Attempt to promote skin reinnervation by direct neurotization and stem cell transplantation

Research Project

Project/Area Number	18K09480
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Review Section	Basic Section 56070:Plastic and reconstructive surgery-related
Research Institution	Osaka University
Principal Investigator	YANO KENJI 大阪大学, 医学系研究科, 招へい教授 (40174560)
Co-Investigator(Kenkyū-buntansha)	冨田興一大阪大学, 医学系研究科, 准教授 (90423178) 田港見布江大阪大学, 医学系研究科, 特任助教(常勤) (80815697)
Project Period (FY)	2018-04-01 – 2021-03-31
Project Status	Completed (Fiscal Year 2020)
Budget Amount *help	¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000) Fiscal Year 2020: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000) Fiscal Year 2019: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000) Fiscal Year 2018: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000)
Keywords	末梢神経再建 / 再建乳房の知覚化 / Direct neurotization / direct neurotization / 乳房再建 / 皮膚知覚 / 知覚回復
Outline of Final Research Achievements	Background: There is no means of reinnervation in implant-based breast reconstruction. In this study, we focused on the direct neurotization (DN) method, which guides damaged sensory nerves directly to the skin. Methods: An innervated area surrounded by a non-innervated area was created by excising the part other than the left Th13 medial branch (mDCN-T13) on the back of the rat. The mDCN-T13 was cut, sutured to the dermis at another site, and the change in the innervated area was examined by the cutaneous muscle reflex. Results: Four weeks after the operation, a cutaneous muscle reflex appeared in agreement with the DN part. The new sensory area then gradually expanded. Conclusion: DN to the skin can create a new innervated area at any site without the presence of nerve stumps. This method can be a powerful method for the perception of reconstructed breasts.
Academic Significance and Societal Importance of the Research Achievements	DN法は、損傷神経中枢端を脱知覚された真皮へ直接縫合し、知覚再生を得る画期的な方法である。何らかの障害で、軸索伸長が阻まれ、側芽形成のみに頼る状況下では、高度な感覚の再生は望めず、防御知覚すら脱失してしまい問題となる。DN法により神経再生を誘導できたならば、その問題解決の糸口となるだろう。再建乳房においては、DN法により肋間神経切断端をmastectomy flapへ縫合することで実現可能かもしれない。人工神経や神経移植などを介すれば、インプラントや皮弁を障害とせず、神経再生を誘導できる可能性があると考えられる。