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J Thorac Cardiovasc Surg 2007;133:726-732
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Experimental repair of phrenic nerve using a polyglycolic acid and collagen tube

^a Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto, Japan
^b Nerve Regeneration Research Center Kyoto, Kyoto, Japan.

Received for publication April 4, 2006; revisions received August 12, 2006; accepted for publication August 30, 2006.

^_* Address for reprints: Tatsuo Nakamura, MD, Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, 53 Kawahara cho, Sakyo-ku, Kyoto 606-8507, Japan. (Email: nakamura{at}frontier.kyoto-u.ac.jp).

Objective: The feasibility of a nerve guide tube for regeneration of the phrenic nerve with the aim of restoring diaphragmatic function was evaluated in a canine model.

Methods: The nerve tube, made of woven polyglycolic acid mesh, had a diameter of 3 mm and was filled with collagen sponge. This polyglycolic acid–collagen tube was implanted into a 10-mm gap created by transection of the right phrenic nerve in 9 beagle dogs. The tubes were implanted without a tissue covering in 5 of the 9 dogs (group I), and the tubes were covered with a pedicled pericardial fat pad in 4 dogs (group II). Chest x-ray films, muscle action potentials, and histologic samples were examined 4 to 12 months after implantation.

Results: All of the dogs survived without any complications. X-ray film examination showed that the right diaphragm was paralyzed and elevated in all dogs until 3 months after implantation. At 4 months, movement of the diaphragm in the implanted side was observed during spontaneous breathing in 1 dog of group I and in 3 dogs of group II. In the dogs showing diaphragm movement, muscle action potentials were evoked in the diaphragm muscle, indicating restoration of nerve function. Regeneration of the phrenic nerve structure was also examined on the reconstructed site using electron microscopy.

Conclusion: The polyglycolic acid–collagen tube induced functional recovery of the injured phrenic nerve and was aided by coverage with a pedicled pericardial fat pad.

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