Superficial or deep implantation of motor nerve after denervation: an experimental study--superficial or deep implantation of motor nerve

Direct muscle neurotization: Previous advancements in animal models

Peripheral nerve repair is daily activity for several microsurgeons. Numerous nerve repair techniques are applied, including neurorrhaphy, nerve grafting and nerve transfer, depending on the nature and extent of the injury. However, these techniques become unfeasible when the distal nerve end is not preserved during the peripheral nerve injury or a segment of the muscle is transferred without the nerve supplying it. However, direct muscle neurotization (DMN) achieves muscle reinnervation by suturing the nerve directly into the muscle tissue, without requiring a distal nerve end for coaptation. Despite promising results in the literature, DMN is not widely adopted in clinical practice. Animal models may help in advancing novel therapeutic approaches, due to their anatomic and physiologic similarities to humans. This review highlights the current scientific understanding and recent advancements in DMN as well as the animal models and target muscle that have been used in the past to investigate the basic principles behind this surgical technique. The presented information should aid in establishing the clinical importance of DMN in peripheral nerve injury.

Autocrine motility factor injection for motor plate regeneration and muscle function restoration--a pilot study

BACKGROUND

Autocrine motility factor (AMF) is a multifunctional cytokine that promotes cellular adhesion, proliferation, motility, anti-apoptosis, and tissue repair. Direct nerve implantation (DNI) is considered to be effective in peripheral motor nerve injuries with disuse of the distal nerve; however, the repaired muscle function is not satisfactory. In our study, purified AMF was injected in reinnervated muscle after DNI with the intention of assessing if AMF, as a malignant tumor-related cytokine, could improve motor plate regeneration and neuromuscular function restoration.

METHODS

Purified AMF, which was extracted from AMF-transfected myoblast-conditioned medium, was regularly injected into the rat gastrocnemius in an established rat gastrocnemius denervation and reinnervation model. The nerve conduction velocity (NCV) of the tibial nerve, peak-to-peak value (PPV), area under the curve (AUC) of the compound muscle action potential (CMAP) and the Tibial Functional Index (TFI) were measured at 8, 16 and 24 weeks after injection. The regenerated endplates in gastrocnemius were examined by histochemical staining. In another group, an AMF-free solution was injected as the control.

RESULTS

After the AMF injection, the direct-nerve-implanted muscle function recovery was better in terms of both the nerve velocity and the quality. The endplates in the experimental group also had a quantitative advantage in restoration. After comparing the histochemical-stained tissues, no indications of tumorigenesis were detected.

CONCLUSIONS

AMF had positive effects on neuromuscular reparation and need more detailed research to determine the signalling pathways and side effects of AMF.

Successful intramuscular neurotization is dependent on the denervation period. A histomorphological study of the gracilis muscle in rats

To characterize the extent to which reinnervation potential depends on the duration of denervation, intramuscular neurotization of the gracilis muscle was performed either immediately or 2, 4, 6, and 8 weeks after transection of the obturator nerve. For neurotization, the sciatic nerve was split into three fascicle groups and fixed intramuscularly. Muscle morphology after 6 weeks of regeneration was identified with anti-myosin immunohistochemistry and NADH staining. Newly formed motor endplates were characterized using acetylcholinesterase staining and electron microscopy. Wet muscle weight ratio indicated the functional state of synapses. Depending on the denervation period, three levels of regenerative outcome were evident. Best results were seen after immediate neurotization or after 2 weeks of denervation. Regeneration, although at a significantly lower level, also occurred after denervation periods of 4 and 6 weeks. Regeneration following neurotization after 8 weeks of denervation was negligible. Quantity and quality of motor endplate formation depended on the denervation period. Thus, in special clinical situations intramuscular neurotization within a distinct time window provides a good reconstructive option.