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Johnson AR, Said A, Acevedo J, Taylor R, Wu K, Ray WZ, Patterson JM, Mackinnon SE. An Updated Evaluation of the Management of Nerve Gaps: Autografts, Allografts, and Nerve Transfers. Semin Neurol 2024. [PMID: 39393799 DOI: 10.1055/s-0044-1791665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2024]
Abstract
Within the past decade, there have been multiple innovations in the field of nerve surgery. In this review, we highlight critical changes and innovations that have helped advance the field and present opportunities for further study. This includes the modification and clarification of the classification schema for nerve injuries which informs prognosis and treatment, and a refined understanding and application of electrodiagnostic studies to guide patient selection. We provide indications for operative intervention based on this nerve injury classification and propose strategies best contoured for varying injury presentations at differing time points. Lastly, we discuss new developments in surgical techniques and approaches based on these advancements.
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Affiliation(s)
- Anna Rose Johnson
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Abdullah Said
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Jesus Acevedo
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ruby Taylor
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kitty Wu
- Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Wilson Z Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - J Megan Patterson
- Department of Orthopedic Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, Missouri
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Hendry JM, Head LK. Alternative Nerve Coaptations: End-To-Side and Beyond. Hand Clin 2024; 40:369-377. [PMID: 38972681 DOI: 10.1016/j.hcl.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Modern end-to-side (ETS) nerve transfers have undergone several permutations since the early 1990's. Preclinical data have revealed important mechanisms and patterns of donor axon outgrowth into the recipient nerves and target reinnervation. The versatility of ETS nerve transfers can also potentially address several processes that limit functional recovery after nerve injury by babysitting motor end-plates and/or supporting the regenerative environment within the denervated nerve. Further clinical and basic science work is required to clarify the ideal clinical indications, contraindications, and mechanisms of action for these techniques in order to maximize their potential as reconstructive options.
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Affiliation(s)
- J Michael Hendry
- Division of Plastic and Reconstructive Surgery, Queen's University, Kingston, Ontario K7L 5G2, Canada; Centre for Neuroscience Studies, Queens University, 18 Stuart Street, Kingston, Ontario, K7L3N6, Canada
| | - Linden K Head
- Division of Plastic and Reconstructive Surgery, Queen's University, Kingston, Ontario K7L 5G2, Canada.
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3
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Huang H, Lin Q, Rui X, Huang Y, Wu X, Yang W, Yu Z, He W. Research status of facial nerve repair. Regen Ther 2023; 24:507-514. [PMID: 37841661 PMCID: PMC10570629 DOI: 10.1016/j.reth.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
The facial nerve, also known as the seventh cranial nerve, is critical in controlling the movement of the facial muscles. It is responsible for all facial expressions, such as smiling, frowning, and moving the eyebrows. However, damage to this nerve can occur for a variety of reasons, including maxillofacial surgery, trauma, tumors, and infections. Facial nerve injuries can cause severe functional impairment and can lead to different degrees of facial paralysis, significantly affecting the quality of life of patients. Over the past ten years, significant progress has been made in the field of facial nerve repair. Different approaches, including direct suture, autologous nerve grafts, and tissue engineering, have been utilized for the repair of facial nerve injury. This article mainly summarizes the clinical methods and basic research progress of facial nerve repair in the past ten years.
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Affiliation(s)
- Haoyuan Huang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Qiang Lin
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xi Rui
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Yiman Huang
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Xuanhao Wu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenhao Yang
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Zhu Yu
- School of Stomatology, Jinan University, Guangzhou 510632, China
| | - Wenpeng He
- Hospital of stomatology, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- School of Stomatology, Jinan University, Guangzhou 510632, China
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Fernandes MS, Viterbo F, Rodrigues LD, di Luccas CB, de Menezes Neto BF. Nerve Injury and Peripheral Nerve Functional Loss From Injection and Suture Needles: An Experimental Study on Rats. Aesthet Surg J 2023; 43:NP949-NP955. [PMID: 37606256 DOI: 10.1093/asj/sjad267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/25/2023] [Accepted: 08/19/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND During invasive procedures involving needles, there is a chance of damage to peripheral nerves. Therefore, a method for experimentally simulating these situations is needed. OBJECTIVES In this study we aimed to evaluate peripheral nerve lesions caused by the entry and exit of an injection needle, nerve transfixion through a suture stitch, and the injection of saline solution and lidocaine into the nerve. METHODS After obtaining approval from the Animal Ethics Committee, we randomly divided 36 Wistar rats, weighing approximately 250 g each, into 6 groups (control, sham, suture, needle, saline, and lidocaine groups), with 6 animals in each group. All procedures were performed on the left paws of the rats. After the procedure, walking track analysis was performed to assess the walking function of rats for 8 weeks. Four months after the procedures, we performed bilateral electrophysiological studies (measuring the latency and amplitude of the electrical impulse in the peroneal nerve). Subsequently, the rats were euthanized, and bilateral tissue samples were collected from the peroneal nerve and tibialis cranialis muscle for morphometric histological analysis. RESULTS In the walking track analysis, all groups showed normalization of walking functionality after 13 days. There was little histological change between the groups, and no functional loss related to the procedures was observed. CONCLUSIONS Procedures involving the infusion of local anesthetic or saline solution, or suture needles, are safe with regard to peripheral nerve function loss. Accidents tend not to cause nerve impairment.
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Chi D, Ha AY, Alotaibi F, Pripotnev S, Patterson BCM, Fongsri W, Gouda M, Kahn LC, Mackinnon SE. A Surgical Framework for the Management of Incomplete Axillary Nerve Injuries. J Reconstr Microsurg 2023; 39:616-626. [PMID: 36746195 DOI: 10.1055/s-0042-1757752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Axillary nerve injury is the most common nerve injury affecting shoulder function. Nerve repair, grafting, and/or end-to-end nerve transfers are used to reconstruct complete neurotmetic axillary nerve injuries. While many incomplete axillary nerve injuries self-resolve, axonotmetic injuries are unpredictable, and incomplete recovery occurs. Similarly, recovery may be further inhibited by superimposed compression neuropathy at the quadrangular space. The current framework for managing incomplete axillary injuries typically does not include surgery. METHODS This study is a retrospective analysis of 23 consecutive patients with incomplete axillary nerve palsy who underwent quadrangular space decompression with additional selective medial triceps to axillary end-to-side nerve transfers in 7 patients between 2015 and 2019. Primary outcome variables included the proportion of patients with shoulder abduction M3 or greater as measured on the Medical Research Council (MRC) scale, and shoulder pain measured on a Visual Analogue Scale (VAS). Secondary outcome variables included pre- and postoperative Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores. RESULTS A total of 23 patients met the inclusion criteria and underwent nerve surgery a mean 10.7 months after injury. Nineteen (83%) patients achieved MRC grade 3 shoulder abduction or greater after intervention, compared with only 4 (17%) patients preoperatively (p = 0.001). There was a significant decrease in VAS shoulder pain scores of 4.2 ± 2.5 preoperatively to 1.9 ± 2.4 postoperatively (p < 0.001). The DASH scores also decreased significantly from 48.8 ± 19.0 preoperatively to 30.7 ± 20.4 postoperatively (p < 0.001). Total follow-up was 17.3 ± 4.3 months. CONCLUSION A surgical framework is presented for the appropriate diagnosis and surgical management of incomplete axillary nerve injury. Quadrangular space decompression with or without selective medial triceps to axillary end-to-side nerve transfers is associated with improvement in shoulder abduction strength, pain, and DASH scores in patients with incomplete axillary nerve palsy.
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Affiliation(s)
- David Chi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Austin Y Ha
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Fawaz Alotaibi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Stahs Pripotnev
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Brendan C M Patterson
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Warangkana Fongsri
- Hand and Microsurgery Unit, Department of Orthopedic, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Mahmoud Gouda
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Zagazig University, Zagazig City, Sharkia Governorate, Egypt
| | - Lorna C Kahn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
| | - Susan E Mackinnon
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri
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Zhang Y, Hou N, Zhang J, Xie B, Liang J, Chang X, Wang K, Tang X. Treatment options for digital nerve injury: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:675. [PMID: 37700356 PMCID: PMC10496177 DOI: 10.1186/s13018-023-04076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/04/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Surgical treatment of finger nerve injury is common for hand trauma. However, there are various surgical options with different functional outcomes. The aims of this study are to compare the outcomes of various finger nerve surgeries and to identify factors associated with the postsurgical outcomes via a systematic review and meta-analysis. METHODS The literature related to digital nerve repairs were retrieved comprehensively by searching the online databases of PubMed from January 1, 1965, to August 31, 2021. Data extraction, assessment of bias risk and the quality evaluation were then performed. Meta-analysis was performed using the postoperative static 2-point discrimination (S2PD) value, moving 2-point discrimination (M2PD) value, and Semmes-Weinstein monofilament testing (SWMF) good rate, modified Highet classification of nerve recovery good rate. Statistical analysis was performed using the R (V.3.6.3) software. The random effects model was used for the analysis. A systematic review was also performed on the other influencing factors especially the type of injury and postoperative complications of digital nerve repair. RESULTS Sixty-six studies with 2446 cases were included in this study. The polyglycolic acid conduit group has the best S2PD value (6.71 mm), while the neurorrhaphy group has the best M2PD value (4.91 mm). End-to-side coaptation has the highest modified Highet's scoring (98%), and autologous nerve graft has the highest SWMF (91%). Age, the size of the gap, and the type of injury were factors that may affect recovery. The type of injury has an impact on the postoperative outcome of neurorrhaphy. Complications reported in the studies were mainly neuroma, cold sensitivity, paresthesia, postoperative infection, and pain. CONCLUSION Our study demonstrated that the results of surgical treatment of digital nerve injury are generally satisfactory; however, no nerve repair method has absolute advantages. When choosing a surgical approach to repair finger nerve injury, we must comprehensively consider various factors, especially the gap size of the nerve defect, and postoperative complications. Type of study/level of evidence Therapeutic IV.
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Affiliation(s)
- Yi Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Nianzong Hou
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
- Center of Gallbladder Disease, Shanghai East Hospital, Institute of Gallstone Disease, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Bing Xie
- Department of Hand and Foot Surgery, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Jiahui Liang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Xiaohu Chang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
| | - Kai Wang
- Department of Critical Care Medicine, Zibo Central Hospital, No. 54 Gongqingtuan West Road, Zibo, Shandong China
| | - Xin Tang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, 116011 Liaoning China
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Pereira CT, Hill EE, Stasyuk A, Parikh N, Dhillon J, Wang A, Li A. Molecular Basis of Surgical Coaptation Techniques in Peripheral Nerve Injuries. J Clin Med 2023; 12:jcm12041555. [PMID: 36836090 PMCID: PMC9966153 DOI: 10.3390/jcm12041555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Peripheral nerve injuries requiring surgical repair affect over 100,000 individuals in the US annually. Three accepted methods of peripheral repair include end-to-end, end-to-side, and side-to-side neurorrhaphy, each with its own set of indications. While it remains important to understand the specific circumstances in which each method is employed, a deeper understanding of the molecular mechanisms underlying the repair can add to the surgeon's decision-making algorithm when considering each technique, as well as help decide nuances in technique such as the need for making epineurial versus perineurial windows, length and dept of the nerve window, and distance from target muscle. In addition, a thorough knowledge of individual factors that are active in a particular repair can help guide research into adjunct therapies. This paper serves to summarize the similarities and divergences of the three commonly used nerve repair strategies and the scope of molecular mechanisms and signal transduction pathways in nerve regeneration as well as to identify the gaps in knowledge that should be addressed if we are to improve clinical outcomes in our patients.
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Affiliation(s)
- Clifford T. Pereira
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
- Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
- Correspondence:
| | - Elise E. Hill
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
- Department of Surgery, David Grant Medical Center, Travis Air Force Base, Fairfield, CA 94535, USA
| | - Anastasiya Stasyuk
- School of Medicine, University of California Davis, Sacramento, CA 95817, USA
| | - Neil Parikh
- School of Medicine, Boston University, Boston, MA 02118, USA
| | | | - Aijun Wang
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
| | - Andrew Li
- Department of Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
- Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
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Zeiderman MR, Fine J, Asserson DB, Davé DR, Bascone CM, Li AI, Pereira CT. Sensorimotor Outcomes of Upper Extremity End-to-Side Nerve Transfers: A Meta-analysis. Ann Plast Surg 2022; 88:S337-S342. [PMID: 35180756 DOI: 10.1097/sap.0000000000003082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND End-to-side nerve transfer (ETSNT) for treatment of peripheral nerve injuries is controversial given the myriad anatomic locations, injury types, and indications. Efficacy of ETSNT remains debated. We hypothesized differences in age, sex, transfer location, and time to surgery influence outcomes. METHODS We performed a search of the PubMed database for ETSNT in the upper extremity from 1988 to 2018. Age, sex, transfer location, time to surgery, donor and recipient axons, and strength and sensation outcomes as measured by Medical Research Council scale were extracted from articles. Meaningful recovery was classified as Medical Research Council Grade 3 or greater. Association between meaningful recovery and younger (<25) and older (≥25) patients, injury mechanism, sex, transfer location, donor axons, and recipient axons were calculated using a χ 2 or Fisher exact test. A logistic mixed effect model was used with time to surgery, age (categorical), transfer location, and injury type as a fixed effect, and a random paper effect was included to account for correlation among patients from the same paper. RESULTS One hundred fifteen patients from 11 studies were included. Neither age (continuous variable, P = 0.68) nor time to surgery ( P = 0.28) affected meaningful recovery. Injury mechanism, sex, and younger age (<25 vs ≥25 years) were not associated with meaningful recovery. Within the brachial plexus ETSNT demonstrated median M4 ± 1 postoperative strength, with trunks/cords as the primary axon donor ( P = 0.03). The musculocutaneous nerve demonstrated promising but variable results in 31 patients with median strength M3 ± 4. Digital nerves consistently demonstrated meaningful sensory recovery as both donor and recipient axons (15 of 15, 100%). Logistic regression analysis demonstrated that odds of meaningful recovery after ETSNT are significantly greater for transfers within the brachial plexus compared with the distal arm (odds ratio, 41.9; 95% CI, 1.1-1586.7, P = 0.04), but location does not significantly affect meaningful recovery ( P = 0.22). CONCLUSIONS Patients undergoing ETSNT for digital nerve injury demonstrated meaningful recovery. End-to-side nerve transfer seems to be more efficacious when performed within the brachial plexus. This study did not find sex, injury mechanism, or time to surgery to significantly affect meaningful recovery. Additional study is needed to better evaluate the effectiveness of ETSNT in the upper extremity.
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Affiliation(s)
- Matthew R Zeiderman
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Jeffrey Fine
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | | | - Dattesh R Davé
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Corey M Bascone
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Andrew I Li
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
| | - Clifford T Pereira
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California Davis, Davis
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Singh VK, Haq A, Tiwari M, Saxena AK. Approach to management of nerve gaps in peripheral nerve injuries. Injury 2022; 53:1308-1318. [PMID: 35105440 DOI: 10.1016/j.injury.2022.01.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 02/02/2023]
Abstract
Peripheral nerve injuries (PNI) are a major clinical problem. In general, PNI results from motor vehicle accidents, lacerations with sharp objects, penetrating trauma (gunshot wounds) and stretching or crushing trauma and fractures. They can result in significant morbidity, including motor and/or sensory loss, which can affect significantly the life of the patient. Currently, the standard surgical technique for complete nerve transection is end-to-end neurorrhaphy. Unfortunately, there is segmental loss of the nerve trunk in some cases where nerve mobilization may permit end-to-end neurorrhaphy if the gap is less than 1 cm. When the nerve gap exceeds 1 cm, autologous nerve grafting is the gold standard of treatment. But in light of limited availability and concerned donor site morbidity, other techniques have been used: vascularized nerve grafts, cellular and acellular allografts, nerve conduits, nerve transfers and end-to-side neurorrhaphy. This review intends to present an overview of the literature on the applications of these techniques in repair of peripheral nerve injuries. This article also focuses on preoperative assessment, surgical timing, available options and future perspectives.
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Affiliation(s)
- Veena K Singh
- Department of Burns & Plastic surgery, All India Institute of Medical Sciences, Patna, Bihar, India.
| | - Ansarul Haq
- Department of Burns & Plastic surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Meenakshi Tiwari
- Department of Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Ajit K Saxena
- Department of Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Brito da Silva H, Midha R. Editorial. Distal end-to-side motor transfer to augment ulnar nerve entrapment surgery at elbow. J Neurosurg 2022; 136:840-842. [PMID: 34479208 DOI: 10.3171/2021.2.jns21291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Harley Brito da Silva
- 1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Rajiv Midha
- 1Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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de Figueiredo JCA, Viterbo F, Zampar AG, Claro F, Alves JG, Mattioli WM, Paiva GR, Brock RS, Magnani LV. Penile reconstruction and sensitive reinnervation by end-to-side neurorrhaphy. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-021-01910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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The genitofemoral and ilioinguinal nerves as neurorrhaphy candidates for erectile function restoration in patients with prostatectomy-induced erectile dysfunction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Chung E. Regenerative technology to restore and preserve erectile function in men following prostate cancer treatment: evidence for penile rehabilitation in the context of prostate cancer survivorship. Ther Adv Urol 2021; 13:17562872211026421. [PMID: 34434257 PMCID: PMC8381411 DOI: 10.1177/17562872211026421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 06/01/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Erectile dysfunction (ED) following prostate cancer treatment is not uncommon and penile rehabilitation is considered the standard of care in prostate cancer survivorship (PCS), where both patient and his partner desire to maintain and/or recover pre-treatment erectile function (EF). There is a clinical interest in the role of regenerative therapy to restore EF, since existing ED treatments do not always achieve adequate results. Aim To review regenerative therapies for the treatment of ED in the context of PCS. Materials and Methods A review of the existing PubMed literature on low-intensity extracorporeal shockwave therapy (LIESWT), stem cell therapy (SCT), platelet-rich plasma (PRP), gene therapy, and nerve graft/neurorrhaphy in the treatment of ED and penile rehabilitation, was undertaken. Results IESWT promotes neovascularization and neuroprotection in men with ED. While several systematic reviews and meta-analyses showed positive benefits, there is limited published clinical data in men following radical prostatectomy. Cellular-based technology such as SCT and PRP promotes cellular proliferation and the secretion of various growth factors to repair damaged tissues, especially in preclinical studies. However, longer-term clinical outcomes and concerns regarding bioethical and regulatory frameworks need to be addressed. Data on gene therapy in post-prostatectomy ED men are lacking; further clinical studies are required to investigate the optimal use of growth factors and the safest vector delivery system. Conceptually interpositional cavernous nerve grafting and penile re-innervation technique using a somatic-to-autonomic neurorrhaphy are attractive, but issues relating to surgical technique and potential for neural 'regeneration' are questionable. Conclusion In contrast to the existing treatment regime, regenerative ED technology aspires to promote endothelial revascularization and neuro-regeneration. Nevertheless, there remain considerable issues related to these regenerative technologies and techniques, with limited data on longer-term efficacy and safety records. Further research is necessary to define the role of these alternative therapies in the treatment of ED in the context of penile rehabilitation and PCS.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Suite 3, 530 Boundary St., Brisbane, QLD 4000, Australia
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14
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Paiva GR, Viterbo F, Deffune E, Custódio MAD. Stem cells in end-to-side neurorrhaphy. Experimental study in rats. Acta Cir Bras 2021; 35:e351207. [PMID: 33503220 PMCID: PMC7819685 DOI: 10.1590/acb351207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose: To evaluate the influence of mesenchymal stem cells from adipose tissue in
the end-to-side neurorrhaphy, focusing in the nerve regeneration and the
muscle reinnervation in acute trauma. Methods: 140 animals were randomly divided in seven groups: control, denervated,
end-to-side neurorrhaphy between distal stump of common peroneal nerve and
tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and
platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and
platelet gel within stem cells (without culture) removed from the adipose
tissue. Mass measurements of the animal and of cranial tibial muscles,
electromyography, walking track analysis tests and histological examinations
of the nerves and muscles after 180 days was performed. Results: In the groups where the ESN was performed, the results were always better
when compared to the denervated group, showing reinnervation in all ESN
groups. The most sensitive methods were walking track and histological
analysis. Only the group with stem cells showed values similar to the
control group, as well as the functional indices of peroneal nerve and the
number of nerve fibers in the peroneal nerve. Conclusions: Stem cells were effective in ESN according with the functional index of the
peroneal nerve, evaluated by walking track analysis and the number of nerve
fibers in the peroneal nerve.
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Affiliation(s)
| | - Fausto Viterbo
- Universidade Estadual Paulista “Júliode Mesquita Filho”, Brazil
| | - Elenice Deffune
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
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Teixeira RKC, Calvo FC, Santos DRD, Araújo NPD, Tramontin DF, Costa LVPD, Barros RSMD. Criteria for assessing peripheral nerve injury. Behavioral and functional assessment in non-operated Wistar rats. Acta Cir Bras 2020; 35:e202000702. [PMID: 32813758 PMCID: PMC7433661 DOI: 10.1590/s0102-865020200070000002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/14/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the normality pattern in functional tests of peripheral nerves. Methods Sixty female and sixty male Wistar rats were submitted to vibrissae movement and nictitating reflex for facial nerve; grooming test and grasping test for brachial plexus; and walking tracking test and horizontal ladder test for lumbar plexus. The tests were performed separately, with an interval of seven days between each. Results All animals showed the best score in vibrissae movement, nictitating reflex, grooming test, and horizontal ladder test. The best score was acquired for the first time in more than 90% of animals. The mean of strength on the grasping test was 133.46±12.08g for the right and 121.74±8.73g for the left anterior paw. There was a difference between the right and left sides. There was no difference between the groups according to sex. There is no statistical difference comparing all functional indexes between sex, independent of the side analyzed. The peroneal functional index showed higher levels than the sciatic and tibial functional index on both sides and sex. Conclusions The behavioral and functional assessment of peripheral nerve regeneration are low-cost, easy to perform, and reliable tests. However, they need to be performed by experienced researchers to avoid misinterpretation.
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Assessment of axonal sprouting and motor performance after hypoglossal-facial end-to-side nerve repair: experimental study in rats. Exp Brain Res 2020; 238:1563-1576. [PMID: 32488325 DOI: 10.1007/s00221-020-05835-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/15/2020] [Indexed: 10/24/2022]
Abstract
Hypoglossal-facial nerve anastomosis (HFA) aims to reanimate denervated mimic muscles with hypoglossal axons when the transected facial nerve is not accessible. The aim of this study was to evaluate the recovery of HFA using a "Y" tube in two variants: (1) the proximal stump of the hypoglossal nerve was entubulated to the "Y" tube (classic "Y" tube HFA) and (2) the "Y" tube was sutured to an epineurial window of a slightly damaged hypoglossal nerve (end-to-side "Y" tube HFA). A total of 48 adult female rats were divided into four groups: intact controls (group 1), sham operated (group 2), classic "Y" tube HFA (group 3) and end-to-side "Y" tube HFA (group 4). The abdominal aorta with both common iliac arteries of isogeneic male rats served as the Y-tube conduit. Animals from group 4 recovered better than those from group 3: the degree of collateral axonal branching (3 ± 1%) was significantly lower than that determined in group 3 (13 ± 1%). The mean deviation of the tongue from the midline was significantly smaller in group 4 (6 ± 4°) than that measured in animals from group 3 (41 ± 6°). In the determination of vibrissal motor function in group 3 and group 4, a decrease in amplitude was found to be - 66% and - 92%, respectively. No differences in the reinnervation pattern of the target muscles were detected. As a result, these surgical models were not determined to be able to improve vibrissal movements. It was concluded that performance of end-to-side "Y" tube HFA diminishes collateral axonal branching at the lesion site, which in turn, promotes better recovery of tongue- and vibrissal-motor performance.
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Dusseldorp JR, van Veen MM, Guarin DL, Quatela O, Jowett N, Hadlock TA. Spontaneity Assessment in Dually Innervated Gracilis Smile Reanimation Surgery. JAMA FACIAL PLAST SU 2020; 21:551-557. [PMID: 31670745 DOI: 10.1001/jamafacial.2019.1090] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Surgeons have sought to optimize outcomes of smile reanimation surgery by combining inputs from nerve-to-masseter and cross-face nerve grafts. An objective assessment tool could help surgeons evaluate outcomes to determine the optimal neural sources for smile reanimation. Objective To evaluate the use of a novel video time-stamping method and standard outcome measurement tools to assess outcomes of facial reanimation surgery using various innervation strategies. Design, Setting, and Participants Cohort study assessing the outcomes of dually innervated gracilis free muscle transfers vs single-source innervated gracilis transfer performed at a tertiary care facial nerve center between 2007 and 2017 using a novel, video time-stamping spontaneity assessment method. The statistical analyses were performed in 2018. Interventions Dually innervated gracilis free muscle transfers or single-source innervated gracilis transfer. Main Outcomes and Measures Spontaneous smiling was assessed by clinicians and quantified using blinded time-stamped video recordings of smiling elicited while viewing humorous video clips. Results This retrospective cohort study included 25 patients (12 men and 13 women; median [range] age, 38.4 [29.3-46.0] years) treated with dually innervated gracilis free functional muscle graft for unilateral facial palsy between 2007 and 2017. Smile spontaneity assessment was performed in 17 patients and was compared with assessment performed in 24 patients treated with single-source innervated gracilis transfer (ie, nerve-to-masseter-driven or cross-face nerve graft-driven gracilis [n = 13]) (demographic data not available for NTM and CFNG cohorts). The use of time-stamped video assessment revealed that spontaneous synchronous oral commissure movement in a median percentage of smiles was 33% in patients with dually innervated gracilis (interquartile range [IQR], 0%-71%), 20% of smiles in patients with nerve-to-masseter-driven gracilis (IQR, 0%-50%), and 75% of smiles in patients with cross-face nerve graft-driven gracilis (IQR, 0%-100%). Clinicians graded smile spontaneity in dually innervated cases as absent in 40% (n = 6 of 15), trace in 33% (n = 5 of 15) and present in 27% (n = 4 of 15). No association was demonstrated between clinician-reported spontaneity and objectively measured synchronicity. Conclusions and Relevance Dually innervated gracilis free muscle transfers may improve smile spontaneity compared with masseteric nerve-driven transfers but not to the level of cross-face nerve graft-driven gracilis transfers. Quantifying spontaneity is notoriously difficult, and most authors rely on clinical assessment. Our results suggest that clinicians may rate presence of spontaneity higher than objective measures, highlighting the importance of standardized assessment techniques. Level of Evidence 4.
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Affiliation(s)
- Joseph R Dusseldorp
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.,Department of Plastic and Reconstructive Surgery, Royal Australasian College of Surgeons and University of Sydney, Sydney, Australia
| | - Martinus M van Veen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston.,Department of Plastic Surgery, University Medical Center Groningen, and University of Groningen, Groningen, the Netherlands
| | - Diego L Guarin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Olivia Quatela
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Nate Jowett
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
| | - Tessa A Hadlock
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston
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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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20
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Liu CH, Chang HM, Yang YS, Lin YT, Ho YJ, Tseng TJ, Lan CT, Li ST, Liao WC. Melatonin Promotes Nerve Regeneration Following End-to-Side Neurorrhaphy by Accelerating Cytoskeletal Remodeling via the Melatonin Receptor-dependent Pathway. Neuroscience 2019; 429:282-292. [PMID: 31689489 DOI: 10.1016/j.neuroscience.2019.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 12/29/2022]
Abstract
Acceleration of cytoskeletal remodeling in regenerated axons is crucial for a fully functional recovery following peripheral nerve injury (PNI). Melatonin plays important roles in cell differentiation and protection of cytoskeleton stability, thus, the present study aimed to investigate whether melatonin can enhance neurite outgrowth and promote cytoskeletal remodeling in a PNI animal model and in differentiated neurons. End-to-side neurorrhaphy (ESN) rat model was used for assessing cytoskeletal rearrangement in regenerated axon. Subject rats received 1 mg/kg/day melatonin injection for one month. The amplitude of compound muscle action potentials and the number of re-innervated motor end plates on target muscles were assessed to represent the functional recovery after ESN. Melatonin treatment enhanced functional recovery after ESN, compared to the saline treated group. Additionally, in spinal cord and peripheral nerve tissue, animals receiving melatonin displayed enhanced expression of GAP43 and β3-tubulin one month after ESN, and an increased number of re-innervated motor end plates on their target muscle. In vitro analysis revealed that melatonin treatment significantly promoted neurite outgrowth, and increased expression of melatonin receptors as well as β3-tubulin in mouse neuroblastoma Neuro-2a (N2a) cells. Treatment with a melatonin receptor antagonist, luzindole, significantly suppressed melatonin receptors and β3-tubulin expression. Importantly, we found that melatonin treatment suppressed activation of calmodulin-dependent protein kinase II (CaMKII) in vitro and in vivo, suggesting that the β3-tubulin remodeling may occur via CaMKII-mediated Ca2+ signaling. These results suggested that melatonin may promote functional recovery after PNI by accelerating cytoskeletal remodeling through the melatonin receptor-dependent pathway.
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Affiliation(s)
- Chiung-Hui Liu
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Ming Chang
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yin-Shuo Yang
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Ta Lin
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ying-Jui Ho
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
| | - To-Jung Tseng
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chyn-Tair Lan
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shao-Ti Li
- Division of Radiation Oncology, Chung Shan University Hospital, Taichung, Taiwan
| | - Wen-Chieh Liao
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Education, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Gabira MM, Rosa Junior GM, Alcalde GE, Ferraresi C, Simionato LH, Bortoluci CHF. Eficácia da estimulação elétrica com corrente russa após neurorrafia término-lateral do nervo fibular comum: análise eletroneuromiográfica e de força muscular. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/17022626032019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Lesões de nervos periféricos levam a perda funcional elevada no tecido muscular. Assim, muitas pesquisas têm investigado técnicas cirúrgicas, como neurorrafias, e recursos terapêuticos, como eletroestimulação, para melhorar a funcionalidade de um músculo reinervado após lesão periférica. Este estudo tem como objetivo investigar os efeitos da eletroestimulação com corrente russa (2.500Hz, 4ms, 10 seg. de contração por 20 seg. de relaxamento, modulação de 10Hz e 100 Hz) na recuperação funcional após secção e neurorrafia término-lateral do coto distal do nervo fibular comum à face lateral do nervo tibial em ratos. Foram utilizados 25 ratos Wistar, machos, com 80 dias de vida, fornecidos pelo Biotério Central da Universidade Sagrado Coração (Bauru, SP, Brasil). Os animais foram divididos aleatoriamente em cinco grupos: grupo-controle Inicial (GCI), grupo-controle final (GCF), grupo experimental não tratado (GENT), grupo neurorrafia término-lateral com estimulação russa (GNTLER) e grupo-controle desnervado (GCD). A corrente russa foi iniciada cinco dias após neurorrafia e aplicada no músculo tibial cranial do GNTLER, 3 vezes por semana, totalizando 36 sessões. A estimulação elétrica foi eficaz para aumentar a amplitude e diminuir a latência do músculo reinervado, além de aumentar a força muscular em comparação ao GCD. Diante disso, conclui-se que a eletroestimulação de média frequência (corrente russa) foi eficiente na recuperação funcional do músculo tibial cranial após neurorrafia término-lateral do nervo fibular comum.
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Severo AL, Coppi EFM, Cavalheiro HL, Bosco ALD, Filho DB, Lemos MB. Lower Limb Reconstruction - Fasciocutaneous Sural Flap. Rev Bras Ortop 2019; 54:128-133. [PMID: 31363257 PMCID: PMC6529321 DOI: 10.1016/j.rbo.2017.12.016] [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] [Received: 09/26/2017] [Accepted: 12/14/2017] [Indexed: 11/28/2022] Open
Abstract
Objective
The present study aims to evaluate the use of the reverse-flow sural fasciocutaneous flap to cover lesions in the distal third of the lower limb.
Methods
A total of 24 cases were analyzed, including 20 traumatic injuries, 3 sports injuries, and 1 case of tumor resection.
Results
Among the 24 evaluated medical records, 16 patients were male, and 8 were female. Their age ranged from 6 to 75 years old. Most of the patients evolved with total healing of the flap (
n=
21). There was only one case of total necrosis of the flap in an insulin-dependent diabetic, high blood pressure patient, evolving to subsequent limb amputation. In two cases, there was partial necrosis and subsequent healing by secondary intention; one of these patients was a heavy smoker. Complications were associated with comorbidities and, unlike other studies, no correlation was observed with the learning curve. There was also no correlation with the site or size of the lesion to be covered.
Conclusion
It is clinically relevant that the success rate of the reverse-flow sural fasciocutaneous flap technique was of 87.5%. This is a viable and effective alternative in the therapeutic arsenal for complex lower limb lesions.
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Affiliation(s)
- Antonio Lourenco Severo
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
| | - Eduardo Felipe Mandarino Coppi
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
| | - Haiana Lopes Cavalheiro
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
| | - Alexandre Luiz Dal Bosco
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
| | - Danilo Barreto Filho
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
| | - Marcelo Barreto Lemos
- Hospital São Vicente de Paulo (HSVP-RS), Passo Fundo, RS, Brasil.,Instituto de Ortopedia e Traumatologia de Passo Fundo (IOT-RS), Passo Fundo, RS, Brasil
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Modified Selective Neurectomy for the Treatment of Post-Facial Paralysis Synkinesis. Plast Reconstr Surg 2019; 143:1483-1496. [PMID: 30807497 DOI: 10.1097/prs.0000000000005590] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (B.A.) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure. METHODS A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure. RESULTS Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery. CONCLUSION Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Bassilios Habre S, Bond G, Jing XL, Kostopoulos E, Wallace RD, Konofaos P. The Surgical Management of Nerve Gaps: Present and Future. Ann Plast Surg 2019; 80:252-261. [PMID: 29166306 DOI: 10.1097/sap.0000000000001252] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Peripheral nerve injuries can result in significant morbidity, including motor and/or sensory loss, which can affect significantly the life of the patient. Nowadays, the gold standard for the treatment of nerve section is end-to-end neurorrhaphy. Unfortunately, in some cases, there is segmental loss of the nerve trunk. Nerve mobilization allows primary repair of the sectioned nerve by end-to-end neurorrhaphy if the gap is less than 1 cm. When the nerve gap exceeds 1 cm, autologous nerve grafting is the gold standard of treatment. To overcome the limited availability and the donor site morbidity, other techniques have been used: vascularized nerve grafts, cellular and acellular allografts, nerve conduits, nerve transfers, and end-to-side neurorrhaphy. The purpose of this review is to present an overview of the literature on the applications of these techniques in peripheral nerve repair. Furthermore, preoperative evaluation, timing of repair, and future perspectives are also discussed.
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Bendella H, Rink S, Wöhler A, Feiser J, Wilden A, Grosheva M, Stoffels HJ, Meyer C, Manthou M, Nakamura M, Angelov DN. Anatomic conditions for bypass surgery between rostral (T7-T9) and caudal (L2, L4, S1) ventral roots to treat paralysis after spinal cord injury. Ann Anat 2019; 222:139-145. [PMID: 30599238 DOI: 10.1016/j.aanat.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
Severe spinal cord injuries cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate. Re-establishing functional activity especially in the lower limbs by reinnervation of the caudal infra-lesional territories might represent an effective therapeutic strategy. Numerous surgical neurotizations have been developed to bridge the spinal cord lesion site and connect the intact supra-lesional portions of the spinal cord to peripheral nerves (spinal nerves, intercostal nerves) and muscles. The major disadvantage of these techniques is the increased hypersensitivity, spasticity and pathologic pain in the spinal cord injured patients, which occur due to the vigorous sprouting of injured afferent sensory fibers after reconstructive surgery. Using micro-surgical instruments and an operation microscope we performed detailed anatomical preparation of the vertebral canal and its content in five human cadavers. Our observations allow us to put forward the possibility to develop a more precise surgical approach, the so called "ventral root bypass" that avoids lesion of the dorsal roots and eliminates sensitivity complications. The proposed kind of neurotization has been neither used, nor put forward. The general opinion is that radix ventralis and radix dorsalis unite to form the spinal nerve inside the dural sac. This assumption is not accurate, because both radices leave the dural sac separately. This neglected anatomical feature allows a reliable intravertebral exposure of the dura-mater ensheathed ventral roots and their damage-preventing end-to-side neurorrhaphy by interpositional nerve grafts.
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Affiliation(s)
- Habib Bendella
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
| | - Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral Medicine, University of Cologne, Cologne, Germany.
| | - Aliona Wöhler
- Department of Anatomy I, University of Cologne, Germany.
| | - Janna Feiser
- Praxis "Med 360 Grad", Burger Straße 213, 42859 Remscheid, Germany.
| | - Andre Wilden
- Department of Anatomy I, University of Cologne, Germany.
| | - Maria Grosheva
- Department of Otorhinolaryngology, University of Cologne, Germany.
| | | | - Carolin Meyer
- Department of Orthopedics and Trauma Surgery, University of Cologne, Germany.
| | - Marilena Manthou
- Department of Histology and Embryology, Aristotle University Thessaloniki, Greece.
| | - Makoto Nakamura
- Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
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Tognon-Miguel V, Nascimento-Elias AH, Schiavoni MCL, Barreira AA. Plasticity of Unmyelinated Fibers in a Side-to-end Tubulization Model. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e1993. [PMID: 30859022 PMCID: PMC6382236 DOI: 10.1097/gox.0000000000001993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Histomorphometric studies of unmyelinated fibers of the rat fibular nerves are uncommon, and side-to-end neurorrhaphy studies using the fibular nerve investigate primarily motor fibers. We investigated side-to-end tubulization (SET) technique, in which occurs collateral sprouting from the intact donor nerve fibers to the distal stump of receptor nerve, with muscle reinnervation and functional rehabilitation, to assess whether there is a successful growth of unmyelinated fibers in this model. METHODS Adult Wistar rats fibular nerves were sectioned to create a 5-mm gap. A 6-mm silicone tube was attached between a side of the intact tibial nerve and the sectioned fibular nerve distal stump (SET group), with the left fibular nerve as normal (sham group). Seventy days postsurgery, unmyelinated fibers from the distal segment of the fibular nerve were quantified using light and transmission electron microscopy and their diameters were measured. RESULTS The number of unmyelinated fibers was similar between sham (1,882 ± 270.9) and SET (2,012 ± 1,060.8), but axons density was significantly greater in the SET (18,733.3 ± 5,668.6) than sham (13,935.0 ± 1,875.8). Additionally, the axonal diameters differed significantly between groups with mean measures in sham (0.968 ± 0.10) > SET (0.648 ± 0.08). CONCLUSIONS Unmyelinated fiber growth occurred even with a 5-mm distance between the donor and receptor nerves, reaching similar axonal number to the normal nerve, demonstrating that the SET is a reliable technique that can promote a remarkable plasticity of unmyelinated axons.
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Affiliation(s)
- Vânia Tognon-Miguel
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Adriana H Nascimento-Elias
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
- Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Maria C L Schiavoni
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Amilton A Barreira
- Department of Neurosciences and Behavioral Sciences, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
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Wang S, Su D, Li J, Li D, Wan H, Schumacher M, Liu S. Donor nerve axotomy and axonal regeneration after end-to-side neurorrhaphy in a rodent model. J Neurosurg 2019; 130:197-206. [PMID: 29451448 DOI: 10.3171/2017.8.jns17739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/08/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors used a surgical model of end-to-side neurorrhaphy between a nerve graft and a donor tibial nerve in adult rats to investigate the optimal conditions for axonal regeneration induced by the donor nerve. They also assessed the importance of a more favorable pathway using a predegenerated nerve graft to attract regenerating axons to regrow into the graft and then directing and improving their growth toward the target in comparison with results obtained with a fresh nerve graft. METHODS End-to-side neurorrhaphy was performed between a nerve graft and a donor tibial nerve. The nerve graft was obtained from the left tibial nerve, which was either freshly removed or predegenerated 1 week prior to neurorrhaphy. The donor right tibial nerve was injured by epineurium removal alone, injured by epineurium removal with cross section of 20% or 50% of the total axons at the coaptation site, or left intact. The animals were followed postoperatively for a 6-week period, and outcomes were evaluated by optical microscopy and retrograde labeling to detect the regenerated primary sensory neurons located in the lumbar dorsal root ganglia and spinal motor neurons located in the lumbar spinal ventral horn. RESULTS At the end of the follow-up period, no regenerating axons were observed in the nerve grafts when the donor nerve was left intact, and very few axons were detected when the donor nerve was injured by epineurium removal alone. However, numerous regenerating axons appeared in the grafts when the donor nerve was axotomized, and the greatest number was achieved with a 50% cross section axotomized nerve. In the rats with a 50% cross section of the donor nerve, better nerve-like morphology of the grafts was observed, without connective adhesions. When a predegenerated nerve graft was used, more regenerating axons were attracted and elongated with a more regular shape and improved myelination. CONCLUSIONS Axonal regrowth into a nerve graft depends on axotomy of the donor nerve after end-to-side neurorrhaphy. More efficient attraction and an improved structure of the regenerating axons were achieved when a predegenerated nerve graft was used. Furthermore, a nerve graft may require a certain number of regenerating axons to maintain a nerve-like morphology.
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Affiliation(s)
- Shiwei Wang
- 2U 1195, INSERM, Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France; and
| | - Diya Su
- 1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jing Li
- 1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dezhi Li
- 3Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hong Wan
- 1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Michael Schumacher
- 2U 1195, INSERM, Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France; and
| | - Song Liu
- 1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- 2U 1195, INSERM, Université Paris-Sud and Université Paris-Saclay, Le Kremlin-Bicêtre, France; and
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Comparison of conduit and autograft efficiency in repairing femoral nerve injury in New Zealand rabbits. Med J Islam Repub Iran 2018; 32:99. [PMID: 31024865 PMCID: PMC6477882 DOI: 10.14196/mjiri.32.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Peripheral nerve injuries may affect all age groups and exert devastating impacts on the professional and personal life of the patients. The investigation of nerve regeneration and use of biomaterials and synthetic materials have resulted in advancements in the treatment of peripheral nerve injuries and lesions. Nerve conduits can be used to adjoin the digital sensory nerve spaces of less than 3 cm, especially when the direct tension-free repair of peripheral nerve lesions is not possible. The present study was conducted to evaluate the use of nerve conduits by functional and nonfunctional parameters (i.e. histological study). Methods: This experimental study was conducted on 30 male rabbits. After cutting or crushing the right femoral nerve of the rabbits, they were divided into 3 groups: group 1, with right femoral nerve cut; group 2, with right femoral nerve crushed; and group 3, with right femoral nerve cut using a conduit. The 3 groups were evaluated after 1, 8, and 16 weeks for functional parameters (i.e. walking track analysis). In addition, they were subjected to nonfunctional examination (i.e. histological study) after 16 weeks, then, the results were compared. Results: The 3 groups showed no statistically significant differences in motor recovery in the eighth and 16th weeks (p>0.05). Based on the histological study, group 3 with an end-to-end nerve cutting using a conduit, showed a significantly higher axon count compared to groups 2 and 3 (p<0.05). Conclusion: End-to-end anastomosis using conduit led to axon growth; moreover, comparable functional recovery was observed with end-to-end neurorrhaphy in a rabbit model. Given that the diameter of the nerves and muscles, which might be neurotized in humans, and is much bigger and not comparable to that of the rabbits, it is highly recommended to conduct studies on animals with the larger size, such as primates, to facilitate the generalization of the results to humans.
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Liu P, Liao C, Zhong W, Yang M, Li P, Zhang W. Comparison of 4 Different Methods for Direct Hypoglossal-Facial Nerve Anastomosis in Rats. World Neurosurg 2018; 112:e588-e596. [PMID: 29410339 DOI: 10.1016/j.wneu.2018.01.094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/11/2018] [Accepted: 01/12/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Classic hypoglossal-facial nerve anastomosis inevitably causes hemitongue atrophy and dysfunction. Thus, many variants have been developed to reduce tongue-related morbidities. A comparative study concerning these techniques was conducted in rats to systematically evaluate long-term functional and histologic outcomes of the recipient and donor systems. METHODS Rats (8 per group) were treated by end-to-end neurorrhaphy (EEN), EEN using the hemisectioned and longitudinally split donor nerve (EEN-Hemi), end-to-side neurorrhaphy through a perineurial window (ESN-PW), or 30% to 40% partial neurotomy (ESN-PN). Four additional rats were left intact. At 8 months postoperatively, behavioral, electrophysiologic, and morphologic studies were carried out to compare the groups. RESULTS All techniques resulted in partial functional recovery, but complete restoration was not obtained. There were no significant differences between the experimental groups in axon diameter or myelin thickness. The facial nerve fiber count after ESN-PN, but not after EEN-Hemi or ESN-PW, was comparable with that after EEN, which agreed with the behavioral and electrophysiologic results. The hypoglossal nerve fiber count after ESN-PN was slightly less than that after ESN-PW, but markedly more than that after EEN-Hemi, corresponding to the electrophysiologic examination. Quantitative measures of muscle fiber cross-sectional area and connective tissue area density of the tongue demonstrated severe muscle atrophy on the operated side after EEN and EEN-Hemi when compared with ESN-PW and ESN-PN. CONCLUSIONS ESN with 30% to 40% partial donor neurotomy offers the best balance between motor reinnervation and donor deficits. The method of nerve split for provision of hemihypoglossal nerve stump may not effectively preserve the tongue function.
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Affiliation(s)
- Pengfei Liu
- Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chenlong Liao
- Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Wenxiang Zhong
- Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Min Yang
- Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Pengyang Li
- Peking University Aerospace School of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Wenchuan Zhang
- Department of Neurosurgery, XinHua Hospital affiliated to Shanghai JiaoTong University School of Medicine, Shanghai, China.
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Tateshita T, Ueda K, Kajikawa A. End-to-end and end-to-side neurorrhaphy between thick donor nerves and thin recipient nerves: an axon regeneration study in a rat model. Neural Regen Res 2018; 13:699-703. [PMID: 29722323 PMCID: PMC5950681 DOI: 10.4103/1673-5374.230296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
During nerve reconstruction, nerves of different thicknesses are often sutured together using end-to-side neurorrhaphy and end-to-end neurorrhaphy techniques. In this study, the effect of the type of neurorrhaphy on the number and diameter of regenerated axon fibers was studied in a rat facial nerve repair model. An inflow-type end-to-side and end-to-end neurorrhaphy model with nerve stumps of different thicknesses (2:1 diameter ratio) was created in the facial nerve of 14 adult male Sprague-Dawley rats. After 6 and 12 weeks, nerve regeneration was evaluated in the rats using the following outcomes: total number of myelinated axons, average minor axis diameter of the myelinated axons in the central and peripheral sections, and axon regeneration rate. End-to-end neurorrhaphy resulted in a significantly greater number of regenerated myelinated axons and rate of regeneration after 6 weeks than end-to-side neurorrhaphy; however, no such differences were observed at 12 weeks. While the regenerated axons were thicker at 12 weeks than at 6 weeks, no significant differences in axon fiber thickness were detected between end-to-end and end-to-side neurorrhaphy. Thus, end-to-end neurorrhaphy resulted in greater numbers of regenerated axons and increased axon regeneration rate during the early postoperative period. As rapid reinnervation is one of the most important factors influencing the restoration of target muscle function, we conclude that end-to-end neurorrhaphy is desirable when suturing thick nerves to thin nerves.
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Affiliation(s)
- Tohru Tateshita
- Department of Plastic and Reconstructive Surgery, St. Marianna Medical University, Kawasaki City, Japan
| | - Kazuki Ueda
- Department of Plastic and Reconstructive Surgery, Fukushima Medical University, Fukushima Perfecture, Japan
| | - Akiyoshi Kajikawa
- Department of Plastic and Reconstructive Surgery, St. Marianna Medical University, Kawasaki City, Japan
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Viterbo F, Brock RS, Maciel F, Ayestaray B, Garbino JA, Rodrigues CP. End-to-side versus end-to-end neurorrhaphy at the peroneal nerve in rats. Acta Cir Bras 2017; 32:697-705. [PMID: 29019587 DOI: 10.1590/s0102-865020170090000002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/28/2017] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate three different kinds of neurorrhaphy of the peroneal nerve. METHODS Eigthy rats were divided into 5 groups. Control: nerve had no intervention. End-to-end (EE): nerve was cut and elongated with a nerve graft with two end-to-end neurorrhaphies. End-to-side (ES): nerve was cut and sutured to the graft with at the lateral side of the nerve. Side-to-end (SE): the nerve was cut and sutured to the graft with end-to-end neurorrhaphy. Denervated: nerve was cut and both endings were buried into the muscle. The evaluation was done by walking track analysis, electrophysiology, body mass, cranial tibial muscle mass, nerve and muscle fibers morphometry. RESULTS The EE, ES and SE have the same potential of reinnervation. CONCLUSION There is no functional or histological difference between these different types of neurorrhaphy.
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Affiliation(s)
- Fausto Viterbo
- PhD, Associated Professor, Division of Plastic Surgery, Universidade Estadual Paulista (UNESP), Botucatu-SP, Brazil. Conception, design, intellectual and scientific content of the study; critical revision
| | - Ryane Schmidt Brock
- MsC, PhD, Plastic Surgeon, Sociedade Brasileira de Cirurgia Plástica, Sao Paulo-SP, Brazil. Aquisition of data, manuscript writing
| | - Fábio Maciel
- Assistant Professor, Physiotherapy, Institute for Health and Biotechnology, Universidade Federal do Amazonas (UFAM), Coari-AM, Brazil. Scientific content of the study, acquisition of data, manuscript writing
| | - Benoit Ayestaray
- Assistant Professor, Department of Plastic and Reconstructrive Surgery, Sud Francilien Hospital, University Paris, Corbeil-Essonnes, France. Aquisition of data
| | - José Antonio Garbino
- PhD of Science, Specialist in Clinical Neurophysiology and Medical Rehabilitation, Section Head of Assessment and Diagnosis, Instituto Lauro de Souza Lima, Bauru-SP, Brazil. Intellectual and scientific content of the study, critical revision
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Civi S, Durdag E, Aytar MH, Kardes O, Kaymaz F, Aykol S. Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve: An Experimental Research. J Korean Neurosurg Soc 2017; 60:417-423. [PMID: 28689390 PMCID: PMC5544376 DOI: 10.3340/jkns.2016.1010.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/17/2016] [Accepted: 02/13/2017] [Indexed: 01/28/2023] Open
Abstract
Objective Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). Methods We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups: group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. Results Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. Conclusion Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.
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Affiliation(s)
- Soner Civi
- Department of Neurosurgery, Başkent University Faculty of Medicine, Adana, Turkey
| | - Emre Durdag
- Department of Neurosurgery, Başkent University Faculty of Medicine, Adana, Turkey
| | - Murat Hamit Aytar
- Department of Neurosurgery, Acibadem University Vocational School of Health Services, İstanbul, Turkey
| | - Ozgur Kardes
- Department of Neurosurgery, Başkent University Faculty of Medicine, Adana, Turkey
| | - Figen Kaymaz
- Department of Histology and Embryology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sukru Aykol
- Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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Souza Trindade JC, Viterbo F, Petean Trindade A, Fávaro WJ, Trindade-Filho JCS. Long-term follow-up of treatment of erectile dysfunction after radical prostatectomy using nerve grafts and end-to-side somatic-autonomic neurorraphy: a new technique. BJU Int 2017; 119:948-954. [DOI: 10.1111/bju.13772] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Fausto Viterbo
- Division of Plastic Surgery; Botucatu School of Medicine; State University of São Paulo; Sao Paulo Brazil
| | - André Petean Trindade
- Radiology; Botucatu School of Medicine; State University of São Paulo; Sao Paulo Brazil
| | - Wagner José Fávaro
- Department of Anatomy; Faculty of Medical Sciences; University of Campinas; Campinas Brazil
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Xiao Q, Zhang X, Wu Y. Experimental Research on Differentiation-Inducing Growth of Nerve Lateral Bud by HUC-MSCs Chitosan Composite Conduit. Cell Biochem Biophys 2017; 73:305-311. [PMID: 27352316 DOI: 10.1007/s12013-015-0578-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
This study is intended to explore the role of human umbilical-cord-derived mesenchymal stem cells (HUC-MSCs) in nerve end-to-side anastomosis, as well as in the induction and promotion of growth of nerve lateral bud. The chitosan nerve conduit was prepared based on the biological characteristics of chitosan, and the nerve conduit was filled with HUC-MSCs, and was used to bridge the nerve end-to-side anastomotic stoma. The experimental animals were randomly assigned into three groups (10 in each group), and the nerve end-to-side anastomosis was conducted: (1) group A (control group): traditional tibial nerve-common peroneal nerve end-to-side anastomosis; (2) group B (experimental group 1): tibial nerve-common peroneal nerve end-to-side anastomotic stoma bridged with chitosan nerve conduit; (3) group C (experimental group 2): tibial nerve-common peroneal nerve end-to-side anastomotic stoma bridged by chitosan nerve conduit filled with HUC-MSCs. General morphological observation, nerve electrophysiology, and anti-S-100 immunohistochemistry were performed. All experimental animals survived, and no infections were found at operative incisions. The nerve continuity was in good condition through visual observation when sampling, which is mild adhesion to the surrounding tissue and easy to be separated. 12 W HUC-MSCs chitosan composite nerve conduits were degraded completely after operation. Electrophysiological test showed that the nerve conduction velocity (NCV) in group C was significantly higher than that in group A or group B (p < 0.01). There were no significant differences between NCVs of group A and group B. Toluidine blue staining and transmission electron microscope showed that the number of the medullated fibers and the myelin sheath thickness in group C were larger than those in group A or B. There were no significant differences between the numbers of the medullated fibers and between the myelin sheath thicknesses of groups A and B. By means of anti-S-100 immunohistochemistry, the arrangement of a large number of brown-red proliferating schwann cells around the regenerated nerve fibers in group C could be found, while fewer and sparse brown-red matters and very poor growth of schwann cells could be observed in groups A and B. Slightly more favorable situation could be observed in group B compared with group A. HUC-MSCs play obviously an important role in promoting nerve regeneration during the nerve end-to-side anastomosis, which induces the growth of axis bud, accelerates the growth velocity of regenerated fiber, and promotes the growth and maturity of schwann cells.
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Affiliation(s)
- Qiang Xiao
- Department of Hand, Ankle and Foot Surgery, The First Affiliated Hospital of Liaoning Medical University, Shenyang, 121001, Liaoning, China.
| | - Xuepu Zhang
- Department of Hand, Ankle and Foot Surgery, The First Affiliated Hospital of Liaoning Medical University, Shenyang, 121001, Liaoning, China
| | - Yuexin Wu
- Department of Hand, Ankle and Foot Surgery, The First Affiliated Hospital of Liaoning Medical University, Shenyang, 121001, Liaoning, China
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Panagopoulos GN, Megaloikonomos PD, Mavrogenis AF. The Present and Future for Peripheral Nerve Regeneration. Orthopedics 2017; 40:e141-e156. [PMID: 27783836 DOI: 10.3928/01477447-20161019-01] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/23/2016] [Indexed: 02/03/2023]
Abstract
Peripheral nerve injury can have a potentially devastating impact on a patient's quality of life, resulting in severe disability with substantial social and personal cost. Refined microsurgical techniques, advances in peripheral nerve topography, and a better understanding of the pathophysiology and molecular basis of nerve injury have all led to a decisive leap forward in the field of translational neurophysiology. Nerve repair, nerve grafting, and nerve transfers have improved significantly with consistently better functional outcomes. Direct nerve repair with epineural microsutures is still the surgical treatment of choice when a tension-free coaptation in a well-vascularized bed can be achieved. In the presence of a significant gap (>2-3 cm) between the proximal and distal nerve stumps, primary end-to-end nerve repair often is not possible; in these cases, nerve grafting is the treatment of choice. Indications for nerve transfer include brachial plexus injuries, especially avulsion type, with long distance from target motor end plates, delayed presentation, segmental loss of nerve function, and broad zone of injury with dense scarring. Current experimental research in peripheral nerve regeneration aims to accelerate the process of regeneration using pharmacologic agents, bioengineering of sophisticated nerve conduits, pluripotent stem cells, and gene therapy. Several small molecules, peptides, hormones, neurotoxins, and growth factors have been studied to improve and accelerate nerve repair and regeneration by reducing neuronal death and promoting axonal outgrowth. Targeting specific steps in molecular pathways also allows for purposeful pharmacologic intervention, potentially leading to a better functional recovery after nerve injury. This article summarizes the principles of nerve repair and the current concepts of peripheral nerve regeneration research, as well as future perspectives. [Orthopedics. 2017; 40(1):e141-e156.].
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Yu Q, Zhang SH, Wang T, Peng F, Han D, Gu YD. End-to-side neurorrhaphy repairs peripheral nerve injury: sensory nerve induces motor nerve regeneration. Neural Regen Res 2017; 12:1703-1707. [PMID: 29171436 PMCID: PMC5696852 DOI: 10.4103/1673-5374.217350] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve. It involves suturing the distal stump of the disconnected nerve (recipient nerve) to the side of the intimate adjacent nerve (donor nerve). However, the motor-sensory specificity after end-to-side neurorrhaphy remains unclear. This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy. Thirty rats were randomized into three groups: (1) end-to-side neurorrhaphy using the ulnar nerve (mixed sensory and motor) as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve; (2) the sham group: ulnar nerve and cutaneous antebrachii medialis nerve were just exposed; and (3) the transected nerve group: cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied. At 5 months, acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group, and none of the myelinated axons were stained in either the sham or transected nerve groups. Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%. In contrast, no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment. These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.
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Affiliation(s)
- Qing Yu
- Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - She-Hong Zhang
- Department of Rehabilitation Medicine, Huashan Hospital of Fudan University, Shanghai, China
| | - Tao Wang
- Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Feng Peng
- Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Dong Han
- Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
| | - Yu-Dong Gu
- Department of Hand Surgery, Huashan Hospital of Fudan University, Key Laboratory of Hand Reconstruction, the Ministry of Health, Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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Liu CH, Chang HM, Tseng TJ, Lan CT, Chen LY, Youn SC, Lee JJ, Mai FD, Chou JF, Liao WC. Redistribution of Cav2.1 channels and calcium ions in nerve terminals following end-to-side neurorrhaphy: ionic imaging analysis by TOF-SIMS. Histochem Cell Biol 2016; 146:599-608. [PMID: 27468821 DOI: 10.1007/s00418-016-1470-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/27/2022]
Abstract
The P/Q-type voltage-dependent calcium channel (Cav2.1) in the presynaptic membranes of motor nerve terminals plays an important role in regulating Ca2+ transport, resulting in transmitter release within the nervous system. The recovery of Ca2+-dependent signal transduction on motor end plates (MEPs) and innervated muscle may directly reflect nerve regeneration following peripheral nerve injury. Although the functional significance of calcium channels and the levels of Ca2+ signalling in nerve regeneration are well documented, little is known about calcium channel expression and its relation with the dynamic Ca2+ ion distribution at regenerating MEPs. In the present study, end-to-side neurorrhaphy (ESN) was performed as an in vivo model of peripheral nerve injury. The distribution of Ca2+ at regenerating MEPs following ESN was first detected by time-of-flight secondary ion mass spectrometry, and the specific localization and expression of Cav2.1 channels were examined by confocal microscopy and western blotting. Compared with other fundamental ions, such as Na+ and K+, dramatic changes in the Ca2+ distribution were detected along with the progression of MEP regeneration. The re-establishment of Ca2+ distribution and intensity were correlated with the functional recovery of muscle in ESN rats. Furthermore, the re-clustering of Cav2.1 channels after ESN at the nerve terminals corresponded with changes in the Ca2+ distribution. These results indicated that renewal of the Cav2.1 distribution within the presynaptic nerve terminals may be necessary for initiating a proper Ca2+ influx and shortening the latency of muscle contraction during nerve regeneration.
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Affiliation(s)
- Chiung-Hui Liu
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
- Department of Medical Research, Research Center for Traditional Chinese Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Hung-Ming Chang
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - To-Jung Tseng
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
| | - Chyn-Tair Lan
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
| | - Li-You Chen
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
| | - Su-Chung Youn
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
| | - Jian-Jr Lee
- Department of Anatomy and Cell Biology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Division of Plastic Surgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan
| | - Fu-Der Mai
- Department of Biochemistry, School of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Jui-Feng Chou
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan
| | - Wen-Chieh Liao
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, No.110, Sec.1, Jianguo N. Rd, Taichung, 40201, Taiwan.
- Department of Pediatrics, Shan Medical University Hospital, Taichung, 40201, Taiwan.
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Hendry JM, Alvarez-Veronesi MC, Snyder-Warwick A, Gordon T, Borschel GH. Side-To-Side Nerve Bridges Support Donor Axon Regeneration Into Chronically Denervated Nerves and Are Associated With Characteristic Changes in Schwann Cell Phenotype. Neurosurgery 2016; 77:803-13. [PMID: 26171579 DOI: 10.1227/neu.0000000000000898] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Chronic denervation resulting from long nerve regeneration times and distances contributes greatly to suboptimal outcomes following nerve injuries. Recent studies showed that multiple nerve grafts inserted between an intact donor nerve and a denervated distal recipient nerve stump (termed "side-to-side nerve bridges") enhanced regeneration after delayed nerve repair. OBJECTIVE To examine the cellular aspects of axon growth across these bridges to explore the "protective" mechanism of donor axons on chronically denervated Schwann cells. METHODS In Sprague Dawley rats, 3 side-to-side nerve bridges were placed over a 10-mm distance between an intact donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) distal nerve stump. Green fluorescent protein-expressing TIB axons grew across the bridges and were counted in cross section after 4 weeks. Immunofluorescent axons and Schwann cells were imaged over a 4-month period. RESULTS Denervated Schwann cells dedifferentiated to a proliferative, nonmyelinating phenotype within the bridges and the recipient denervated CP nerve stump. As donor TIB axons grew across the 3 side-to-side nerve bridges and into the denervated CP nerve, the Schwann cells redifferentiated to the myelinating phenotype. Bridge placement led to an increased mass of hind limb anterior compartment muscles after 4 months of denervation compared with muscles whose CP nerve was not "protected" by bridges. CONCLUSION This study describes patterns of donor axon regeneration and myelination in the denervated recipient nerve stump and supports a mechanism where these donor axons sustain a proregenerative state to prevent deterioration in the face of chronic denervation.
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Affiliation(s)
- J Michael Hendry
- *Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada; ‡Department of Surgery, §Institute of Medical Science, and ¶Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; ‖SickKids Research Institute Program in Neuroscience, Toronto, ON, Canada
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Novel Atraumatic End-to-Side Repair Model Exhibits Robust Collateral Sprouting Independent of Donor Fiber Injury. Plast Reconstr Surg 2016; 137:523-533. [PMID: 26818287 DOI: 10.1097/01.prs.0000475764.76278.eb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A central issue underlying end-to-side neurorrhaphy technique is whether injury to the donor nerve fibers is necessary for successful reinnervation of the recipient nerve. To address this question, the authors developed a novel atraumatic end-to-side neurorrhaphy model that uses the preexisting anatomical structure of the median nerve as the Y-chamber to study the mechanism of collateral sprouting. METHODS In this rat forelimb model, the authors transected the musculocutaneous nerve and the lateral head of the median nerve, and coapted their distal stumps together. In this model, the authors use the medial head of the median nerve as the donor nerve, and the lateral head of the median nerve (distal stump) as a Y-shaped chamber, which provided structural connection to the recipient musculocutaneous nerve in end-to-side fashion. RESULTS Three months after surgery, converging histologic, electrophysiologic, and behavioral observations confirmed the successful reinnervation of the recipient nerve. Retrograde labeling indicated that sensory fibers exhibited greater collateral sprouting than observed for motor fibers. Interestingly, fluorescence of these collateral sprouting fibers was present only when the median nerve lateral head was attached to the musculocutaneous nerve of the biceps, indicating that factors derived from the denervated tissue likely induced the collateral sprouting in this model. CONCLUSIONS The authors' findings provide strong evidence that collateral sprouting can be robustly initiated independent of donor nerve fiber injury. The authors' model can accelerate the understanding of the mechanism underlying end-to-side neurorrhaphy and the optimization of its clinical use.
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Tognon-Miguel V, Nascimento-Elias AHD, Schiavoni MCL, Barreira AA. A histomorphometric study of unmyelinated fibers of the fibular nerve in Wistar rats. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:367-72. [PMID: 27191231 DOI: 10.1590/0004-282x20160051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/16/2016] [Indexed: 11/21/2022]
Abstract
There are few histomorphometric studies on the unmyelinated fibers of the fibular nerve in rats, and the number of experimental studies using this nerve has been increasing in the last years. Sixty-two percent of the endoneurial area from 10 fibular nerves of adult Wistar rats was scanned by electron microscopy, and digitized. The total number of unmyelinated axons (1.882 ± 271) was significantly lesser, and their axon diameters (0.2 µm to 2.8 µm) significantly higher than that determined in previous studies. The histogram peaked at 1 µm. The differences could be due to the nerve sampled area, the number and the age of the animals evaluated, and the laboratory techniques used. This study brings new and referential data to be used in experimental investigations involving histomorphometric evaluation of the rat fibular nerve.
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Affiliation(s)
- Vânia Tognon-Miguel
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Adriana Helena do Nascimento-Elias
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Maria Cristina Lopes Schiavoni
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Amilton Antunes Barreira
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Gordon T. Nerve Regeneration: Understanding Biology and Its Influence on Return of Function After Nerve Transfers. Hand Clin 2016; 32:103-17. [PMID: 27094884 DOI: 10.1016/j.hcl.2015.12.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Poor functional outcomes are frequent after peripheral nerve injuries despite the regenerative support of Schwann cells. Motoneurons and, to a lesser extent, sensory neurons survive the injuries but outgrowth of axons across the injury site is slow. The neuronal regenerative capacity and the support of regenerating axons by the chronically denervated Schwann cells progressively declines with time and distance of the injury from the denervated targets. Strategies, including brief low-frequency electrical stimulation that accelerates target reinnervation and functional recovery, and the insertion of cross-bridges between a donor nerve and a recipient denervated nerve stump, are effective in promoting functional outcomes after complete and incomplete injuries.
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Affiliation(s)
- Tessa Gordon
- Division of Plastic Reconstructive Surgery, Department of Surgery, 06.9706 Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, Toronto, Ontario M5G 0A4, Canada.
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Papalia I, Magaudda L, Righi M, Ronchi G, Viano N, Geuna S, Colonna MR. Epineurial Window Is More Efficient in Attracting Axons than Simple Coaptation in a Sutureless (Cyanoacrylate-Bound) Model of End-to-Side Nerve Repair in the Rat Upper Limb: Functional and Morphometric Evidences and Review of the Literature. PLoS One 2016; 11:e0148443. [PMID: 26872263 PMCID: PMC4752340 DOI: 10.1371/journal.pone.0148443] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/18/2016] [Indexed: 12/27/2022] Open
Abstract
End-to-side nerve coaptation brings regenerating axons from the donor to the recipient nerve. Several techniques have been used to perform coaptation: microsurgical sutures with and without opening a window into the epi(peri)neurial connective tissue; among these, window techniques have been proven more effective in inducing axonal regeneration. The authors developed a sutureless model of end-to-side coaptation in the rat upper limb. In 19 adult Wistar rats, the median and the ulnar nerves of the left arm were approached from the axillary region, the median nerve transected and the proximal stump sutured to the pectoral muscle to prevent regeneration. Animals were then randomly divided in two experimental groups (7 animals each, 5 animals acting as control): Group 1: the distal stump of the transected median nerve was fixed to the ulnar nerve by applying cyanoacrylate solution; Group 2: a small epineurial window was opened into the epineurium of the ulnar nerve, caring to avoid damage to the nerve fibres; the distal stump of the transected median nerve was then fixed to the ulnar nerve by applying cyanoacrylate solution. The grasping test for functional evaluation was repeated every 10-11 weeks starting from week-15, up to the sacrifice (week 36). At week 36, the animals were sacrificed and the regenerated nerves harvested and processed for morphological investigations (high-resolution light microscopy as well as stereological and morphometrical analysis). This study shows that a) cyanoacrylate in end-to-side coaptation produces scarless axon regeneration without toxic effects; b) axonal regeneration and myelination occur even without opening an epineurial window, but c) the window is related to a larger number of regenerating fibres, especially myelinated and mature, and better functional outcomes.
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Affiliation(s)
- Igor Papalia
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Ludovico Magaudda
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Maria Righi
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Giulia Ronchi
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
- Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Torino, Orbassano (Torino), Italy
| | - Nicoletta Viano
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
| | - Stefano Geuna
- Department of Clinical and Biological Sciences, University of Torino, Orbassano (Torino), Italy
- Neuroscience Institute of the “Cavalieri Ottolenghi” Foundation (NICO), University of Torino, Orbassano (Torino), Italy
- * E-mail:
| | - Michele Rosario Colonna
- Department of Experimental and Clinical Surgical and Medical Specialties, University of Messina, Messina, Italy
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Effectively Axonal-supercharged Interpositional Jump-Graft with an Artificial Nerve Conduit for Rat Facial Nerve Paralysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e416. [PMID: 26180717 PMCID: PMC4494486 DOI: 10.1097/gox.0000000000000397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/23/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve. However, for using the technique, an autologous nerve, which should contain the great auricular and sural nerves, must be obtained. Depending on the donor site, unavoidable issues such as nerve disorders and postoperative scarring may appear. To reduce the issues, in this study, the authors developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit and investigated the efficacy of an IPJG with an artificial nerve conduit in a rat facial nerve paresis model. METHODS A ligature clip was used to crush the facial nerve trunk, thereby creating a partial facial nerve paresis model. An artificial nerve conduit was then prepared with a 10-mm-long silicone tube containing 10 μL type I collagen and used to create an IPJG between the facial nerve trunk and the hypoglossal nerve (the silicone tube group). Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve. RESULTS Retrograde tracer test confirmed a double innervation by the facial and hypoglossal nerve nuclei. In the autograft and silicone tube groups, the regeneration of myelinated axons was observed. CONCLUSION In this study, the authors successfully developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit, and revealed that an IPJG in the conduit was effective in the rat facial nerve paresis model.
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Sakakibara S, Ishida Y, Hashikawa K, Terashi H. Neural circuit analysis of axons regenerated by facial-hypoglossal nerve cross-link surgery. Regen Ther 2015; 1:86-90. [PMID: 31245447 PMCID: PMC6581805 DOI: 10.1016/j.reth.2015.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 05/07/2015] [Accepted: 05/16/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Several methods of nerve reconstruction for facial nerve palsy are known. Although the recently introduced method of “cross-linking” of the facial and hypoglossal nerves with a grafted nerve has proved efficacious, the underlying mechanism is unclear. Methods In this study, we created an animal model with Wistar rats and analyzed the newly reconstructed neural circuit by anterograde and retrograde neural tracer methods. The saphenous nerve was harvested as a graft, and its double end-to-side neurorrhaphy with the facial and hypoglossal nerves with epineural windows was carried out under the microscope. After an appropriate interval, small amounts of fluoro-ruby or fluoro-emerald were injected into the animals and analyzed 5 days later by fluorescent microscopy (Anterograde experiment: fluoro-ruby into the hypoglossal nucleus at 5 weeks; retrograde experiment: fluoro-ruby into the distal facial nerve sheath and fluoro-emerald into the distal hypoglossal nerve sheath, both at two months.). Results The labeled axons derived from the hypoglossal nucleus were observed passing through the grafted nerve to the facial nerve. On the other hand, retrogradely labeled neurons were observed at both the hypoglossal and facial nuclei with some double-labeled neurons, suggesting that collateral sprouting had occurred. Conclusions We suggest that the newly constructed neural circuits we observed are conducive to the treatment of facial nerve palsy. We studied the mechanism of nerve crosslinking for ameliorating facial nerve palsy. In a rat model, retrograde tracers demonstrated the crosslink connections. Axon collateralization into the crosslink was found. This may be therapeutic by increasing nerve supply to the damaged side.
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Affiliation(s)
- Shunsuke Sakakibara
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Yasuhisa Ishida
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Kazunobu Hashikawa
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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Enhancement of facial nerve motoneuron regeneration through cross-face nerve grafts by adding end-to-side sensory axons. Plast Reconstr Surg 2015; 135:460-471. [PMID: 25626793 DOI: 10.1097/prs.0000000000000893] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND In unilateral facial palsy, cross-face nerve grafts are used for emotional facial reanimation. Facial nerve regeneration through the grafts takes several months, and the functional results are sometimes inadequate. Chronic denervation of the cross-face nerve graft results in incomplete nerve regeneration. The authors hypothesize that donor axons from regional sensory nerves will enhance facial motoneuron regeneration, improve axon regeneration, and improve the amplitude of facial muscle movement. METHODS In the rat model, a 30-mm nerve graft (right common peroneal nerve) was used as a cross-face nerve graft. The graft was coapted to the proximal stump of the transected right buccal branch of the facial nerve and the distal stumps of the transected left buccal and marginal mandibular branches. In one group, sensory occipital nerves were coapted end-to-side to the cross-face nerve graft. Regeneration of green fluorescent protein-positive axons was imaged in vivo in transgenic Thy1-green fluorescent protein rats, in which all neurons express green fluorescence. After 16 weeks, retrograde labeling of regenerated neurons and histomorphometric analysis of myelinated axons was performed. Functional outcomes were assessed with video analysis of whisker motion. RESULTS "Pathway protection" with sensory axons significantly enhanced motoneuron regeneration, as assessed by retrograde labeling, in vivo fluorescence imaging, and histomorphometry, and significantly improved whisker motion during video analysis. CONCLUSION Sensory pathway protection of cross-face nerve grafts counteracts chronic denervation in nerve grafts and improves regeneration and functional outcomes.
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Morphometric and Functional Analysis of Axonal Regeneration after End-to-end and End-to-side Neurorrhaphy in Rats. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2015; 3:e326. [PMID: 25878937 PMCID: PMC4387148 DOI: 10.1097/gox.0000000000000280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is available in the text. Background: End-to-side neurorrhaphy is controversial in the literature and has sparked debate over its degree of recovery. In this study, nerve regeneration was assessed in rats after end-to-side neurorrhaphy by morphometric analysis, electromyography, electron microscopy, and retrograde horseradish peroxidase (HRP) and Fluoro-Gold (FG; Fluorochrome Inc., Denver, Colo.) transport and then compared to end-to-end neurorrhaphy and sham operation. Methods: Thirty-seven animals were operated on and divided randomly into 4 groups: group 1, sham; group 2, end-to-end neurorrhaphy; group 3, end-to-side neurorrhaphy with an epineural window; and group 4, end-to-side neurorrhaphy without an epineural window. Three months after surgery, HRP was injected into the peroneal muscles. After 48 hours, nerve segments and lumbar spine segments were collected. Electromyography data were compared between groups, and FG uptake was compared in 20 other animals. Analysis of variance with Tukey-Kramer correction was used for group comparison. Results: The fiber count after end-to-end neurorrhaphy was higher than after end-to-side neurorrhaphy with an epineural window (q = 5.243 and P < 0.01) or without an epineural window (q = 4.951 and P < 0.01). HRP labeling showed a difference between group 2 and end-to-side neurorrhaphy with an epineural window (q = 5.291 and P < 0.01) and without an epineural window (q = 5.617 and P < 0.01). There was also a difference in mean area labeled with FG. Furthermore, the amplitudes of the action potentials were significantly higher in groups 1 and 2. Conclusions: There was nerve regeneration in all groups studied. However, the end-to-end neurorrhaphy group had better reinnervation than the end-to-side neurorrhaphy groups.
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Papalia I, Ronchi G, Muratori L, Mazzucco A, Magaudda L, Geuna S. Direct muscle neurotization after end-to end and end-to-side neurorrhaphy: An experimental study in the rat forelimb model. Neural Regen Res 2014; 7:2273-8. [PMID: 25538749 PMCID: PMC4268728 DOI: 10.3969/j.issn.1673-5374.2012.29.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/10/2012] [Indexed: 01/09/2023] Open
Abstract
The need for the continuous research of new tools for improving motor function recovery after nerve injury is justified by the still often unsatisfactory clinical outcome in these patients. It has been previously shown that the combined use of two reconstructive techniques, namely end-to-side neurorrhaphy and direct muscle neurotization in the rat hindlimb model, can lead to good results in terms of skeletal muscle reinnervation. Here we show that, in the rat forelimb model, the combined use of direct muscle neurotization with either end-to-end or end-to-side neurorrhaphy to reinnervate the denervated flexor digitorum muscles, leads to muscle atrophy prevention over a long postoperative time lapse (10 months). By contrast, very little motor recovery (in case of end-to-end neurorrhaphy) and almost no motor recovery (in case of end-to-side neurorrhaphy) were observed in the grasping activity controlled by flexor digitorum muscles. It can thus be concluded that, at least in the rat, direct muscle neurotization after both end-to-end and end-to-side neurorrhaphy represents a good strategy for preventing denervation-related muscle atrophy but not for regaining the lost motor function.
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Affiliation(s)
- Igor Papalia
- Department of Biomorphology and Biotechnologies, University of Messina, Messina 98100, Italy
| | - Giulia Ronchi
- Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO) & Department of Clinical and Biological Sciences, University of Turin, Torino 10043, Italy
| | - Luisa Muratori
- Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO) & Department of Clinical and Biological Sciences, University of Turin, Torino 10043, Italy
| | - Alessandra Mazzucco
- Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO) & Department of Clinical and Biological Sciences, University of Turin, Torino 10043, Italy
| | - Ludovico Magaudda
- Department of Biomorphology and Biotechnologies, University of Messina, Messina 98100, Italy
| | - Stefano Geuna
- Neuroscience Institute of the Cavalieri Ottolenghi Foundation (NICO) & Department of Clinical and Biological Sciences, University of Turin, Torino 10043, Italy
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Donaldson K, Höke A. Studying axonal degeneration and regeneration using in vitro and in vivo models: the translational potential. FUTURE NEUROLOGY 2014. [DOI: 10.2217/fnl.14.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ABSTRACT: Since the initial studies by Cajal, multiple models of peripheral nerve degeneration and regeneration have been developed to address the ever-increasing complexity of the mechanisms involved in regeneration. In vitro models offer the principal benefit of a system that can be readily manipulated to address specific mechanistic questions in a deconstructed system. However, in vitro models can be overly simplified and intricacies of the interactions between neurons and glia can be lost. In vivo animal models seek to remedy some of these shortcomings, but most in vivo animal systems fail to precisely model human nerve regeneration. Rodent models of chronic nerve regeneration have been developed to better recapitulate human nerve regeneration, but are not widely used. An important development in the field has been the establishment of experimental nerve regeneration in humans, involving the reinnervation of the epidermis after cutaneous axotomy or topical capsaicin application. Use of such human models will likely accelerate the development and evaluation of new drugs that enhance peripheral nerve regeneration.
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Affiliation(s)
- Katelyn Donaldson
- Departments of Neurology & Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Ahmet Höke
- Departments of Neurology & Neuroscience, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Yang W, Yang J, Yu C, Gu Y. End-to-side neurotization with different donor nerves for treating brachial plexus injury: An experimental study in a rat model. Muscle Nerve 2014; 50:67-72. [PMID: 24639264 DOI: 10.1002/mus.24110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 09/21/2013] [Accepted: 10/27/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Wengbo Yang
- Department of Hand Surgery Nanjing First Hospital; Nanjing China
| | - Jianyun Yang
- Department of Hand Surgery; Huashan Hospital; 12 WuLuMuQi Zhong Road Shanghai China 200040
| | - Cong Yu
- Department of Hand Surgery; Huashan Hospital; 12 WuLuMuQi Zhong Road Shanghai China 200040
| | - Yudong Gu
- Department of Hand Surgery; Huashan Hospital; 12 WuLuMuQi Zhong Road Shanghai China 200040
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Treatment options for brachial plexus injuries. ISRN ORTHOPEDICS 2014; 2014:314137. [PMID: 24967125 PMCID: PMC4045367 DOI: 10.1155/2014/314137] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/08/2014] [Indexed: 11/18/2022]
Abstract
The incidence of brachial plexus injuries is rapidly growing due to the increasing number of high-speed motor-vehicle accidents. These are devastating injuries leading to significant functional impairment of the patients. The purpose of this review paper is to present the available options for conservative and operative treatment and discuss the correct timing of intervention. Reported outcomes of current management and future prospects are also analysed.
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