1
|
Bueno CRDS, Buchaim DV, Barraviera B, Ferreira RS, Santos PSDS, Reis CHB, Cini MA, Kuga MC, Rosa GM, Buchaim RL. Delayed repair of the facial nerve and its negative impacts on nerve and muscle regeneration. J Venom Anim Toxins Incl Trop Dis 2024; 30:e20230093. [PMID: 38808073 PMCID: PMC11132725 DOI: 10.1590/1678-9199-jvatitd-2023-0093] [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: 11/24/2023] [Accepted: 04/12/2024] [Indexed: 05/30/2024] Open
Abstract
Background In this experimental protocol, we evaluated the immediate and delayed repair of the buccal branch of the facial nerve (BBFN) with heterologous fibrin biopolymer (HFB) as a coaptation medium and the use of photobiomodulation (PBM), performing functional and histomorphometric analysis of the BBFN and perioral muscles. Methods Twenty-eight rats were divided into eight groups using the BBFN bilaterally (the left nerve was used for PBM), namely: G1 - control group, right BBFN (without injury); G2 - control group, left BBFN (without injury + PBM); G3 - Denervated right BBFN (neurotmesis); G4 - Denervated left BBFN (neurotmesis + PBM); G5 - Immediate repair of right BBFN (neurotmesis + HFB); G6 - Immediate repair of left BBFN (neurotmesis + HFB + PBM); G7 - Delayed repair of right BBFN (neurotmesis + HFB); G8 - Delayed repair of left BBFN (neurotmesis + HFB + PBM). Delayed repair occurred after two weeks of denervation. All animals were sacrificed after six weeks postoperatively. Results In the parameters of the BBFN, we observed inferior results in the groups with delayed repair, in relation to the groups with immediate repair, with a significant difference (p < 0.05) in the diameter of the nerve fiber, the axon, and the thickness of the myelin sheath of the group with immediate repair with PBM compared to the other experimental groups. In measuring the muscle fiber area, groups G7 (826.4 ± 69.90) and G8 (836.7 ± 96.44) were similar to G5 (882.8 ± 70.51). In the functional analysis, the G7 (4.10 ± 0.07) and G8 (4.12 ± 0.08) groups presented normal parameters. Conclusion We demonstrated that delayed repair of BBFN is possible with HFB, but with worse results compared to immediate repair, and that PBM has a positive influence on nerve regeneration results in immediate repair.
Collapse
Affiliation(s)
- Cleuber Rodrigo de Souza Bueno
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Dentistry School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
- Medical School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
| | - Daniela Vieira Buchaim
- Medical School, University Center of Adamantina (UNIFAI),
Adamantina, SP, Brazil
- Graduate Program in Structural and Functional Interactions in
Rehabilitation, University of Marilia (UNIMAR), Marília, SP, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of
Veterinary Medicine and Animal Science (FMVZ), University of São Paulo (USP), São
Paulo, SP, Brazil
| | - Benedito Barraviera
- Center for the Study of Venoms and Venomous Animals (CEVAP), São
Paulo State University (UNESP), Botucatu, SP, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School
(FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Rui Seabra Ferreira
- Center for the Study of Venoms and Venomous Animals (CEVAP), São
Paulo State University (UNESP), Botucatu, SP, Brazil
- Graduate Program in Tropical Diseases, Botucatu Medical School
(FMB), São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Paulo Sérgio da Silva Santos
- Department of Surgery, Stomatology, Pathology and Radiology, Bauru
School of Dentistry (FOB), University of São Paulo (USP), Bauru, SP, Brazil
| | - Carlos Henrique Bertoni Reis
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Graduate Program in Structural and Functional Interactions in
Rehabilitation, University of Marilia (UNIMAR), Marília, SP, Brazil
- UNIMAR Beneficent Hospital (HBU), University of Marilia (UNIMAR),
Marília, SP, Brazil
| | | | - Milton Carlos Kuga
- Department of Restorative Dentistry, School of Dentistry, São Paulo
State University (UNESP), Araraquara, SP, Brazil
| | - Geraldo Marco Rosa
- Dentistry School, Faculty of the Midwest Paulista (FACOP),
Piratininga, SP, Brazil
| | - Rogerio Leone Buchaim
- Department of Biological Sciences, Bauru School of Dentistry (FOB),
University of São Paulo (USP), Bauru, SP, Brazil
- Graduate Program in Anatomy of Domestic and Wild Animals, Faculty of
Veterinary Medicine and Animal Science (FMVZ), University of São Paulo (USP), São
Paulo, SP, Brazil
| |
Collapse
|
2
|
McMorrow LA, Czarnecki P, Reid AJ, Tos P. Current perspectives on peripheral nerve repair and management of the nerve gap. J Hand Surg Eur Vol 2024:17531934241242002. [PMID: 38603601 DOI: 10.1177/17531934241242002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
From the first surgical repair of a nerve in the 6th century, progress in the field of peripheral nerve surgery has marched on; at first slowly but today at great pace. Whether performing primary neurorrhaphy or managing multiple large nerve defects, the modern nerve surgeon has an extensive range of tools, techniques and choices available to them. Continuous innovation in surgical equipment and technique has enabled the maturation of autografting as a gold standard for reconstruction and welcomed the era of nerve transfer techniques all while bioengineers have continued to add to our armamentarium with implantable devices, such as conduits and acellular allografts. We provide the reader a concise and up-to-date summary of the techniques available to them, and the evidence base for their use when managing nerve transection including current use and applicability of nerve transfer procedures.
Collapse
Affiliation(s)
- Liam A McMorrow
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Piotr Czarnecki
- Department of Traumatology, Orthopaedics and Hand Surgery, Poznań University of Medical Sciences, Poznań, Poland
| | - Adam J Reid
- Blond McIndoe Laboratories, Division of Cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Department of Plastic Surgery & Burns, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Pierluigi Tos
- Azienda Socio Sanitaria Territoriale Gaetano Pini, Milan, Italy
| |
Collapse
|
3
|
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: 6] [Impact Index Per Article: 6.0] [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
|
4
|
Haldane C, Frost G, Ogalo E, Bristol S, Doherty C, Berger M. A systematic review and meta-analysis of patient-reported outcomes following nerve transfer surgery for brachial plexus injury. PM R 2022; 14:1368-1381. [PMID: 35100499 DOI: 10.1002/pmrj.12778] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The purpose of this systematic review and meta-analysis was to determine the effect of nerve transfer surgery for brachial plexus injury (BPI) on patient-reported outcomes. LITERATURE SURVEY MEDLINE, EMBASE, and CINAHL were searched and screened in duplicate for relevant studies on September 25, 2019 and repeated June 24, 2020. METHODOLOGY The patient population included male and female patients who received nerve transfer surgery for BPI. Further inclusion criteria were: (1) all levels of evidence; (2) published in English; (3) conducted in humans; and (4) report of patient-reported outcome. Two reviewers independently abstracted data regarding injury type, surgical technique, surgical timing, follow-up duration, strength, and patient-reported outcome measures. Quality was assessed in duplicate using the Methodological Index for Non-Randomized Studies criteria. SYNTHESIS Twenty-one studies involving 464 participants were included in analyses. The mean age ± SD was 32.4 ± 1.8 (range: 5-77) and 89.2% of included participants were male. The mean time to surgery was 5.6 ± 0.6 months and the mean follow-up time was 48.1 ± 8.4 months. The most used patient-reported outcome was the Disabilities of Arm, Shoulder and Hand (DASH), where scores variably improved postoperatively, although the degree of disability remained high. Return to work was reported in five studies, with 66.0% of participants returning to work. Patient satisfaction was assessed in four studies with an overall satisfaction proportion of 64.0%. Pain was assessed in 12 studies using various measures. In studies reporting pain intensity postoperatively, 29.3% of patients were "pain-free" or had "no pain." CONCLUSIONS Patient-reported outcomes following nerve transfer for BPI are infrequently reported in the literature. Although patient-reported outcomes demonstrate variable postoperative improvement, there is evidence of ongoing limitations and postoperative DASH scores report a high degree of ongoing disability. Future studies with greater reporting as well as validation of patient-reported outcomes within BPI are warranted.
Collapse
Affiliation(s)
- Chloe Haldane
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey Frost
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emmanuel Ogalo
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sean Bristol
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Doherty
- Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Berger
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
5
|
Abstract
Many surgical techniques are available for the repair of peripheral nerve defects. Autologous nerve grafts are the gold standard for most clinical conditions. In selected cases, alternative types of reconstructions are performed to fill the nerve gap. Non-nervous autologous tissue-based conduits or synthetic ones are alternatives to nerve autografts. Allografts represent another new field of interest. Decision making in the treatment of nerve defects is based on timing of referral, level of the injury, type of lesion, and size of any gap. This review focuses on current clinical practice, influenced by the numerous new experimental researches.
Collapse
Affiliation(s)
- Bruno Battiston
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy.
| | - Paolo Titolo
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
| | - Davide Ciclamini
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
| | - Bernardino Panero
- U.O.C Orthopaedics, Traumatology and Hand Surgery, U.O.D. Microsurgery, C.T.O. Hospital, Via Zuretti 29, Turin 10126, Italy
| |
Collapse
|
6
|
Comparison of Peripheral Nerve Regeneration with Side-to-side, End-to-side, and End-to-end Repairs: An Experimental Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1179. [PMID: 28293523 PMCID: PMC5222668 DOI: 10.1097/gox.0000000000001179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/25/2016] [Indexed: 11/26/2022]
Abstract
Background: The present study was conducted to find out a tool to enable improved functional recovery with proximal nerve injury. In this experimental study, nerve regeneration was compared between side-to-side (STS), end-to-side (ETS), and end-to-end repairs. Methods: The walk track analysis was used as an outcome of functional recovery. Nerve regeneration was studied with morphometry and histology 6 or 26 weeks postoperatively. Results: All 3 repair techniques showed regeneration of the nerve. From 12 weeks onward, the functional results of the 3 intervention groups were significantly better compared with the unrepaired control group. End-to-end repair was significantly better when compared with the STS and ETS groups. At 26 weeks, the functional and morphometric results and histologic findings did not differ between the STS and ETS groups. The functional results correlated with the morphometric findings in all groups. Conclusions: STS neurorrhaphy showed nerve regeneration, and the end results did not differ from clinically widely used ETS repair. Further studies are warranted to optimize the neurorrhaphy technique and examine possible applications of STS repair in peripheral nerve surgery.
Collapse
|
7
|
Schenck TL, Stewart J, Lin S, Aichler M, Machens HG, Giunta RE. Anatomical and histomorphometric observations on the transfer of the anterior interosseous nerve to the deep branch of the ulnar nerve. J Hand Surg Eur Vol 2015; 40:591-6. [PMID: 25261412 DOI: 10.1177/1753193414551909] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study focuses on the anatomical and histomorphometric features of the transfer of the anterior interosseous nerve to the deep motor branch of the ulnar nerve. The transfer was carried out in 15 cadaver specimens and is described using relevant anatomical landmarks. Nerve samples of donor and target nerves were histomorphometrically analysed and compared. The superficial and the deep ulnar branches had to be separated from each other for a length of 67 mm (SD 12; range 50-85) to reach the site of coaptation. We identified a suitable site for coaptation lying proximal to the pronator quadratus muscle, 202 mm (SD 15; range 185-230) distal to the medial epicondyle of the humerus. The features of the anterior interosseous nerve included a smaller nerve diameter, smaller cross-sectional area of fascicles, fewer fascicles and axons, but a similar axon density. The histomorphometric inferiority of the anterior interosseous nerve raises a question about whether it should be transferred only to selected parts of the deep motor branch of the ulnar nerve.Level III.
Collapse
Affiliation(s)
- T L Schenck
- Department of Plastic Surgery and Hand Surgery, University Hospital rechts der Isar, Technical University Munich, Germany
| | - J Stewart
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
| | - S Lin
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
| | - M Aichler
- Research Unit Analytical Pathology, Helmholtzzentrum München, German Research Center for Environmental Health, Munich, Germany
| | - H-G Machens
- Department of Plastic Surgery and Hand Surgery, University Hospital rechts der Isar, Technical University Munich, Germany
| | - R E Giunta
- Hand Surgery, Plastic Surgery and Aesthetic Surgery, Ludwig Maximilians University Munich, Germany
| |
Collapse
|
8
|
Gao W, Liu Q, Li S, Zhang J, Li Y. End-to-side neurorrhaphy for nerve repair and function rehabilitation. J Surg Res 2015; 197:427-35. [PMID: 25979558 DOI: 10.1016/j.jss.2015.03.100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 03/13/2015] [Accepted: 03/31/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND End-to-side neurorrhaphy is a promising procedure for nerve repair in peripheral nerve injury. However, in previous studies, this technique was limited to somatic nerves. The present study was designed to investigate the feasibility of nerve regeneration after end-to-side neurorrhaphy between autonomic nerve and somatic nerve. MATERIALS AND METHODS Thirty adult male Sprague-Dawley rats were randomly divided into the following three groups (n = 10 per group) for different treatments: (1) end-to-side neurorrhaphy group, the left L6 and S1 spinal nerves were transected in the dura, and the distal stump of L6 ventral root (L6VR) was sutured to the lateral face of L4 ventral root (L4VR) through end-to-side coaptation; (2) no repair group, the rats received the same operation as the end-to-side neurorrhaphy group but without coaptation; (3) control group, the rats received the same operation as the end-to-side neurorrhaphy group but the L6VR was preserved. After 4 month, the origin and mechanism of nerve regeneration were evaluated by retrograde nerve tracing. Morphologic and functional properties of the regenerated nerve were investigated by morphologic examination and intravesical pressure measurement. RESULTS Retrograde nerve tracing indicated that the new neural reflex pathway was successfully established, and the main regeneration mechanism was axon collateral sprouting. Morphologic examination and intravesical pressure measurement indicated prominent axonal regeneration and good bladder functional rehabilitation in the neurorrhaphy group. Wet weight and morphology of left extensor digitorum longus muscles appeared no detrimental effect on the donor nerve. CONCLUSIONS These results indicated that the somatic motor axons growth into autonomic nerve may be achieved through axon collateral sprouting for nerve repair and function rehabilitation after end-to-side neurorrhaphy of autonomic nerve and somatic nerve without apparent impairment of the donor somatic nerve.
Collapse
Affiliation(s)
- Wansheng Gao
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Qin Liu
- Department of Medical Affairs, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Songchao Li
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianwei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yansheng Li
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Clinical applications of end-to-side neurorrhaphy: an update. BIOMED RESEARCH INTERNATIONAL 2014; 2014:646128. [PMID: 25136607 PMCID: PMC4127263 DOI: 10.1155/2014/646128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/14/2014] [Accepted: 07/07/2014] [Indexed: 01/16/2023]
Abstract
End-to-side neurorrhaphy constitutes an interesting option to regain nerve function after damage in selected cases, in which conventional techniques are not feasible. In the last twenty years, many experimental and clinical studies have been conducted in order to understand the biological mechanisms and to test the effectiveness of this technique, with contrasting results. In this updated review, we consider the state of the art about end-to-side coaptation, focusing on all the current clinical applications, such as sensory and mixed nerve repair, treatment of facial palsy, and brachial plexus injuries and painful neuromas management.
Collapse
|
11
|
Gao WS, Dong CJ, Li SQ, Kunwar KJ, Li B. Re-innervation of the bladder through end-to-side neurorrhaphy of autonomic nerve and somatic nerve in rats. J Neurotrauma 2012; 29:1704-13. [PMID: 22332710 DOI: 10.1089/neu.2011.2255] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
End-to-side neurorrhaphy is widely used in the peripheral nervous system for nerve repair; however, the application of this technique has been limited to somatic nerves. The feasibility of nerve regeneration through end-to-side neurorrhaphy between autonomic and somatic nerves with different characteristics in the peripheral nervous system is still undetermined. In this study, rats were divided into three groups for different treatments (n=10 per group). In the end-to-side neurorrhaphy group, left L6 and S1 were transected in the dura, and the distal stump of L6 ventral root was sutured to the lateral face of L4 ventral root through end-to-side coaptation. In the no repair group, the rats did not undergo neurorrhaphy. In the control group, the left L6 dorsal root and S1 roots were transected, respectively, but the L6 ventral root was kept intact. After 16 weeks, the origin and mechanism of nerve regeneration was evaluated by retrograde double labeling technique as well as histological examination and intravesical pressure measurement. Retrograde double labeling indicated that the reconstructed reflex pathway was successfully established and the primary regeneration mechanism involved axon collateral sprouting. Morphological examination and intravesical pressure measurement indicated prominent nerve regeneration and successful re-innervation of the bladder in the neurorrhaphy group, compared with the "no repair" group (p<0.05). No significant changes were observed in the histology of the donor nerve and the bilateral extensor digitorum longus muscles in the neurorrhaphy group. Nerve regeneration may be achievable for nerve repair through end-to-side neurorrhaphy between autonomic and somatic nerves without apparent impairment of donor somatic nerve.
Collapse
Affiliation(s)
- Wan-Sheng Gao
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | | | | | | | | |
Collapse
|
12
|
Pabari A, Yang SY, Seifalian AM, Mosahebi A. Modern surgical management of peripheral nerve gap. J Plast Reconstr Aesthet Surg 2010; 63:1941-8. [PMID: 20061198 DOI: 10.1016/j.bjps.2009.12.010] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/08/2009] [Accepted: 12/12/2009] [Indexed: 11/30/2022]
Abstract
The management of peripheral nerve injury requires a thorough understanding of the complex physiology of nerve regeneration. The ability to perform surgery under magnification has improved our understanding of the anatomy of the peripheral nerves. However, the level of functional improvement that can be expected following peripheral nerve injury has plateaued. Advancements in the field of tissue engineering have led to an exciting complement of commercially available products that can be used to bridge peripheral nerve gaps. However, the quest for enhanced options is ongoing. This article provides a review of the current treatment options available following peripheral nerve injury, a summary of the published studies using commercially available nerve conduits and nerve allografts in humans and the emerging hopes for the next generation of nerve conduits with the advancement of nanotechnology.
Collapse
Affiliation(s)
- Amit Pabari
- Department of Plastic Surgery, Royal Free Hampstead NHS Trust Hospital, and Centre for Nanotechnology, Biomaterials & Tissue Engineering, Division of Surgical and Interventional Sciences, University College London, London, UK
| | | | | | | |
Collapse
|
13
|
Tos P, Artiaco S, Papalia I, Marcoccio I, Geuna S, Battiston B. Chapter 14 End‐to‐Side Nerve Regeneration. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2009; 87:281-94. [DOI: 10.1016/s0074-7742(09)87014-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|