title: Effect of bleeding on nerve regeneration and epineural scar formation in rat sciatic nerves: an experimental study.
abstract: OBJECTIVE
  Epineural scar formation is one of the most significant negative factors affecting surgical repair after peripheral nerve injury. The scar tissue mechanically hinders axonal regeneration and causes adhesions between nerves and surrounding tissues. A hemostatic agent Ankaferd Blood Stopper (ABS; İmmun Gıda İlaç Kozmetik San. ve Tic. Ltd. Şti., Istanbul, Turkey) has not been previously used. Decreasing the postoperative bleeding and adhesions between nerve and surrounding tissues will prevent the formation of scar tissue, as well as corresponding compressive neuropathy and/or deceleration of axonal regeneration. The purpose of this experimental study was to investigate the effects of bleeding on nerve healing and scar tissue after repair of peripheral nerve injuries.
  
  
  METHODS
  The right sciatic nerve of 30 Sprague-Dawley male rats (weighing 260-330 g) was cut 1.5 cm proximal to the trifurcation and repaired primarily with 8/0 sutures using epineural technique. The rats were then divided into 3 groups. Saline was applied in Group 1 (n=10), ABS in Group 2 (n=10), and heparin in Group 3 (n=10) for 5 minutes to the repair site and surrounding tissues. In each group, electrophysiological measurements were performed with electromyography (EMG) at postoperative week 12. Magnetic resonance diffusion tensor imaging was used at week 12. Macroscopical and histopathological evaluations were conducted after sacrificing the rats at week 24 with total excision of the repaired sciatic nerves and surrounding tissues.
  
  
  RESULTS
  The ABS and saline groups showed better healing than the heparin group. The ABS and saline groups were better in the histopathologic evaluations, but there was no statistically significant difference between the 2 groups.
  
  
  CONCLUSIONS
  Statistically significant differences were not found between the 3 groups. Significant results may be obtained with larger studies.
authors.affiliation: Gaziantep Medical Park Hospital, Department of Orthopaedics and Traumatology, Gaziantep, Turkey.
authors.forename: Erkan
authors.initials: E
authors.lastname: Servet
authors.affiliation: Dr. Lütfi Kırdar Kartal Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Halil
authors.initials: H
authors.lastname: Bekler
authors.affiliation: Bahçeşehir University Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Volkan
authors.initials: V
authors.lastname: Kılınçoğlu
authors.affiliation: Yeditepe University Faculty of Medicine, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Turhan
authors.initials: T
authors.lastname: Özler
authors.affiliation: Göztepe Training and Research Hospital, Department of Orthopaedics and Traumatology, İstanbul, Turkey.
authors.forename: Afşar
authors.initials: A
authors.lastname: Özkut
mesh_terms: D000818:Animals; D002921:Cicatrix / Q000517:prevention & control*; D056324:Diffusion Tensor Imaging; D004195:Disease Models, Animal; D004576:Electromyography; D006470:Hemorrhage / Q000628:therapy*; D006493:Heparin / Q000494:pharmacology*; D008297:Male; D009416:Nerve Regeneration / Q000187:drug effects*; D059348:Peripheral Nerve Injuries / Q000628:therapy*; D010936:Plant Extracts / Q000494:pharmacology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012584:Sciatic Nerve / Q000293:injuries*; D012965:Sodium Chloride / Q000494:pharmacology*; D000267:Tissue Adhesions / Q000517:prevention & control; D014945:Wound Healing / Q000187:drug effects
chemical_list: D010936:Plant Extracts; C539751:ankaferd blood stopper; D012965:Sodium Chloride; D006493:Heparin