1
|
Kaufman Goldberg T, Trzcinski LO, McGonagle ER, Hadlock TA. Does supercharging with cross-face nerve graft enhance smile in non-flaccid facial paralysis patients undergoing selective neurectomy? Microsurgery 2024; 44:e31118. [PMID: 37772398 DOI: 10.1002/micr.31118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cross face nerve grafting (CFNG) is a well-established nerve transfer technique in facial reanimation; however, no study has assessed outcome of supercharging the smile with CFNG in patients with synkinesis. The goal of this study was to examine the smile outcome in non-flaccid facial paralysis (NFFP) patients after supercharging with CFNG during selective neurectomy. METHODS NFFP patients who underwent CFNG with end-to-side coaptation to a smile branch on the paralyzed side during selective neurectomy were retrospectively identified and their charts were reviewed. Pre-operative and post-operative facial function was assessed with the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Smile metrics were compared pre-operatively, in early post-operative time (EPO, <6 months), and late post-operative time (LPO, >9 months) when CFNG contribution would be expected. RESULTS Thirteen cases were performed between June 2019 and December 2021. No objective smile metrics improved following supercharging with CFNG. Oral commissure excursion improved by 1.23 points in eFACE (p = .812), and by 0.84 in Emotrtics (p = .187) from EPO to LPO. EFACE dynamic score was improved by 0.08 points from EPO to LPO (p = .969). CONCLUSIONS Using CFNG for supercharging the smile during selective neurectomy in NFFP patients may not enhance smile. Longer term results following supercharging and long term natural history of selective neurectomy should be assessed.
Collapse
Affiliation(s)
- Tal Kaufman Goldberg
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Mozafari N, Yavari M, Karimi Rouzbahani A, Mozafari MA, Mozafari A, Beiranvand S, Mahmoudvand H. Improved Neurotization in High Peripheral Nerve Injury: Side to Side H-shaped Nerve Graft at the Most Distal Part of an Injured Extremity in a Rabbit Model. World J Plast Surg 2024; 13:50-57. [PMID: 39193240 PMCID: PMC11346692 DOI: 10.61186/wjps.13.2.50] [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: 02/04/2024] [Accepted: 06/29/2024] [Indexed: 08/29/2024] Open
Abstract
Background We aimed to investigate the effects of nerve repair by setting a side-to-side (H-shaped) nerve graft on the most distal part of the damaged nerve to the adjacent intact nerve to accelerate its regeneration in the end organ. Methods This pure experimental study was done on the lower extremities of two groups of rabbits in Animal Laboratory Department, 15 Khordad Hospital Tehran, Iran. In both groups, the sciatic nerve at the proximal part of the extremity below the superficial femoral branch was first cut and then repaired. In the investigation group, side-to-side H-shaped nerve grafts were applied between the sciatic and superficial femoral nerves (i.e., two branches) at the most distal to the cut site of the sciatic nerve below the superficial femoral branch at the lower extremity. The sciatic nerve was conventionally repaired in the control group. Results None of the rabbits' feet in the control group respond to pain stimulation (were without senses) and had ulcers. They had numb legs and went lame. All had muscular atrophy and lacked nerve growth (regeneration) according to pathology. In the investigation group, 86.7% of the rabbits responded to pain stimulation and only 13.3% of them had ulcers. In addition, in pathology report, 13.3% had suffered muscular atrophy and lacked nerve regeneration. Therefore, nerve regeneration was successful in 86.7% of rabbits who underwent H-shaped nerve grafts. Conclusion Side-to-side H-shaped nerve graft at the most distal part of an injured nerve may cause successful recovery of high (proximal) nerve injury.
Collapse
Affiliation(s)
- Naser Mozafari
- Department of Plastic Surgery, School of Medicine, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoud Yavari
- Department of Plastic Surgery, School of Medicine, Panzdahe Khordad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arian Karimi Rouzbahani
- Student Research Committee, Lorestan University of Medical Sciences, Khorramabad, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | | | - Siavash Beiranvand
- Department of Anesthesiology, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Hormoz Mahmoudvand
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
- Department of Surgery, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Czarnecki P, Huber J, Szymankiewicz-Szukała A, Górecki M, Romanowski L. End-to-Side vs. Free Graft Nerve Reconstruction-Experimental Study on Rats. Int J Mol Sci 2023; 24:10428. [PMID: 37445608 DOI: 10.3390/ijms241310428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
The long history of regeneration nerve research indicates many clinical problems with surgical reconstruction to be resolved. One of the promising surgical techniques in specific clinical conditions is end-to-side neurorrhaphy (ETS), described and then repeated with different efficiency in the 1990s of the twentieth century. There are no reliable data on the quality of recipient nerve regeneration, possible donor nerve damage, and epineural window technique necessary to be performed. This research attempts to evaluate the possible regeneration after end-to-side neurorrhaphy, its quality, potential donor nerve damage, and the influence of epineural windows on regeneration efficiency. Forty-five female Wistar rats were divided into three equal groups, and various surgical technics were applied: A-ETS without epineural window, B-ETS with epineural window, and C-free graft reconstruction. The right peroneal nerve was operated on, and the tibial nerve was selected as a donor. After 24 weeks, the regeneration was evaluated by (1) footprint analysis every two weeks with PFI (peroneal nerve function index), TFI (tibial nerve function index), and SFI (sciatic nerve function index) calculations; (2) the amplitude and latency measurements of motor evoked potentials parameters recorded on both sides of the peroneal and tibial nerves when electroneurography with direct sciatic nerve electrical stimulation and indirect magnetic stimulation were applied; (3) histomorphometry with digital conversion of a transverse semithin nerve section, with axon count, fibers diameter, and calculation of axon area with a semiautomated method were performed. There was no statistically significant difference between the groups investigated in all the parameters. The functional indexes stabilized after eight weeks (PFI) and six weeks (TFI and SFI) and were positively time related. The lower amplitude of tibial nerve potential in groups A and B was proven compared to the non-operated side. Neurophysiological parameters of the peroneal nerve did not differ significantly. Histomorphometry revealed significantly lower diameter and area of axons in operated peroneal nerves compared to non-operated nerves. The axon count was at a normal level in every group. Tibial nerve parameters did not differ from non-operated values. Regeneration of the peroneal nerve after ETS was ascertained to be at the same level as in the case of free graft reconstruction. Peroneal nerves after ETS and free graft reconstruction were ascertained to have a lower diameter and area than non-operated ones. The technique of an epineural window does not influence the regeneration result of the peroneal nerve. The tibial nerve motor evoked potentials were characterized by lower amplitudes in ETS groups, which could indicate axonal impairment.
Collapse
Affiliation(s)
- Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, 61-545 Poznań, Poland
| | - Juliusz Huber
- Department of Pathophysiology of Locomotor Organs, Poznań University of Medical Sciences, 61-545 Poznań, Poland
| | | | - Michał Górecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, 61-545 Poznań, Poland
| | - Leszek Romanowski
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, 61-545 Poznań, Poland
| |
Collapse
|
5
|
Bueno CRDS, Tonin MCC, Buchaim DV, Barraviera B, Ferreira Junior RS, Santos PSDS, Reis CHB, Pastori CM, Pereira EDSBM, Nogueira DMB, Cini MA, Rosa Junior GM, Buchaim RL. Morphofunctional Improvement of the Facial Nerve and Muscles with Repair Using Heterologous Fibrin Biopolymer and Photobiomodulation. Pharmaceuticals (Basel) 2023; 16:ph16050653. [PMID: 37242436 DOI: 10.3390/ph16050653] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Peripheral nerve injuries impair the patient's functional capacity, including those occurring in the facial nerve, which require effective medical treatment. Thus, we investigated the use of heterologous fibrin biopolymer (HFB) in the repair of the buccal branch of the facial nerve (BBFN) associated with photobiomodulation (PBM), using a low-level laser (LLLT), analyzing the effects on axons, muscles facials, and functional recovery. This experimental study used twenty-one rats randomly divided into three groups of seven animals, using the BBFN bilaterally (the left nerve was used for LLLT): Control group-normal and laser (CGn and CGl); Denervated group-normal and laser (DGn and DGl); Experimental Repair Group-normal and laser (ERGn and ERGl). The photobiomodulation protocol began in the immediate postoperative period and continued for 5 weeks with a weekly application. After 6 weeks of the experiment, the BBFN and the perioral muscles were collected. A significant difference (p < 0.05) was observed in nerve fiber diameter (7.10 ± 0.25 µm and 8.00 ± 0.36 µm, respectively) and axon diameter (3.31 ± 0.19 µm and 4.07 ± 0.27 µm, respectively) between ERGn and ERGl. In the area of muscle fibers, ERGl was similar to GC. In the functional analysis, the ERGn and the ERGI (4.38 ± 0.10) and the ERGI (4.56 ± 0.11) showed parameters of normality. We show that HFB and PBM had positive effects on the morphological and functional stimulation of the buccal branch of the facial nerve, being an alternative and favorable for the regeneration of severe injuries.
Collapse
Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Dentistry School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
| | - Maria Clara Cassola Tonin
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI), Adamantina 17800-000, Brazil
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Rui Seabra Ferreira Junior
- Center for the Study of Venoms and Venomous Animals (CEVAP), São Paulo State University (Universidade Estadual Paulista, UNESP), Botucatu 18610-307, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP-Universidade Estadual Paulista), Botucatu 18618-687, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- UNIMAR Beneficent Hospital (HBU), University of Marilia (UNIMAR), Marília 17525-160, Brazil
| | | | - Eliana de Souza Bastos Mazuqueli Pereira
- Postgraduate Program in Structural and Functional Interactions in Rehabilitation, Postgraduate Department, University of Marilia (UNIMAR), Marília 17525-902, Brazil
| | - Dayane Maria Braz Nogueira
- Department of Prosthodontics and Periodontics, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
| | - Marcelo Augusto Cini
- Medical School, University of West Paulista (UNOESTE), Guarujá 11441-225, Brazil
| | | | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB/USP), University of São Paulo, Bauru 17012-901, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of Veterinary Medicine and Animal Science, University of São Paulo (FMVZ/USP), São Paulo 05508-270, Brazil
| |
Collapse
|
6
|
Liu CY, Arteaga AC, Fung SE, Cortina MS, Leyngold IM, Aakalu VK. Corneal neurotization for neurotrophic keratopathy: Review of surgical techniques and outcomes. Ocul Surf 2021; 20:163-172. [PMID: 33647470 PMCID: PMC8113161 DOI: 10.1016/j.jtos.2021.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
Neurotrophic keratopathy is a degenerative disease in which damage to the corneal nerves leads to corneal hypoesthesia. Injuries to neurotrophic corneas are notoriously difficult to treat and have traditionally been approached with supportive management. However, recent progress in the field of corneal neurotization has given new direction for addressing nerve loss directly by stimulating new nerve growth onto the cornea from nearby sensory nerves transferred to the perilimbal region. Herein, we review the surgical techniques utilized in corneal neurotization, including direct transfers and the use of nerve grafts. Considerations in surgical approach, as well as factors that influence prognosis and outcomes of the surgical intervention are also discussed.
Collapse
Affiliation(s)
- Catherine Y Liu
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, CA, USA.
| | - Andrea C Arteaga
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Sammie E Fung
- Viterbi Family Department of Ophthalmology, UC San Diego, San Diego, CA, USA
| | - M Soledad Cortina
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Ilya M Leyngold
- Duke University Medical Center, Department of Ophthalmology, Durham, NC, USA
| | - Vinay K Aakalu
- Illinois Eye and Ear Infirmary, Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
7
|
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.
Collapse
Affiliation(s)
| | - Fausto Viterbo
- Universidade Estadual Paulista “Júliode Mesquita Filho”, Brazil
| | - Elenice Deffune
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Brazil
| | | |
Collapse
|
8
|
Dual innervation of free gracilis muscle for facial reanimation: What we know so far. J Plast Reconstr Aesthet Surg 2020; 73:2196-2209. [DOI: 10.1016/j.bjps.2020.05.084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/20/2022]
|
9
|
Hashimoto K, Matsumine H, Osaki H, Ueta Y, Kamei W, Shimizu M, Fujii K, Niimi Y, Miyata M, Sakurai H. Prevention of denervated muscle atrophy with accelerated nerve-regeneration by babysitter procedure in rat facial nerve paralysis model. Microsurgery 2020; 41:61-69. [PMID: 32233044 DOI: 10.1002/micr.30580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 12/26/2019] [Accepted: 03/13/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE The "babysitter" procedure is a reconstruction technique for facial nerve complete paralysis and uses the movement source from the healthy facial nerve with a cross-nerve graft. First, an end-to-side neurorrhaphy is performed between the affected facial nerve trunk and hypoglossal nerve for continuously delivering stimuli to the mimetic muscles for preventing the atrophy of mimetic muscles. Despite favorable clinical results, histological and physiological mechanisms remain unknown. This study attempted to establish a model for the "babysitter" procedure and find its efficacy in rats with facial nerve complete paralysis. MATERIALS AND METHODS A total of 16 Lewis rats were used and divided into 2 groups; cross nerve graft (n = 8) and babysitter groups (n = 8). The facial nerve trunk was transected in both groups. Babysitter group underwent a two-stage procedure. Cross nerve graft group underwent only the transfer of nerve graft from the healthy side to affected side. The animals were assessed physiologically by compound muscle action potential (CMAP), and the regenerated nerve tissues were evaluated histopathologically at 13 weeks after surgery. RESULTS Facial nucleus stained with retrograde tracers proved the re-innervation of affected facial muscle by the babysitter procedure. In CMAP, the amplitude of babysitter group was significantly higher than that of the cross-facial nerve graft group (p < .05). Histological examination found a significant difference in myelin g-ratio between two groups (p < .05). CONCLUSION This study investigated the "babysitter" procedure for rat facial nerve palsy. Babysitter procedure shortened the denervation period without mimic muscle atrophy.
Collapse
Affiliation(s)
- Kazuki Hashimoto
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironobu Osaki
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshifumi Ueta
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Kamei
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mari Shimizu
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Kaori Fujii
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Mariko Miyata
- Department of Physiology, Division of Neurophysiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
10
|
Ulnar Nerve Injuries (Sunderland Grade V): A Simplified Classification System and Treatment Algorithm. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2474. [PMID: 31942286 PMCID: PMC6908344 DOI: 10.1097/gox.0000000000002474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 08/06/2019] [Indexed: 10/28/2022]
Abstract
This study introduced a novel technical approach to the ulnar nerve injuries. The ulnar nerve was divided into 4 distinct surgical zones, each mandating a unique management strategy. Methods A prospective observational study was conducted to verify the hypothesized algorithm. The study included 110 patients diagnosed with ulnar nerve injury (Sunderland grade 5). We divided the patients into 4 groups depending on the site of injury. Each group of patients was managed in accordance with a particular strategy, exploiting nerve transfer techniques along with the updated knowledge of the internal topography of the ulnar nerve. The motor recovery of the small muscles of the hand was assessed after 2 years of follow-up, using the disabilities of the arm, shoulder, and hand score, and other parameters including key pinch strength, hand grip strength, and the motor power of the first dorsal interosseous muscle on the Medical Research Council scale. Results The mean values of the disabilities of the arm, shoulder, and hand score, key pinch strength, and hand grip strength showed a statistically significant improvement across all patient groups (P < 0.05). Of those with zone (I) injury, postoperatively, 79.9% patients attained a first dorsal interosseous muscle power grade >3 on the Medical Research Council scale, while 93.9% of patients with zone (II) damage achieved the same result. Surprisingly, 84% of patients included in both zones (III) and (IV) also recovered to the same extent. Conclusions This prospective observational study examined and successfully confirmed the validity of our proposed novel algorithm for the management of ulnar nerve injuries (Sunderland grade 5).
Collapse
|
11
|
Somensi DN, Teixeira RKC, Feijó DH, Loureiro KD, Valente AL, Carvalho LTFD, Calvo FC, Santos DRD, Barros RSMD. Does the type of electrode affect the electromyoneurographic parameters in rats?1. Acta Cir Bras 2019; 34:e201900304. [PMID: 30892390 PMCID: PMC6585890 DOI: 10.1590/s0102-865020190030000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/12/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate if the type of electrode (needle vs. surface) affects the
electromyoneurography parameters in rats. Methods Twenty male rats were anesthetized, then compound muscle action potential
were recorded using a Neuropack S1 MEB- 9400©. All animals were
submitted to two electroneuromyography analysis: first with surface
electrode and then by needle electrode. We evaluated the latency, amplitude,
duration and area of the negative peak of the gastrocnemius and cranial
tibial muscles. Results There were no significant differences between the groups in the mean of
duration, latency, amplitude or area of the negative peak in gastrocnemius
and cranial tibial muscles. Conclusion The type of electrode does not affect the electroneuromyography
parameters.
Collapse
Affiliation(s)
- Danusa Neves Somensi
- MD, MS, Department of Neurology, School of Medicine, Universidade do Estado do Pará (UEPA), Belem-PA, Brazil. Conception, design, intellectual and scientific content of the study; interpretation of data; manuscript writing; critical revision
| | - Renan Kleber Costa Teixeira
- MD, MS, Department of Experimental Surgery, School of Medicine, UEPA, Belem-PA, Brazil. Interpretation of data, manuscript writing, critical revision
| | - Daniel Haber Feijó
- Fellow Master degree, Postgraduate Program in Surgery and Experimental Research, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data, manuscript writing
| | - Karine Drumond Loureiro
- MD, Department of Neurology, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data
| | - André Lopes Valente
- Graduate student, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data
| | | | - Faustino Chaves Calvo
- Graduate student, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data
| | - Deivid Ramos Dos Santos
- Graduate student, School of Medicine, UEPA, Belem-PA, Brazil. Acquisition and interpretation of data
| | - Rui Sergio Monteiro de Barros
- PhD, Associate Professor, Department of Experimental Surgery, School of Medicine, UEPA, Belem-PA, Brazil. Scientific content of the study, critical revision
| |
Collapse
|