Tiam Mana Saffari

247 GENERAL DISCUSSION 11 o Planned experiments at Mayo Clinic: the nerve research line will be advanced towards the investigation of long-term results after combined angiogenesis and stem cell delivery to evaluate motor recovery. To overcome the superlative nerve regenerative capacity of the rat, studies will then be translated to a larger nerve gap model in rabbits. The rabbit model will allow for confirmation of the independent effect of angiogenesis and stem cell delivery found in rats and assess the combined application which will provide stronger evidence for clinical translation. o Augmentation of nerve autografts with angiogenesis: while the goal is to augment off-the-shelf decellularized nerve allografts to meet outcomes of autografts, it would be interesting to investigate the effect of angiogenesis on nerve autograft to enhance nerve regeneration. Future experimental research could compare the autograft wrapped within a pedicled SIEF flap to the autograft alone to assess motor recovery outcomes. This has great potential for clinical translation, as many pedicled adipofascial flap options currently exist that could augment the autologous sural nerve, or any other autologous donor nerve, depending on the location of the injury. o The role of adipose tissue in nerve fibrosis: another interesting future aspect for investigation would be to assess the role of adipose tissue in perineural scar formation. Scar formation after peripheral nerve injury is a significant clinical problem that impedes regeneration 69,70 . Results from this thesis suggest that the adipofascial flap provides a supportive microenvironment that diminishes nerve fibrosis. Further histologic assessment could be performed to evaluate the collagen deposition, and cellular count of fibroblasts and inf lammatory cells in nerve tissue 71 . The experimental groups could include (i) nerve graft wrapped within a pedicled adipofascial flap and (ii) autologous fat grafting administered to the nerve graft, compared to the (iii) nerve graft alone. The concept of fat grafting has been longstanding in the field of reconstructive surgery and has become a dynamic modality to improve functional outcomes and aesthetic form in clinical practice 72 .