Room R135, Stanford, CA 94305-5328 (e-mail: dterris{at}stanford.edu).
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