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Kollitz KM, Giusti G, Friedrich PF, Bishop AT, Shin AY. The rabbit brachial plexus as a model for nerve injury and repair Part 1: Anatomic study of the biceps and triceps innervation. Microsurgery 2020; 40:183-188. [DOI: 10.1002/micr.30482] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Accepted: 05/24/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Kathleen M. Kollitz
- Department of Orthopedic Surgery, Division of Hand and Microvascular SurgeryMayo Clinic Rochester Minnesota
| | - Guilherme Giusti
- Department of Orthopedic Surgery, Division of Hand and Microvascular SurgeryMayo Clinic Rochester Minnesota
| | - Patricia F. Friedrich
- Department of Orthopedic Surgery, Division of Hand and Microvascular SurgeryMayo Clinic Rochester Minnesota
| | - Allen T. Bishop
- Department of Orthopedic Surgery, Division of Hand and Microvascular SurgeryMayo Clinic Rochester Minnesota
| | - Alexander Y. Shin
- Department of Orthopedic Surgery, Division of Hand and Microvascular SurgeryMayo Clinic Rochester Minnesota
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Sulaiman OAR, Gordon T. A rat study of the use of end-to-side peripheral nerve repair as a "babysitting" technique to reduce the deleterious effect of chronic denervation. J Neurosurg 2019; 131:622-632. [PMID: 30215557 DOI: 10.3171/2018.3.jns172357] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/01/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Functional recovery is disappointing after surgical repair of nerves that are injured far from their target organs and/or after delayed repair. In the former case, a nerve transfer that transects a distal nerve fascicle to innervate denervated targets is one strategy to promote nerve regeneration and functional recovery. An alternate strategy tested in this study is to perform an end-to-side neurorrhaphy to "babysit" (protect) the denervated distal nerve stump at the time of nerve repair and reduce the deleterious effect of chronic denervation on nerve regeneration. METHODS In the hindlimbs of Sprague-Dawley rats, the common peroneal (CP) nerve was transected unilaterally and the distal CP nerve stump inserted through a perineurial window into the intact tibial (TIB) nerve, i.e., CP-TIB end-to-side neurorrhaphy. In the first experiment, TIB nerve motoneurons that had regenerated and/or sprouted axons into the CP nerve within 3 months were stimulated to elicit contractions, and thereafter, identified with retrograde dyes for counting. In the second experiment, the intact TIB nerve was transected and cross-sutured to a 3-month chronically denervated distal CP nerve stump that had either been "protected" by ingrown TIB nerves after CP-TIB neurorrhaphy or remained chronically denervated. Thereafter, the number of retrogradely labeled TIB nerve motoneurons that had regenerated their nerves within 3 months were counted and reinnervated tibialis anterior (TA) muscles weighed. RESULTS A mean (± SE) of 231 ± 83 TIB nerve motoneurons grew into the end-to-side CP distal nerve stump with corresponding ankle flexion; 32% regenerated their axons and 24% sprouted axons from the intact TIB nerve, eliciting ankle flexor-extensor co-contraction. In the second experiment, after a 3-month period of TIB nerve regeneration, significantly more TIB motoneurons regenerated their axons into "protected" than "unprotected" CP distal nerve stumps within 3 months (mean 332 ± 43.6 vs 235 ± 39.3 motoneurons) with corresponding and significantly higher numbers of regenerated nerve fibers, resulting in significantly better recovery of reinnervated TA muscle weight. CONCLUSIONS These experiments in rats demonstrated that delayed nerve repair is more effective when the deleterious effects of chronic denervation of the distal nerve stump are reduced by protecting the nerve stump with ingrowing nerve fibers across an end-to-side insertion of the distal nerve stump into a neighboring intact nerve. Such an end-to-side neurorrhaphy may be invaluable as a means of preventing the atrophy of distal nerve stumps and target organs after chronic denervation, which allows for effective reinnervation of the protected distal nerve stumps and target organs over distance and time.
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Affiliation(s)
- Olawale A R Sulaiman
- 1Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana; and
| | - Tessa Gordon
- 2Division of Neuroscience, University of Alberta Faculty of Medicine, Edmonton, Alberta, Canada
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Zheng MX, Shen YD, Hua XY, Hou AL, Zhu Y, Xu WD. Cortical Reorganization in Dual Innervation by Single Peripheral Nerve. Neurosurgery 2019; 83:819-826. [PMID: 29029335 DOI: 10.1093/neuros/nyx474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 08/18/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Functional recovery after peripheral nerve injury and repair is related with cortical reorganization. However, the mechanism of innervating dual targets by 1 donor nerve is largely unknown. OBJECTIVE To investigate the cortical reorganization when the phrenic nerve simultaneously innervates the diaphragm and biceps. METHODS Total brachial plexus (C5-T1) injury rats were repaired by phrenic nerve-musculocutaneous nerve transfer with end-to-side (n = 15) or end-to-end (n = 15) neurorrhaphy. Brachial plexus avulsion (n = 5) and sham surgery (n = 5) rats were included for control. Behavioral observation, electromyography, and histologic studies were used for confirming peripheral nerve reinnervation. Cortical representations of the diaphragm and reinnervated biceps were studied by intracortical microstimulation techniques before and at months 0.5, 3, 5, 7, and 10 after surgery. RESULTS At month 0.5 after complete brachial plexus injury, the motor representation of the injured forelimb disappeared. The diaphragm representation was preserved in the "end-to-side" group but absent in the "end-to-end" group. Rhythmic contraction of biceps appeared in "end-to-end" and "end-to-side" groups, and the biceps representation reappeared in the original biceps and diaphragm areas at months 3 and 5. At month 10, it was completely located in the original biceps area in the "end-to-end" group. Part of the biceps representation remained in the original diaphragm area in the "end-to-side" group. Destroying the contralateral motor cortex did not eliminate respiration-related contraction of biceps. CONCLUSION The brain tends to resume biceps representation from the original diaphragm area to the original biceps area following phrenic nerve transfer. The original diaphragm area partly preserves reinnervated biceps representation after end-to-side transfer.
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Affiliation(s)
- Mou-Xiong Zheng
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Central Laboratory, Jing'an District Center Hospital, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yun-Dong Shen
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Central Laboratory, Jing'an District Center Hospital, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Xu-Yun Hua
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Central Laboratory, Jing'an District Center Hospital, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Ao-Lin Hou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Central Laboratory, Jing'an District Center Hospital, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yi Zhu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wen-Dong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China.,Department of Central Laboratory, Jing'an District Center Hospital, Shanghai, China.,Department of Hand and Upper Extremity Surgery, Jing'an District Center Hospital, Shanghai, China.,Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China.,Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
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Rui J, Zhou YJ, Zhao X, Li JF, Gu YD, Lao J. Endogenous automatic nerve discharge promotes nerve repair: an optimized animal model. Neural Regen Res 2018; 14:306-312. [PMID: 30531014 PMCID: PMC6301173 DOI: 10.4103/1673-5374.244802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exogenous electrical nerve stimulation has been reported to promote nerve regeneration. Our previous study has suggested that endogenous automatic nerve discharge of the phrenic nerve and intercostal nerve has a positive effect on nerve regeneration at 1 month postoperatively, but a negative effect at 2 months postoperatively, which may be caused by scar compression. In this study, we designed four different rat models to avoid the negative effect from scar compression. The control group received musculocutaneous nerve cut and repair. The other three groups were subjected to side-to-side transfer of either the phrenic (phrenic nerve group), intercostal (intercostal nerve group) or thoracodorsal nerves (thoracic dorsal nerve group), with sural nerve autograft distal to the anastomosis site. Musculocutaneous nerve regeneration was assessed by electrophysiology of the musculocutaneous nerve, muscle tension, muscle wet weight, maximum cross-sectional area of biceps, and myelinated fiber numbers of the proximal and distal ends of the anastomosis site of the musculocutaneous nerve and the middle of the nerve graft. At 1 month postoperatively, compound muscle action potential amplitude of the biceps in the phrenic nerve group and the intercostal nerve group was statistically higher than that in the control group. The myelinated nerve fiber numbers in the distal end of the musculocutaneous nerve and nerve graft anastomosis in the phrenic nerve and the intercostal nerve groups were statistically higher than those in the control and thoracic dorsal nerve groups. The neural degeneration rate in the middle of the nerve graft in the thoracic dorsal nerve group was statistically higher than that in the phrenic nerve and the intercostal nerve groups. At 2 and 3 months postoperatively, no significant difference was detected between the groups in all the assessments. These findings confirm that the phrenic nerve and intercostal nerve have a positive effect on nerve regeneration at the early stage of recovery. This study established an optimized animal model in which suturing the nerve graft to the distal site of the musculocutaneous nerve anastomosis prevented the inhibition of recovery from scar compression.
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Affiliation(s)
- Jing Rui
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
| | - Ying-Jie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Zhao
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji-Feng Li
- Key Laboratory of Hand Reconstruction, Ministry of Health; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital, Fudan University; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai, China
| | - Jie Lao
- Department of Hand Surgery, Huashan Hospital, Fudan University; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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Kollitz KM, Giusti G, Friedrich PF, Bishop AT, Shin AY. Validation of Isometric Tetanic Force as a Measure of Muscle Recovery After Nerve Injury in the Rabbit Biceps. J Hand Surg Am 2018; 43:488.e1-488.e8. [PMID: 29305235 DOI: 10.1016/j.jhsa.2017.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 10/05/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to describe and validate a technique for measurement of isometric tetanic force (ITF) in the rabbit biceps muscle. MATERIALS AND METHODS Eighteen New Zealand White rabbits were randomized to test either the right side or the left side first. Under propofol anesthesia, the brachial plexus and biceps brachii were exposed. The middle trunk (C6, C7) was secured in a bipolar electrode. Compound muscle action potential (CMAP) was measured. The proximal, tendinous portion of the biceps was severed at the shoulder and clamped in a custom-made force transducer. Muscle preload and electrical stimulation variables were optimized to obtain the highest tetanic muscle contraction. Wet muscle weight (WMW) and nerve histomorphometry were analyzed. Statistical analysis was performed to determine side-to-side equivalence. RESULTS The rabbit biceps muscle force demonstrated side-to-side equivalence with overlapping 95% confidence intervals (95% CI). The right side, expressed as a percentage of the left, averaged 99.69% (95% CI, 88.89%-110.5%). The WMW of the right expressed as a percentage of the left was 98.9% (95% CI, 95.8%-102%). CONCLUSIONS The ITF is equivalent from side to side in the rabbit as demonstrated by the high degree of overlap in the 95% CIs for each side. The width of the 95% CI implies that there is more variability in the rabbit upper extremity than for the lower extremity of the rabbit or rat models, and researchers should take this into account when performing sample size estimates in pre-experimental planning. CLINICAL RELEVANCE The rabbit biceps muscle ITF measurements can be used to measure motor recovery in a rabbit model of brachial plexus injury and compared with the contralateral uninjured side.
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Affiliation(s)
| | | | | | - Allen T Bishop
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN
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Jia X, Chen C, Yang J, Yu C. End-to-side neurotization with the phrenic nerve in restoring the function of toe extension: an experimental study in a rat model. J Plast Surg Hand Surg 2017; 52:185-188. [PMID: 29179656 DOI: 10.1080/2000656x.2017.1408017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The phrenic nerve being transferred to the posterior division of the lower trunk with end-to-end neurorrhaphy is reported to be effective in restoring the function of digit extension in literature. However, the phrenic nerve is extremely important in respiration. We designed an animal experiment to discover whether the phrenic nerve being transferred to the posterior division of the lower trunk with end-to-side neurotization was feasible and provided the theoretical basis. A sum of 36 Sprague-Dawley rats was randomly assigned to one of two groups. In Group A, the phrenic nerve was transferred to the posterior division of the lower trunk with end-to-side neurotization. In Group B, the posterior division of the lower trunk was directly sutured. The results of behavioral assessment, electrophysiology, histology and nerve fiber count and muscle weight at 12 weeks postoperatively were recorded. In Group A, none of the rats experienced tachypnea. The motion of slight toe extension was observed. The results of electrophysiology, histology and nerve fiber count and muscle weight in Group A were not as well as those of Group B, but gradually improved with time. The phrenic nerve being transferred to the posterior division of lower trunk with end-to-side neurotization can partially restore the function of toe extension in a rat model. Whether the function of digit extension can be restored by the phrenic nerve with end-to-side neurotization in humans still needs more practice in clinic.
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Affiliation(s)
- Xiaotian Jia
- a Department of Hand Surgery , Huashan Hospital, Fudan University, Shanghai; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery , Shanghai , China
| | - Chao Chen
- b Department of Gynecology and Obstetrics , Putuo District Center Hospital, Shanghai University of Traditional Chinese Medicine , Shanghai , China
| | - Jianyun Yang
- a Department of Hand Surgery , Huashan Hospital, Fudan University, Shanghai; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery , Shanghai , China
| | - Cong Yu
- a Department of Hand Surgery , Huashan Hospital, Fudan University, Shanghai; Key Laboratory of Hand Reconstruction, Ministry of Health, Shanghai; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery , Shanghai , China
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Abstract
OBJECTIVE The phrenic nerve and the contralateral seventh cervical (C7) nerve root are the most commonly used donor nerves in the treatment of total brachial plexus avulsion. The aim of this study was to determine if the phrenic nerve or the contralateral C7 nerve root yields a superior outcome for nerve transfer. METHODS A total of 60 Sprague-Dawley rats were randomly assigned to 1 of 3 groups. In Group A the phrenic nerve was used as the donor nerve; in Group B the contralateral C7 nerve root nerve was used as the donor nerve; in Group C the nerve was directly sutured. The results of behavioral assessment, electrophysiology, histology, nerve fiber count and muscle weight at 24 weeks postoperatively were recorded. RESULTS Group A showed a faster recovery time compared to Group B; however Group B showed a better functional recovery at the final outcome assessment compared to Group A. CONCLUSION The contralateral C7 nerve root was better as the donor nerve for nerve transfer in the treatment of total brachial plexus avulsion.
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Korus L, Ross DC, Doherty CD, Miller TA. Nerve transfers and neurotization in peripheral nerve injury, from surgery to rehabilitation. J Neurol Neurosurg Psychiatry 2016; 87:188-97. [PMID: 26134850 DOI: 10.1136/jnnp-2015-310420] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 06/04/2015] [Indexed: 12/11/2022]
Abstract
Peripheral nerve injury (PNI) and recent advances in nerve reconstruction (such as neurotization with nerve transfers) have improved outcomes for patients suffering peripheral nerve trauma. The purpose of this paper is to bridge the gap between the electromyographer/clinical neurophysiologist and the peripheral nerve surgeon. Whereas the preceding literature focuses on either the basic science behind nerve injury and reconstruction, or the surgical options and algorithms, this paper demonstrates how electromyography is not just a 'decision tool' when deciding whether to operate but is also essential to all phases of PNI management including surgery and rehabilitation. The recent advances in the reconstruction and rehabilitation of PNI is demonstrated using case examples to assist the electromyographer to understand modern surgical techniques and the unique demands they ask from electrodiagnostic testing.
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Affiliation(s)
- Lisa Korus
- Division of Plastic Surgery, Departments of Surgery, University of Alberta
| | - Douglas C Ross
- Co-directors Peripheral Nerve Clinic, St. Josephs Health Care, London, Ontario, Canada Roth-McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, Western University, London, Ontario, Canada Department of Surgery, Western University, (Hospital) St Joseph's Health Care, London, Ontario, Canada
| | - Christopher D Doherty
- Roth-McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, Western University, London, Ontario, Canada Department of Surgery, Western University, (Hospital) St Joseph's Health Care, London, Ontario, Canada
| | - Thomas A Miller
- Co-directors Peripheral Nerve Clinic, St. Josephs Health Care, London, Ontario, Canada Roth-McFarlane Hand and Upper Limb Centre, St. Josephs Health Care, Western University, London, Ontario, Canada Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, Canada
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