Comparison of the adhesion and SCAR-reducing effects of vein and buccal mucosa graft application after CRUSH-TYPE injury in the RAT sciatic nerve

The healing process after peripheral nerve injury is adversely affected by many reasons, both scar and non-scarring. Scar tissues are usually formed after trauma and surgical interventions. Although adhesion and anti-scar treatments are used, scar tissue and adhesion are the leading factors affecting the healing process. Compression neuropathies due to scarring and adhesion are frequently encountered in clinical studies. Scar tissue that causes compression neuropathies is usually treated with surgical interventions, but in clinical studies, it has been stated that symptoms persist in some patients after surgical intervention. Scar and anti-adhesion treatments after peripheral nerve injury have been mostly used in experimental studies. In these studies, agents such as hyaluronic acid, various drugs, amniotic membranes, radiation, carbohydrate polymer gel (ADCON-T/N) have been used and positive results have been obtained, but these are both difficult to reach and It is also challenging in terms of cost. Apart from this, tissues such as vein, mucosa and fat graft from autologous tissues have been used and positive results have been obtained, but they have disadvantages such as donor site morbidity and surgical acquisition. Although many injury models, scar and anti-adhesion treatments have been used experimentally in the peripheral nerve healing process, there is no standardized treatment protocol yet. The decision process in clinical use is influenced by the experience of the surgeon, availability of anti-scarring agent, donor site morbidity that may occur for autologous sources, and limited information in the literature. In our study, a total of 24 female Spradue-Dawley type rats weighing 250-300 g and 3 months old were used. The rats were divided into three groups. A crush injury was created on the right sciatic nerve of the rats. In the first group, a femoral vein graft conduit to the right sciatic nerve was used. In the second group, buccal mucosal conduit to the right sciatic nerve was used. The sciatic nerve in the third group was used as the control group. At the end of the 4-week follow-up, the rats were sacrificed and evaluated macroscopically and histopathologically. In our study, Peterson classification was used macroscopically. When tissue and muscle fascia were compared in three groups, no significant difference was observed (p>0.05). When the nerve adhesion and detachment were compared between the mucosa and control groups, no significant difference was observed (p>0.05). Nerve adhesion and separability were found to be statistically significantly higher in the vein group than in the mucosa and control groups (p<0.05). Histopathologically, inflammation, intraneural and extraneural scars were examined in three groups. When inflammation was compared in the three groups, no statistically significant difference was observed (p>0.05). When intraneural and extraneural scars were compared with the control group in both mucosa and vein groups, there was a statistically significant difference (p<0.05). No statistically significant difference was observed in the intraneural and extraneural scar vein groups compared to the mucosal group(p>0.05). Our study showed that vein and mucosal graft can be used to reduce scar and adhesion in peripheral nerve crush injuries. Appropriate graft material can be selected after the size of the injury, the surgeon's preference, and patient consent.