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Specificity of reinnervation and motor recovery after interposition of an artificial barrier between transected and repaired nerves in adjacency: an experimental study in the rat
Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine & Chang Gung University, Taipei, Taiwan, R.O.C..
Linköping University, Department of Biomedicine and Surgery, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences.
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2001 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 143, no 4, 393-399 p.Article in journal (Refereed) Published
Abstract [en]

Non-specific re-innervation of target organs caused by misdirected axonal growth at the repair site is regarded as one reason for a poor functional outcome after peripheral nerve transsection and repair. This study investigates the rate of aberrant re-innervation and its influence on motor recovery in the rat sciatic nerve using artificial sheets as barrier between tibial and peroneal nerves.

The sciatic nerve was transsected and repaired as follows: epineural sutures (A × 6), fascicular repair of tibial and peroneal nerves respectively (B × 8), and the same as in group B, but separating both nerves using an Integra®-sheet with silicone (C × 8), or Integra® without silicone (D × 8). As control, solely the tibial nerve was transsected and repaired (E × 5).

Final investigations after 4 months revealed that in group C, 50% of the Integra®-silicone sheets were dislocated. No dislocation was found in group D. Muscle contraction force of the gastrocnemius muscle was significantly higher in group E as compared to all other groups. However although not significant, group D showed a consistently higher muscle contraction force than groups A, B, and C. Histology in groups A, B, and C with dislocated sheets demonstrated multiple axons growing from the tibial to the peroneal nerve and vice versa. In groups D and E, no such axonal growth was visible. These findings were confirmed by a significantly higher rate of specific re-innervation of the soleus muscle using sequential retrograde double labelling technique.

Results of this study suggest that an artificial sheet such as Integra® bears the potential of preventing aberrant re-innervation between repaired adjacent nerves resulting in improved motor recovery. Clinically, this technique may be of importance for brachial plexus, sciatic nerve, and facial nerve repair.

Place, publisher, year, edition, pages
2001. Vol. 143, no 4, 393-399 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25220DOI: 10.1007/s007010170095Local ID: 9659OAI: oai:DiVA.org:liu-25220DiVA: diva2:245547
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-22Bibliographically approved
In thesis
1. Repair of divided peripheral nerves: experimental studies in rabbit and rat
Open this publication in new window or tab >>Repair of divided peripheral nerves: experimental studies in rabbit and rat
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to provide new knowledge, through experimental studies, that may contribute to an improvement of the results after microsurgical peripheral nerve repair in patients.

An adequate function of the human body depends, among other things, on a correctly functioning peripheral nervous system. Peripheral nerve injuries may impair the motor and sensory function of muscles, the proprioceptive joint control, the cutaneous sensibility, and the autonomic control of the skin, which can result in severe dysfunction of e.g. an extremity. The worst grade- of nerve injury is the division of an entire nerve. In the ideal case, the divided nerve can be sutured so that the distal and proximal nerve stumps are brought together. When peripheral nerve tissue has been lost at the site of injury, a direct repair is not possible. In such cases, the use of nerve grafts to bridge the defect, and/or suture of the distal nerve stump to an entirely different donor nerve is necessary to restore some function. Both types of such nerve repair, however, produce new sequelae due to loss of function of the nerves used for repair. To avoid such donor nerve morbidity, two different types of repair, end-to-end coaptation to part of a healthy donor nerve and end-to- side neurorrhaphy were investigated experimentally.

Neurotomy studies in the rabbit showed that use of 1/3 of a donor nerve (ulnar nerve) for reinnervation of an agonistic recipient nerve (median nerve) results in a useful muscle function with negligible donor nerve morbidity.

In the rat, end-to-side neurorrhaphy of a recipient nerve (median nerve) to an agonistic donor nerve (ulnar nerve) turned out to give a useful muscle function without causing donor nerve morbidity. After end-to-side neurorrhaphy, reinnervation of the recipient nerve stump was executed by collateral sprouting from intact donor nerve axons. The regeneration of sensory axons was numerically superior to the regeneration of motor axons. Altogether, however, good results after end-to-side neurorrhaphy are not predictable.

Both types of nerve repair (end-to-side neurorrhaphy and partial end-to-end neurorrhaphy) give better results with respect to reinnervation of a nerve to a simple muscle target than with respect to reinnervation of a nerve to a complex muscle target.

In the ideal situation, after conventional end-to-end nerve suture, nerve repair results in an axonal regeneration that restores muscle function as well as cutaneous sensibility and autonomous function. However, a completely normal function is usually not achieved due to e.g. aberrant axonal regeneration that results in a nerve-target mismatch. One of the causes for aberrant regeneration is axonal criss-crossing between fascicles in adjacency. Hence, barriers of different materials were tested in the rat to see if interfascicular axonal criss-crossing can be counteracted.

Three materials - a pedicle fat flap, Integra®, and non-vascularized autologous fasciawere used as barriers between the peroneal and the tibial fascicles in rats. The results showed that all three barriers improved axonal alignment after sciatic nerve transection and fascicular end-to-end repair. The pedicle fat flap was the most valuable barrier.

Finally, coaptation of the divided rat sciatic nerve with the aid of couplers, normally used for microvascular anastomoses, was evaluated as a method to hinder erratic centrifugal axon growth. The results showed that couplers provided a secluded coaptation site avoiding aberrant axonal sprouting to the surroundings. However, a minor nerve compression was evident.

Altogether, these results show that the microsurgical repair of nerve transections can be improved a bit further. However, the future developments in this area are likely to occur at the molecular level.

Place, publisher, year, edition, pages
Örebro: Prinfo Welins Tryckeri, 2004. 57 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 841
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24389 (URN)6482 (Local ID)91-7373-813-1 (ISBN)6482 (Archive number)6482 (OAI)
Public defence
2004-03-19, Elsa Brändströmsalen, Hälsouniversitetet, Linköping, 13:00 (English)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-22Bibliographically approved

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Lutz, Barbara S.Lidman, Disa

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