title: Potassium titanyl phosphate laser welding following complete nerve transection.
abstract: Cranial nerve transection during head and neck surgery is conventionally repaired by microsuture reanastomosis. Laser nerve welding (LNW), using CO2laser to spot-weld the epineurium of transected nerve endings, has been shown in animal models to be a novel alternative to microsuture repair. This method avoids needle/suture material and minimizes instrumentation of the nerve. We hypothesized that potassium titanyl phosphate (KTP) laser would be superior to CO2laser in repairing transected nerves. Using a rat posterior tibial nerve injury model, we compared CO2laser, KTP laser, and microsuture reanastomosis.
  
  
  
  Animal study.
  
  
  
  Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by microsuture repair (n = 15), CO2laser repair (n = 15), or KTP laser repair (n = 15). Weekly walking tracks were performed to measure functional recovery. Nerve segments were harvested for axon counting.
  
  
  
  At 6 weeks, the KTP LNW had the best functional recovery (92.4 ± 8.6%) compared to microsuture repair (84.5 ± 10.2%, difference 7.9%, 95% confidence interval [CI]: 0.84%-14.96%). CO2laser repair had a functional recovery of 86.8 ± 11.2%. KTP LNW had better axon recovery compared to transection/repair (difference 530.7 axons, 95% CI: 329.9-731.5). Operative time for the microsuture repair was 18.2 ± 6.8 minutes, compared to 5.8 ± 3.7 minutes for the LNW groups (difference 12.4 minutes, 95% CI: 8.6-16.2 minutes).
  
  
  
  KTP, CO2, and microsuture repair all showed good functional recovery following complete transection of the posterior tibial nerve. Following complete nerve transection during head and neck surgery, KTP LNW may be a novel alternative to microsuture repair.
  
  
  
  NA Laryngoscope, 127:1525-1530, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Neel K
authors.initials: NK
authors.lastname: Bhatt
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mejias
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Dorina
authors.initials: D
authors.lastname: Kallogjeri
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Derrick C
authors.initials: DC
authors.lastname: Gale
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Park
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University in Saint Louis, St. Louis, Missouri, U.S.A.
authors.forename: Randal C
authors.initials: RC
authors.lastname: Paniello
mesh_terms: D000818:Animals; D020209:Cranial Nerve Injuries / Q000601:surgery*; D004195:Disease Models, Animal; D007431:Intraoperative Complications / Q000601:surgery*; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D009416:Nerve Regeneration / Q000502:physiology; D051381:Rats; D017207:Rats, Sprague-Dawley; D013979:Tibial Nerve / Q000293:injuries / Q000601:surgery
keywords: CO2 laser; Laser nerve welding; cranial nerve injury; nerve repair; potassium titanyl phosphate laser