Methods and devices for in situ formed nerve cap
Disclosed are methods, devices and materials for the in situ formation of a nerve cap to inhibit neuroma formation following planned or traumatic nerve injury. The method includes the steps of identifying a severed end of a nerve, and positioning the severed end into a cavity defined by a form. A transformable media is introduced into the form cavity to surround the severed end. The media is permitted to undergo a transformation from a first, relatively flowable state to a second, relatively non flowable state to form a protective barrier surrounding the severed end. The media may be a hydrogel, and the transformation may produce a synthetic crosslinked hydrogel protective barrier. The media may include at least one anti-regeneration agent to inhibit nerve regrowth.
1. A method of in situ formation of a nerve cap, the method comprising the steps of:
identifying a severed end of a nerve;
positioning the severed end into a cavity defined by a form;
introducing media into the cavity to surround the severed end; and
permitting the media to undergo a transformation from a first, relatively flowable state to a second, relatively non flowable state to form a protective barrier surrounding the severed end; wherein the transformation occurs within about 10 seconds of the introducing step; wherein the form is composed of a nondegradable material that can be removed from the surgical site after the media is transformed to the second, relatively non flowable state to form the protective barrier surrounding the severed end.
2. A method of in situ formation of a nerve cap as in claim 1 , further comprising the step of removing the form.
3. A method of in situ formation of a nerve cap as in claim 1 , comprising identifying a surgically severed nerve.
4. A method of in situ formation of a nerve cap as in claim 1 , wherein the form comprises a nerve guide, and said positioning step comprises positioning the nerve such that the nerve guide maintains the severed end within the cavity spaced apart from a sidewall of the form.
5. A method of in situ formation of a nerve cap as in claim 4 , comprising positioning the severed end between 0.1 mm and 2 mm away from the sidewall.
6. A method of in situ formation of a nerve cap as in claim 1 , additionally comprising the step of blotting a volume of axoplasm from the severed nerve prior to the introducing step.
7. A method of in situ formation of a nerve cap as in claim 1 , wherein the transformation comprises a crosslinking or polymerizing.
8. A method of in situ formation of a nerve cap as in claim 1 , wherein the transformation produces a synthetic crosslinked hydrogel protective barrier.
9. A method of in situ formation of a nerve cap as in claim 1 , wherein the form comprises a first configuration in which the cavity is exposed, and a second configuration in which the cavity is covered; and further comprising the step of advancing the form from the first configuration to the second configuration prior to the introducing media step.
10. A method of in situ formation of a nerve cap as in claim 1 , wherein the form comprises a first configuration in which the cavity is exposed and a second configuration in which the cavity is covered, and wherein the step of positioning the severed end comprises advancing the form from the first configuration to the second configuration prior to introducing media into the cavity.
11. A method of in situ formation of a nerve cap as in claim 1 , wherein the protective barrier has an in vivo persistence of at least about two months.
12. A method of in situ formation of a nerve cap as in claim 1 , wherein the transformation causes the media to swell in volume within a range of from about 2% to about 30%.
13. A method of in situ formation of a nerve cap as in claim 1 further comprising the step of positioning the form at a treatment site before the positioning the severed end step.
14. A method of in situ formation of a nerve cap as in claim 1 further comprising the step of forming the form in situ before the positioning the severed end step.
15. A method of in situ formation of a nerve cap as in claim 1 further comprises delivering the media around the nerve in two successive steps.
16. A method of in situ formation of a nerve cap as in claim 1 , wherein the form contains an integral post for seating the nerve.
17. A method of in situ formation of a nerve cap as in claim 1 , wherein the form has a clamshell lid.
18. A method of in situ formation of a nerve cap as in claim 1 , wherein the viscosity of the flowable media is between 300 cP to 70,000 cP.