Tiam Mana Saffari

148 CHAPTER 7 rich in growth factors and stem cells, may be combined with stem cells delivered to the nerve allograft to achieve a higher state of therapeutic potential 56,57 , potentially resulting in synergistic mechanisms to enhance nerve regeneration. In this study, surgical angiogenesis to nerve allograft produced statistical improvement in a number of measured variables at 12 weeks. These differences were less apparent at 16 weeks, consistent with the well-known superlative nerve regenerative capacity of the rat. It could be speculated that earlier time points prior to 12 weeks, would be ideal in future studies as interventions that result in improved and more rapid nerve regeneration in the logistical growth phase are potentially clinically relevant. This can be ascertained from the recent study by Tang and colleagues, whose ITF outcomes at 16 weeks are in line with the results of this study for all groups 46 . The effect of surgical angiogenesis to nerve allograft could be evaluated at earlier time points or in a larger nerve gap model to overcome these limitations 58 . Additionally, future research may further investigate the impact of fibrosis in the nerve graft to elucidate the suppression of fibrosis during axonal regeneration or the combined effect of surgical angiogenesis and stem cells to improve regeneration. CONCLUSIONS Wrapping of processed nerve allografts with a pedicled adipofascial flap to provide surgical angiogenesis increases vascularity of the allograft, as well as improves early muscle force recovery when compared to allografts alone. Although we still do not have a nerve graft substitute that performs as well as autograft nerve, these data support the use of surgical angiogenesis as part of the equation required to improve processed nerve allograft outcomes. Disclosure The authors have no financial interests to disclose. Acknowledgments We would like to thank Jim Postier for the artwork of Figure 1.