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Tereshenko V, Dotzauer DC, Luft M, Ortmayr J, Maierhofer U, Schmoll M, Festin C, Carrero Rojas G, Klepetko J, Laengle G, Politikou O, Farina D, Blumer R, Bergmeister KD, Aszmann OC. Autonomic Nerve Fibers Aberrantly Reinnervate Denervated Facial Muscles and Alter Muscle Fiber Population. J Neurosci 2022; 42:8297-8307. [PMID: 36216502 PMCID: PMC9653283 DOI: 10.1523/jneurosci.0670-22.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
The surgical redirection of efferent neural input to a denervated muscle via a nerve transfer can reestablish neuromuscular control after nerve injuries. The role of autonomic nerve fibers during the process of muscular reinnervation remains largely unknown. Here, we investigated the neurobiological mechanisms behind the spontaneous functional recovery of denervated facial muscles in male rodents. Recovered facial muscles demonstrated an abundance of cholinergic axonal endings establishing functional neuromuscular junctions. The parasympathetic source of the neuronal input was confirmed to be in the pterygopalatine ganglion. Furthermore, the autonomically reinnervated facial muscles underwent a muscle fiber change to a purely intermediate muscle fiber population myosin heavy chain type IIa. Finally, electrophysiological tests revealed that the postganglionic parasympathetic fibers travel to the facial muscles via the sensory infraorbital nerve. Our findings demonstrated expanded neuromuscular plasticity of denervated striated muscles enabling functional recovery via alien autonomic fibers. These findings may further explain the underlying mechanisms of sensory protection implemented to prevent atrophy of a denervated muscle.SIGNIFICANCE STATEMENT Nerve injuries represent significant morbidity and disability for patients. Rewiring motor nerve fibers to other target muscles has shown to be a successful approach in the restoration of motor function. This demonstrates the remarkable capacity of the CNS to adapt to the needs of the neuromuscular system. Yet, the capability of skeletal muscles being reinnervated by nonmotor axons remains largely unknown. Here, we show that under deprivation of original efferent input, the neuromuscular system can undergo functional and morphologic remodeling via autonomic nerve fibers. This may explain neurobiological mechanisms of the sensory protection phenomenon, which is because of parasympathetic reinnervation.
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Affiliation(s)
- Vlad Tereshenko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dominik C Dotzauer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias Luft
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Joachim Ortmayr
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Udo Maierhofer
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Christopher Festin
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Johanna Klepetko
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Gregor Laengle
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Olga Politikou
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
| | - Dario Farina
- Department of Bioengineering, Imperial College London, London SW7 2AZ, United Kingdom
| | | | - Konstantin D Bergmeister
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Centers for Biomedical Research, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Aesthetic, and Reconstructive Surgery, Karl Landsteiner University of Health Sciences, University Hospital, A-3500 Krems an der Donau, Austria
| | - Oskar C Aszmann
- Clinical Laboratory for Bionic Extremity Reconstruction, Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical University of Vienna, 1090 Vienna, Austria
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Adidharma W, Khouri AN, Lee JC, Vanderboll K, Kung TA, Cederna PS, Kemp SWP. Sensory nerve regeneration and reinnervation in muscle following peripheral nerve injury. Muscle Nerve 2022; 66:384-396. [PMID: 35779064 DOI: 10.1002/mus.27661] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/11/2022]
Abstract
Sensory afferent fibers are an important component of motor nerves and compose the majority of axons in many nerves traditionally thought of as "pure" motor nerves. These sensory afferent fibers innervate special sensory end organs in muscle, including muscle spindles that respond to changes in muscle length and Golgi tendons that detect muscle tension. Both play a major role in proprioception, sensorimotor extremity control feedback, and force regulation. After peripheral nerve injury, there is histological and electrophysiological evidence that sensory afferents can reinnervate muscle, including muscle that was not the nerve's original target. Reinnervation can occur after different nerve injury and muscle models, including muscle graft, crush, and transection injuries, and occurs in a nonspecific manner, allowing for cross-innervation to occur. Evidence of cross-innervation includes the following: muscle spindle and Golgi tendon afferent-receptor mismatch, vagal sensory fiber reinnervation of muscle, and cutaneous afferent reinnervation of muscle spindle or Golgi tendons. There are several notable clinical applications of sensory reinnervation and cross-reinnervation of muscle, including restoration of optimal motor control after peripheral nerve repair, flap sensation, sensory protection of denervated muscle, neuroma treatment and prevention, and facilitation of prosthetic sensorimotor control. This review focuses on sensory nerve regeneration and reinnervation in muscle, and the clinical applications of this phenomena. Understanding the physiology and limitations of sensory nerve regeneration and reinnervation in muscle may ultimately facilitate improvement of its clinical applications.
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Affiliation(s)
- Widya Adidharma
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Alexander N Khouri
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Jennifer C Lee
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Kathryn Vanderboll
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Theodore A Kung
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan
| | - Paul S Cederna
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Biomedical Engineering, Ann Arbor, Michigan
| | - Stephen W P Kemp
- Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, Michigan.,Department of Biomedical Engineering, Ann Arbor, Michigan
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R Rai SK, Dandpat SK, Ranjan S, Shah A, Sudarshan N, Mancarella C, Pathak HM, Goel AH. Antegrade Subperiosteal Temporalis Muscle Elevation and Posterior Retraction Technique Avoiding Muscle Incision for Pterional Craniotomy: A Technical Note. Neurol India 2022; 70:1391-1395. [PMID: 36076633 DOI: 10.4103/0028-3886.355156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The current technique of pterional craniotomy involves temporalis muscle incision followed by retrograde elevation. Feasibility of antegrade temporalis muscle elevation without any direct incision over its bulk is evaluated. Objective Incisionless "antegrade, subgaleal, subfascial, and subperiosteal elevation" of temporalis muscle preserves vascularity and muscle bulk. Posterior maneuvering of "bare" temporalis muscle bulk either above (out rolling) or under (in rolling) the scalp for pterional craniotomy is discussed. Material and Methods Technique of antegrade, subfascial, subperiosteal elevation, and posterior rotation of temporalis muscle without incising in its bulk by "out rolling" or "in rolling" along the posterior aspect of the scalp incision was carried out in 15 cadavers and later in 50 surgical cases undergoing pterional craniotomy. Postoperatively, patients were evaluated for subgaleal collection and periorbital edema. Operated side cosmesis and temporalis muscle bulk was compared with nonoperated temporalis muscle at 6 months interval. Results Antegrade subperiosteal dissection of temporalis muscle was possible in all cases. "In-rolling" or "out rolling" technique provided adequate surgical exposure during pterional craniotomy. Postoperative subgaleal collection and periorbital edema was prevented. Facial nerve paresis or temporalis muscle-related complications were avoided. Conclusion Antegrade, subgaleal, subfascial, and subperiosteal dissection techniques of temporalis muscle elevation without any direct incision in its bulk enables neurovascular and muscle volume preservation. Posterior maneuvering of elevated temporalis muscle with "out rolling" or "in-rolling" technique is easy, quick, and provides adequate exposure during pterional craniotomy. Opening and closing of scalp layers without violating subgaleal space prevent postoperative subgaleal hematoma and periorbital edema.
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Affiliation(s)
- Survendra Kumar R Rai
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
| | - Saswat K Dandpat
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
| | - Shashi Ranjan
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
| | - Abhidha Shah
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
| | - Nishchith Sudarshan
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
| | | | - Harish M Pathak
- Department of Forensic Medicine, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital
| | - Atul H Goel
- Department of Neurosurgery, King Edward Memorial Hospital, Seth Gordhandas Memorial Hospital, Acharya Donde Marg, Parel, Mumbai, India
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Santosa KB, Oliver JD, Cederna PS, Kung TA. Regenerative Peripheral Nerve Interfaces for Prevention and Management of Neuromas. Clin Plast Surg 2020; 47:311-321. [DOI: 10.1016/j.cps.2020.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Prognostic value of the posterior cricoarytenoid muscle atrophy in computerized tomography scans for unilateral vocal fold paralysis recovery. Eur Arch Otorhinolaryngol 2020; 277:827-832. [DOI: 10.1007/s00405-019-05780-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/24/2019] [Indexed: 10/25/2022]
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Kozusko SD, Kaminsky AJ, Boyd LC, Konofaos P. Sensory neurotization of muscle: past, present and future considerations. J Plast Surg Hand Surg 2018; 53:31-36. [PMID: 30380962 DOI: 10.1080/2000656x.2018.1523180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Research has shown that temporary innervation by a sensory neuron can provide trophic support to a denervated muscle and stave off muscular atrophy until motor neuron transfer is viable. This so called 'sensory protection' allows for improved outcomes when motor reinnervation able to occur. The theoretical benefit of sensory neurotization is hypothesized to maintain tissue architecture of the end organ due to tropic effects of stimulation. While the literature supports direct motor neurotization from 2 to 4 months post-injury, patient factors including the location of the injury and loss of nerve can preclude this therapeutic window. When direct neurotization is not possible, or there is a long distance to traverse for reinnervation, sensory neurotization may be beneficial. The theorized trophic stimulation enabling end organ architectural maintenance provided by sensory neurotization has been shown to allow for delayed direct motor neurotization without the irreversible sequelae of prolonged denervation. This is a review of the pathogenesis of nerve injury and a literature review of sensory neurotization. An analytical search of the literature in PubMed was performed in order to find articles pertinent to the topic of sensory neurotization, including experimental data from both animal models and case reports in humans.
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Affiliation(s)
- Steven D Kozusko
- a Department of Plastic Surgery , University of Tennessee Health Science Center Memphis , TN , USA
| | - Alexander J Kaminsky
- a Department of Plastic Surgery , University of Tennessee Health Science Center Memphis , TN , USA
| | - Louisa C Boyd
- b College of Medicine , University of Tennessee Health Science Center , Memphis , TN , USA
| | - Petros Konofaos
- c Department of Plastic Surgery and Neurology , University of Tennessee Health Science Center Memphis , TN , USA
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Hosseinian MA, Shirian S, Loron AG, Ebrahimy AA, Hayatolah GH. Distal sensory to distal motor nerve anastomosis can protect lower extremity muscle atrophy in a murine model. EUROPEAN JOURNAL OF PLASTIC SURGERY 2018. [DOI: 10.1007/s00238-017-1313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Ruven C, Li W, Li H, Wong WM, Wu W. Transplantation of Embryonic Spinal Cord Derived Cells Helps to Prevent Muscle Atrophy after Peripheral Nerve Injury. Int J Mol Sci 2017; 18:ijms18030511. [PMID: 28264437 PMCID: PMC5372527 DOI: 10.3390/ijms18030511] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/10/2017] [Accepted: 02/22/2017] [Indexed: 02/07/2023] Open
Abstract
Injuries to peripheral nerves are frequent in serious traumas and spinal cord injuries. In addition to surgical approaches, other interventions, such as cell transplantation, should be considered to keep the muscles in good condition until the axons regenerate. In this study, E14.5 rat embryonic spinal cord fetal cells and cultured neural progenitor cells from different spinal cord segments were injected into transected musculocutaneous nerve of 200–300 g female Sprague Dawley (SD) rats, and atrophy in biceps brachii was assessed. Both kinds of cells were able to survive, extend their axons towards the muscle and form neuromuscular junctions that were functional in electromyographic studies. As a result, muscle endplates were preserved and atrophy was reduced. Furthermore, we observed that the fetal cells had a better effect in reducing the muscle atrophy compared to the pure neural progenitor cells, whereas lumbar cells were more beneficial compared to thoracic and cervical cells. In addition, fetal lumbar cells were used to supplement six weeks delayed surgical repair after the nerve transection. Cell transplantation helped to preserve the muscle endplates, which in turn lead to earlier functional recovery seen in behavioral test and electromyography. In conclusion, we were able to show that embryonic spinal cord derived cells, especially the lumbar fetal cells, are beneficial in the treatment of peripheral nerve injuries due to their ability to prevent the muscle atrophy.
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Affiliation(s)
- Carolin Ruven
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wen Li
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Heng Li
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wai-Man Wong
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
| | - Wutian Wu
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Hong Kong, China.
- State Key Laboratory of Brain and Cognitive Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
- Joint Laboratory for CNS Regeneration, Jinan University and The University of Hong Kong, GHM Institute of CNS Regeneration, Jinan University, Guangzhou 510000, China.
- Guangdong Engineering Research Center of Stem Cell Storage and Clinical Application, Saliai Stem Cell Science and Technology, Guangzhou 510000, China.
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Sensory nerve cross-anastomosis and electrical muscle stimulation synergistically enhance functional recovery of chronically denervated muscle. Plast Reconstr Surg 2015; 134:736e-745e. [PMID: 25347648 DOI: 10.1097/prs.0000000000000599] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Long-term muscle denervation leads to severe and irreversible atrophy coupled with loss of force and motor function. These factors contribute to poor functional recovery following delayed reinnervation. The authors' previous work demonstrated that temporarily suturing a sensory nerve to the distal motor stump (called sensory protection) significantly reduces muscle atrophy and improves function following reinnervation. The authors have also shown that 1 month of electrical stimulation of denervated muscle significantly improves function and reduces atrophy. In this study, the authors tested whether a combination of sensory protection and electrical stimulation would enhance functional recovery more than either treatment alone. METHODS Rat gastrocnemius muscles were denervated by cutting the tibial nerve. The peroneal nerve was then sutured to the distal tibial stump following 3 months of treatment (i.e., electrical stimulation, sensory protection, or both). Three months after peroneal repair, functional and histologic measurements were taken. RESULTS All treatment groups had significantly higher muscle weight (p<0.05) and twitch force (p<0.001) compared with the untreated group (denervated), but fiber type composition did not differ between groups. Importantly, muscle weight and force were significantly greater in the combined treatment group (p<0.05) compared with stimulation or sensory protection alone. The combined treatment also produced motor unit counts significantly greater than sensory protection alone (p<0.05). CONCLUSIONS The combination treatment synergistically reduces atrophy and improves reinnervation and functional measures following delayed nerve repair, suggesting that these approaches work through different mechanisms. The authors' research supports the clinical use of both modalities together following peripheral nerve injury.
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Wu P, Chawla A, Spinner RJ, Yu C, Yaszemski MJ, Windebank AJ, Wang H. Key changes in denervated muscles and their impact on regeneration and reinnervation. Neural Regen Res 2014; 9:1796-809. [PMID: 25422641 PMCID: PMC4239769 DOI: 10.4103/1673-5374.143424] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/29/2022] Open
Abstract
The neuromuscular junction becomes progressively less receptive to regenerating axons if nerve repair is delayed for a long period of time. It is difficult to ascertain the denervated muscle's residual receptivity by time alone. Other sensitive markers that closely correlate with the extent of denervation should be found. After a denervated muscle develops a fibrillation potential, muscle fiber conduction velocity, muscle fiber diameter, muscle wet weight, and maximal isometric force all decrease; remodeling increases neuromuscular junction fragmentation and plantar area, and expression of myogenesis-related genes is initially up-regulated and then down-regulated. All these changes correlate with both the time course and degree of denervation. The nature and time course of these denervation changes in muscle are reviewed from the literature to explore their roles in assessing both the degree of detrimental changes and the potential success of a nerve repair. Fibrillation potential amplitude, muscle fiber conduction velocity, muscle fiber diameter, mRNA expression levels of myogenic regulatory factors and nicotinic acetylcholine receptor could all reflect the severity and length of denervation and the receptiveness of denervated muscle to regenerating axons, which could possibly offer an important clue for surgical choices and predict the outcomes of delayed nerve repair.
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Affiliation(s)
- Peng Wu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China ; Department of Orthopedic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Aditya Chawla
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cong Yu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Michael J Yaszemski
- Departments of Orthopedic Surgery and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Huan Wang
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA ; Shanghai Key Laboratory of Peripheral Nerve and Microsurgery, Shanghai, China
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Zhao L, Lv G, Jiang S, Yan Z, Sun J, Wang L, Jiang D. Morphological differences in skeletal muscle atrophy of rats with motor nerve and/or sensory nerve injury. Neural Regen Res 2014; 7:2507-15. [PMID: 25337102 PMCID: PMC4200706 DOI: 10.3969/j.issn.1673-5374.2012.32.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/31/2012] [Indexed: 02/06/2023] Open
Abstract
Skeletal muscle atrophy occurs after denervation. The present study dissected the rat left ventral root and dorsal root at L4-6 or the sciatic nerve to establish a model of simple motor nerve injury, sensory nerve injury or mixed nerve injury. Results showed that with prolonged denervation time, rats with simple motor nerve injury, sensory nerve injury or mixed nerve injury exhibited abnormal behavior, reduced wet weight of the left gastrocnemius muscle, decreased diameter and cross-sectional area and altered ultrastructure of muscle cells, as well as decreased cross-sectional area and increased gray scale of the gastrocnemius muscle motor end plate. Moreover, at the same time point, the pathological changes were most severe in mixed nerve injury, followed by simple motor nerve injury, and the changes in simple sensory nerve injury were the mildest. These findings indicate that normal skeletal muscle morphology is maintained by intact innervation. Motor nerve injury resulted in larger damage to skeletal muscle and more severe atrophy than sensory nerve injury. Thus, reconstruction of motor nerves should be considered first in the clinical treatment of skeletal muscle atrophy caused by denervation.
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Affiliation(s)
- Lei Zhao
- Department of Orthopedics, Third Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China
| | - Guangming Lv
- Key Laboratory of Neural Regeneration of Jiangsu Province, Nantong University, Nantong 223001, Jiangsu Province, China
| | - Shengyang Jiang
- Central Laboratory, Third Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China
| | - Zhiqiang Yan
- Laboratory of Mechanical Biology and Medical Engineering, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Junming Sun
- Central Laboratory, Third Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China
| | - Ling Wang
- Central Laboratory, Third Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China
| | - Donglin Jiang
- Central Laboratory, Third Affiliated Hospital of Nantong University, Wuxi 214041, Jiangsu Province, China
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Future Perspectives in Nerve Repair and Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2013; 109:165-92. [DOI: 10.1016/b978-0-12-420045-6.00008-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Boyd KU, Nimigan AS, Mackinnon SE. Nerve reconstruction in the hand and upper extremity. Clin Plast Surg 2012; 38:643-60. [PMID: 22032591 DOI: 10.1016/j.cps.2011.07.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In the management of traumatic peripheral nerve injuries, the severity or degree of injury dictates the decision making between surgical management versus conservative management and serial examination. This review explores some of the recent literature, specifically addressing recent basic science advances in end-to-side and reverse end-to-side recovery, Schwann cell migration, and neuropathic pain. The management of nerve gaps, including the use of nerve conduits and acellularized nerve allografts, is examined. Current commonly performed nerve transfers are detailed with focus on both motor and sensory nerve transfers, their indications, and a basic overview of selected surgical techniques.
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Affiliation(s)
- Kirsty U Boyd
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Ottawa, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada
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Kale SS, Glaus SW, Yee A, Nicoson MC, Hunter DA, Mackinnon SE, Johnson PJ. Reverse end-to-side nerve transfer: from animal model to clinical use. J Hand Surg Am 2011; 36:1631-1639.e2. [PMID: 21872405 DOI: 10.1016/j.jhsa.2011.06.029] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 06/23/2011] [Accepted: 06/24/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE Functional recovery after peripheral nerve injury is predominantly influenced by time to reinnervation and number of regenerated motor axons. For nerve injuries in which incomplete regeneration is anticipated, a reverse end-to-side (RETS) nerve transfer might be useful to augment the regenerating nerve with additional axons and to more quickly reinnervate target muscle. This study evaluates the ability of peripheral nerve axons to regenerate across an RETS nerve transfer. We present a case report demonstrating its potential clinical applicability. METHODS Thirty-six Lewis rats were randomized into 3 groups. In group 1 (negative control), the tibial nerve was transected and prevented from regenerating. In group 2 (positive control), the tibial and peroneal nerves were transected, and an end-to-end (ETE) nerve transfer was performed. In group 3 (experimental model), the tibial nerve and peroneal nerves were transected, and an RETS nerve transfer was performed between the proximal end of the peroneal nerve and the side of the denervated distal tibial stump. Nerve histomorphometry and perfused muscle mass were evaluated. Six Thy1-GFP transgenic Sprague Dawley rats, expressing green fluorescent protein in their neural tissues, also had the RETS procedure for evaluation with confocal microscopy. RESULTS Nerve histomorphometry showed little to no regeneration in chronic denervation animals but statistically similar regeneration in ETE and RETS animals at 5 and 10 weeks. Muscle mass preservation was similar between ETE and RETS groups by 10 weeks and significantly better than negative controls at both time points. Nerve regeneration was robust across the RETS coaptation of Thy1-GFP rats by 5 weeks. CONCLUSIONS Axonal regeneration occurs across an RETS coaptation. An RETS nerve transfer might augment motor recovery when less-than-optimal recovery is otherwise anticipated. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Santosh S Kale
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Jiang GL, Gu YD, Zhang LY, Shen LY, Yu C, Xu JG. Randomized, double-blind, and placebo-controlled trial of clenbuterol in denervated muscle atrophy. ISRN PHARMACEUTICS 2011; 2011:981254. [PMID: 22389867 PMCID: PMC3263717 DOI: 10.5402/2011/981254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/21/2011] [Indexed: 12/21/2022]
Abstract
Objectives. β2-adrenergic agonists, such as clenbuterol, have been shown to promote the hypertrophy of healthy skeletal muscles and to ameliorate muscle wasting in a few pathological conditions in both animals and humans. We intended to investigate the clinical efficacy of clenbuterol on attenuating denervation-induced muscle atrophy. Methods. A double-blind, placebo-controlled, parallel, and randomized trial was employed. 71 patients, suffering from brachial plexus injuries, were given either clenbuterol (60 μg, bid) or placebo for 3 months. Before and at the end of the study, patients were given physical examinations, biopsies of biceps brachii, electromyograms (EMGs), and other laboratory tests. Results. Compared with placebo treatment, clenbuterol significantly mitigated the decreases in cross-sectional areas of type I and II muscle fibers and alleviated the reduction in fibrillation potential amplitudes, without any adverse effects. Conclusions. Clenbuterol safely ameliorated denervated muscle atrophy in this cohort; thus larger clinical studies are encouraged for this or other β2 agonists on denervation-induced muscle atrophy.
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Affiliation(s)
- Guang-Liang Jiang
- Department of Hand Surgery, Huashan Hospital of Fudan University, Shanghai 200040, China
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Zuijdendorp HM, Tra WMW, van Neck JW, Mollis L, Coert JH. Delay of denervation atrophy by sensory protection in an end-to-side neurorrhaphy model: a pilot study. J Plast Reconstr Aesthet Surg 2010; 63:1949-52. [PMID: 20303842 DOI: 10.1016/j.bjps.2010.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 12/25/2009] [Accepted: 01/19/2010] [Indexed: 11/15/2022]
Abstract
OBJECT Temporary sensory innervation delays the atrophy process. A major disadvantage of most experimental models is that sensory-protected muscles must be denervated a second time to allow reinnervation by the affected nerve. The aim of this study was to assess the effect of sensory protection on denervated gastrocnemius muscle in an end-to-side neurorrhaphy model, in which denervated muscles may be preserved until axons of the native nerve reach their target without the necessity for a second operation. METHODS The tibial nerve of 24 female Lewis rats was transected. Twelve animals acted as the controls. In the other 12 animals, the end of the sural nerve was connected to the side of the distal tibial nerve stump (sensory protection group). At 5 and 10 weeks, wet gastrocnemius muscle weight was reported as a ratio of the operated to the unoperated side. For histological analysis, muscle samples were rapidly frozen and sections were stained with haematoxylin and eosin, Oil Red O stain and modified Gomori trichrome stain. RESULTS The difference between the sensory protection group and the control group was statistically significant at 5 (0.36±0.01 and 0.29±0.01, respectively; p<0.001) and 10 weeks postoperatively (0.28±0.01 and 0.19±0.00, respectively; p<0.001). Histological observations revealed that sensory-protected muscles underwent less atrophy. CONCLUSION Sensory protection delays atrophy in an end-to-side neurorrhaphy model.
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Affiliation(s)
- Hendrika M Zuijdendorp
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 50, NL 3015 GE Rotterdam, The Netherlands.
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Sensory protection of rat muscle spindles following peripheral nerve injury and reinnervation. Plast Reconstr Surg 2010; 124:1860-1868. [PMID: 19952642 DOI: 10.1097/prs.0b013e3181bcee47] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skeletal muscle structure and function are dependent on intact innervation. Prolonged muscle denervation results in irreversible muscle fiber atrophy, connective tissue hyperplasia, and deterioration of muscle spindles, specialized sensory receptors necessary for proper skeletal muscle function. The protective effect of temporary sensory innervation on denervated muscle, before motor nerve repair, has been shown in the rat. Sensory-protected muscles exhibit less fiber atrophy and connective tissue hyperplasia and maintain greater functional capacity than denervated muscles. The purpose of this study was to determine whether temporary sensory innervation also protects muscle spindles from degeneration. METHODS Rat tibial nerve was transected and repaired with either the saphenous or the original transected nerve. Negative controls remained denervated. After 3 to 6 months, the electrophysiologic response of the nerve to stretch in the rat gastrocnemius muscle was measured (n = 3 per group). After the animals were euthanized, the gastrocnemius muscle was removed, sectioned, stained, and examined for spindle number (n = 3 per group) and morphology (one rat per group). Immunohistochemical assessment of muscle spindle innervation was examined in four additional animals. RESULTS Significant deterioration of muscle spindles was seen in denervated muscle, whereas in muscle reinnervated with the tibial or the saphenous nerve, spindle number and morphology were improved. Histologic and functional evidence of spindle reinnervation by the sensory nerve was obtained. CONCLUSION These findings add to the known means by which motor or sensory nerves exert protective effects on denervated muscle, and further promote the use of sensory protection for improving the outcome after peripheral nerve injury.
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Abstract
OBJECT Mobilizing the temporal muscle is a common neurosurgical maneuver. Unfortunately, the cosmetic and functional complications that arise from postoperative muscular atrophy can be severe. Proper function of the muscle depends on proper innervation, vascularization, muscle tension, and the integrity of muscle fibers. In this study the authors describe the anatomy of the temporal muscle and report technical nuances that can be used to prevent its postoperative atrophy. METHODS This study was designed to determine the susceptibility of the temporal muscle to injury during common surgical dissection. The authors studied the anatomy of the muscle and its vascularization and innervation in seven cadavers. A zygomatic osteotomy was performed followed by downward mobilization of the temporal muscle by using subperiosteal dissection, which preserved the muscle and allowed a study of its arterial and neural components. The temporal muscle is composed of a main portion and three muscle bundles. The muscle is innervated by the deep temporal nerves, which branch from the anterior division of the mandibular nerve. Blood is supplied through a rich anastomotic connection between the deep temporal arteries (anterior and posterior) on the medial side and the middle temporal artery (a branch of the superficial temporal artery [STA]) on the lateral side. CONCLUSIONS Based on these anatomical findings, the authors recommend the following steps to preserve the temporal muscle: 1) preserve the STA; 2) prevent injury to the facial branches by using subfascial dissection; 3) use a zygomatic osteotomy to avoid compressing the muscle, arteries, and nerves, and for greater exposure when retracting the muscle; 4) dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; 5) deinsert the muscle to the superior temporal line without cutting the fascia; and 6) reattach the muscle directly to the bone.
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Affiliation(s)
- Paulo A S Kadri
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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