Fiber type morphometry and capillary geometry in free, vascularized muscle transfers

Neurovascular Transfer Does Not Cause Skeletal Muscle Fiber Degeneration

BACKGROUND

The mechanisms responsible for the incomplete recovery of muscle function after microneurovascular transfer have not been fully determined. Because fiber degeneration and regeneration can impact muscle mechanical function, the authors tested the null hypothesis that ischemia-induced fiber degeneration is not responsible for the force deficits observed after neurovascular muscle transfer.

METHODS

Rats were assigned to one of three groups: orthotopic, nonvascularized grafting of the extensor digitorum longus muscle (STD group); orthotopic, neurovascular transfer of the extensor digitorum longus muscle with no intraoperative ischemia (NV-0 group); or orthotopic, neurovascular transfer of the extensor digitorum longus muscle with 3 hours of intraoperative ischemia (NV-3 group). At 1 and 2 weeks, extensor digitorum longus muscle cross-sections were labeled for developmental myosin heavy chain isoforms, markers of fiber regeneration.

RESULTS

In extensor digitorum longus muscles from animals in the STD group, many small cells strongly labeled for developmental myosin heavy chain were observed and identified as myoblasts, indicating recent muscle fiber necrosis with subsequent regeneration. Extensor digitorum longus muscles from rats in the NV-0 and NV-3 groups contained no cells labeled for developmental myosin heavy chain.

CONCLUSIONS

After neurovascular muscle transfer (with ischemia times up to 3 hours), ischemia-induced muscle fiber degeneration and regeneration does not occur. Muscle fiber degeneration is not responsible for the force deficits observed after microneurovascular skeletal muscle transfer.

Metabolic characteristics of experimental free vascularized canine gracilis muscle transfers

A canine gracilis model was used to study muscle energy metabolism and enzyme activities after free vascularized muscle transfer. Fifteen male mongrel dogs underwent orthotopic, free transfer of the left gracilis with microneurovascular anastomosis. After a minimum of 10 months' recovery, muscle biopsy specimens were obtained from the transfers and the contralateral controls and analyzed for relative fiber type areas and maximum activities of phosphorylase, hexokinase, phosphofructokinase, glycerol-3-phosphate dehydrogenase (GPDH), pyruvate kinase, lactate dehydrogenase, citrate synthase, succinate dehydrogenase, 3-hydroxyacyl coenzyme A dehydrogenase (HAD), and creatine phosphokinase. Biopsy specimens obtained before and after a 10 minute, 20-Hz contraction were analyzed for glucose, glycogen, glycolytic intermediates, phosphocreatine, total creatine, and adenine nucleotides (adenosine triphosphate, adenosine diphosphate, adenosine monophosphate, inosine monophosphate, and inosine). There was no significant transfer versus control difference in type I relative fiber area (45 +/- 4 percent versus 44 +/- 3 percent). Total creatine was significantly reduced in the transferred muscles relative to control (83.1 +/- 3.0 mmol/kg versus 100.6 +/- 5.1 mmol/kg dry weight). Maximal activities of phosphorylase, pyruvate kinase, lactate dehydrogenase, citrate synthase, succinate dehydrogenase, HAD, and creatine phosphokinase were diminished in transfers relative to controls, although hexokinase activity was significantly higher in the freely transferred gracilis muscles. During the 20-Hz contraction, muscle transfers produced less force initially, although the force/time integral over the 10-minute stimulation was similar in transfers (277 +/- 25 N/g/second) and controls (272 +/- 24 N/g/second). The contraction was associated with significant glvcogen use and lactate accumulation in both transfers and controls, although this was less pronounced for the transfers. Glycolytic flux appeared muted in the transfers relative to controls. Significant, similar high-energy phosphagen reductions and inosine monophosphate accumulation were noted during the contraction in both groups. Contractile activity is associated with the expected pattern of muscle metabolite changes following free vascularized transfer, indicating the components of cellular energy metabolism are not qualitatively altered after microneurovascular muscle transfer. In contrast, quantitative differences suggest that free vascularized muscle transfer can be associated with a muscle enzyme profile consistent with deconditioning and the presence of denervated muscles fibers in the absence of fiber type profile changes.

Qualitative and quantitative changes in acetylcholine receptor distribution at the neuromuscular junction following free muscle transfer

The qualitative and quantitative changes in acetylcholine receptor distribution were studied in the gracilis muscle of the Wistar rat following free neurovascular transfer. Even at 30 weeks after transfer, the morphology of the neuromuscular junction failed to return to the presurgical state. The number of acetylcholine receptors at the reinnervated neuromuscular junction also remained lower than the control. The persistent weakness following free neurovascular muscle transfer may be attributed to these qualitative and quantitative changes at the neuromuscular junction.

Termino-lateral neurorrhaphy: the functional axonal anatomy

The goal of this study was to determine the functional axonal anatomy of a termino-lateral neurorrhaphy (TLN). We hypothesize that axons populating a TLN must relinquish functional connections with their original targets prior to establishing new connections via the TLN. Two-month-old F344 rats underwent a TLN between the left peroneal nerve and a nerve graft tunneled to the contralateral hindlimb. Three months postoperatively, an end-to-end neurorrhaphy was performed between the nerve graft and the right peroneal nerve. Four months after the second operation, contractile properties and electromyographic (EMG) signals were measured in the bilateral hindlimbs. Left peroneal nerve stimulation proximal to the TLN site resulted in bilateral extensor digitorum longus (EDL) and tibialis anterior (TA) muscle contractions, with significantly lower forces on the side reinnervated by TLN. Evoked EMGs demonstrated that the right and left hindlimb musculature were electrically discontinuous following TLN. These data support our hypothesis that axons can form functional connections via a TLN, but they must first relinquish functional connections with their original targets.

A murine skeletal muscle ischemia-reperfusion injury model: differential pathology in BALB/c and DBA/2N mice

Ischemia-reperfusion injuries can occur with diseases such as myocardial infarction and stroke and during surgical procedures such as organ transplantation and correction of aortic aneurysms. We developed a murine model to mimic abdominal aortic aneurysm repair with cross-clamping of the aorta distal to the renal artery. After model development, we compared the normal complement BALB/c mouse with the C5-deficient DBA/2N mouse. To assess quantitative differences, we measured neuromuscular function up to 72 h after ischemia with a subjective clinical scoring system, as well as plasma chemistries, hematology, and histopathology. There were significant increases in clinical scores and creatine phosphokinase, lactate dehydrogenase, and muscle histopathology scores in BALB/c mice compared with those in DBA/2N mice and sham-surgery mice. Muscle histopathology scores of the cranial tibialis and quadriceps correlated well with clinical signs, creatine phosphokinase, and lactate dehydrogenase, and indicated the greatest pathology in these muscle groups. We developed a murine model of skeletal muscle ischemia-reperfusion injury that can utilize the benefits of murine genetic and transgenic models to assess therapeutic principles of this model. Additionally, we have shown a significant reduction in clinical signs, plasma muscle enzyme concentrations, and muscle pathology in the C5-deficient DBA/2N mouse in this model.