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Marra, Kacey G. Ph.D.; Clavijo-Alvarez, Julio A. M.D., Ph.D.

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Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 345-346
doi: 10.1097/01.prs.0000294965.69617.46
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Sir:

We thank Drs. Geuna and Tos for their interest in our article, “Comparison of Biodegradable Conduits within Aged Rat Sciatic Nerve Defects” (Plast. Reconstr. Surg. 119: 1839, 2007). We appreciate their important comments. With regard to their two comments (the 3-month endpoint for the rat studies and the use of the Luxol blue myelin stain), we would like to present further justification.

With regard to the endpoint for the rat studies, our rationale for choosing to end the nerve regeneration study at 3 months was as follows: 3 months is a well-accepted endpoint for rat sciatic nerve repair (1.0-cm gap) and is important for gauging the potential for nerve regeneration. We identified more than a dozen publications that utilized the 3-month endpoint for a 1.0-cm gap in the rat sciatic nerve defect.

On the second point, we disagree that Luxol blue is a “rather unusual” stain for nerve repair studies. Indeed, Luxol fast blue is one of the classic stains for myelin, dating back to 1953.1 We identified more than two dozen articles that used Luxol fast blue as a myelin stain, from 1953 to 2007. Due to the Journal’s limits on citations, we herein reference nine key articles.2–10 Although toluidine blue may be more commonly used and is the accepted standard, we believe our choice of Luxol blue for myelin staining was also appropriate and adequate.

Again, we appreciate Drs. Geuna and Tos’s interest and important comments.

Kacey G. Marra, Ph.D.

Julio A. Clavijo-Alvarez, M.D., Ph.D.

Division of Plastic Surgery

University of Pittsburgh

Pittsburgh, Pa.

REFERENCES

1. Kluver, H., and Barrera, E. A method for the combined staining of cells and fibers in the nervous system. J. Neuropathol. Exp. Neurol. 12: 400, 1953.
2. Odaka, M., Uchiyama, Y., Oka, Y., and Tamaki, T. Evaluation of morphological and functional regeneration of rat nerve-muscle units after temporary and permanent tubulization Muscle Nerve 28: 194, 2003.
3. Yin, D., Wang, X. H., Yan, Y., and Zhang, R. Preliminary studies on peripheral nerve regeneration using a new polyurethane conduit. J. Bioact. Compat. Polym. 22: 143, 2007.
4. Pineros-Fernandez, A., Rodeheaver, P. F., and Rodeheaver, G. T. Octyl 2-cyanoacrylate for repair of peripheral nerve. Ann. Plast. Surg. 55: 188, 2005.
5. Snodgress, A. B., Dorsey, C. H., and Lacey, L. B. Luxol fast blue staining of degenerating myelinated fibers. Anat. Rec. 140: 83, 1961.
6. Watanabe, K., Tsukagoshi, T., Kuroda, M., and Hosaka, Y. Nerve conduit using fascia-wrapped fibrocollagenous tube. J. Reconstr. Microsurg. 17: 363, 2001.
7. Smith, R., Wiedl, C., Chubb, P., and Greene, C. Role of small intestine submucosa (SIS) as a nerve conduit: Preliminary report. J. Invest. Surg. 17: 339, 2004.
8. Rao, P., Kotwal, P., Farooque, M., and Dinda, A. Muscle autografts in nerve gaps: Pattern of regeneration and myelination in various lengths of graft: An experimental study in guinea pigs. J. Orthop. Sci. 6: 527, 2001.
9. Marta, C., Paez, P., Lopez, M., Pellegrino de Iraldi, A., Soto, E., and Pasquini, J. Morphological changes of myelin sheaths in rats intracranially injected with apotransferrin. Neurochem. Res. 28: 101, 2001.
10. Patani, R., Balaratnam, M., Vora, A., and Reynolds, R. Remyelination can be extensive in multiple sclerosis despite a long disease course. Neuropathol. Appl. Neurobiol. 33: 277, 2007.

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