title: A novel technique using hydrophilic polymers to promote axonal fusion.
abstract: The management of traumatic peripheral nerve injury remains a considerable concern for clinicians. With minimal innovations in surgical technique and a limited number of specialists trained to treat peripheral nerve injury, outcomes of surgical intervention have been unpredictable. The inability to manipulate the pathophysiology of nerve injury (i.e., Wallerian degeneration) has left scientists and clinicians depending on the slow and lengthy process of axonal regeneration (~1 mm/day). When axons are severed, the endings undergo calcium-mediated plasmalemmal sealing, which limits the ability of the axon to be primarily repaired. Polythethylene glycol (PEG) in combination with a bioengineered process overcomes the inability to fuse axons. The mechanism for PEG axonal fusion is not clearly understood, but multiple studies have shown that a providing a calcium-free environment is essential to the process known as PEG fusion. The proposed mechanism is PEG-induced lipid bilayer fusion by removing the hydration barrier surrounding the axolemma and reducing the activation energy required for membrane fusion to occur. This review highlights PEG fusion, its past and current studies, and future directions in PEG fusion.
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Surgery, Georgetown University, Washington, DC, USA.
authors.forename: Ravinder
authors.identifier: 0000-0002-5432-2764
authors.initials: R
authors.lastname: Bamba
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA; Georgetown University School of Medicine, Washington, DC, USA.
authors.forename: D Colton
authors.initials: DC
authors.lastname: Riley
authors.affiliation: Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
authors.forename: Nathaniel D
authors.initials: ND
authors.lastname: Kelm
authors.affiliation: Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Does
authors.affiliation: Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Dortch
authors.affiliation: Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Wesley P
authors.initials: WP
authors.lastname: Thayer
keywords: axonal fusion; nerve transection; peripheral nerve injury; polyethylene glycol; traumatic neuropathy