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Doherty C, Lodyga M, Correa J, Di Ciano-Oliveira C, Plant PJ, Bain JR, Batt J. Utilization of the Rat Tibial Nerve Transection Model to Evaluate Cellular and Molecular Mechanisms Underpinning Denervation-Mediated Muscle Injury. Int J Mol Sci 2024; 25:1847. [PMID: 38339124 PMCID: PMC10855399 DOI: 10.3390/ijms25031847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/19/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Peripheral nerve injury denervates muscle, resulting in muscle paralysis and atrophy. This is reversible if timely muscle reinnervation occurs. With delayed reinnervation, the muscle's reparative ability declines, and muscle-resident fibro-adipogenic progenitor cells (FAPs) proliferate and differentiate, inducing fibro-fatty muscle degradation and thereby physical disability. The mechanisms by which the peripheral nerve regulates FAPs expansion and differentiation are incompletely understood. Using the rat tibial neve transection model, we demonstrated an increased FAPs content and a changing FAPs phenotype, with an increased capacity for adipocyte and fibroblast differentiation, in gastrocnemius muscle post-denervation. The FAPs response was inhibited by immediate tibial nerve repair with muscle reinnervation via neuromuscular junctions (NMJs) and sensory organs (e.g., muscle spindles) or the sensory protection of muscle (where a pure sensory nerve is sutured to the distal tibial nerve stump) with reinnervation by muscle spindles alone. We found that both procedures reduced denervation-mediated increases in glial-cell-line-derived neurotrophic factor (GDNF) in muscle and that GDNF promoted FAPs adipogenic and fibrogenic differentiation in vitro. These results suggest that the peripheral nerve controls FAPs recruitment and differentiation via the modulation of muscle GDNF expression through NMJs and muscle spindles. GDNF can serve as a therapeutic target in the management of denervation-induced muscle injury.
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Affiliation(s)
- Christina Doherty
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
| | - Monika Lodyga
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
| | - Judy Correa
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
| | - Caterina Di Ciano-Oliveira
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
| | - Pamela J. Plant
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
| | - James R. Bain
- Division of Plastic Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L8, Canada;
| | - Jane Batt
- Keenan Research Center for Biomedical Science, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON M5B 1T8, Canada; (C.D.); (M.L.); (J.C.); (C.D.C.-O.); (P.J.P.)
- Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
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Daniel BW, Giesen T, Lu JCY, Chang TNJ, Zavala A, Chuang DCC. Supercharge End-to-Side Sensory Transfer to A Long Nerve Graft to Enhance Motor Regeneration in A Brachial Plexus Model—An Experimental Rat Study. J Reconstr Microsurg 2022. [DOI: 10.1055/s-0042-1758186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Abstract
Background Long nerve grafts will affect muscle recovery. Aim of this study is to investigate if supercharged end-to-side (SETS) sensory nerve transfer to long nerve graft can enhance functional outcomes in brachial plexus animal model.
Methods A reversed long nerve graft (20–23-mm) was interposed between C6 and musculocutaneous nerve (MCN) in 48 SD rats. The sensory nerves adjacent to the proximal and distal coaptation sites of the nerve graft were used for SETS. There were four groups with 12 rats in each: (A) nerve graft alone, (B) proximal SETS sensory transfer, (C) distal SETS sensory transfer, and (D) combined proximal and distal SETS sensory transfers. Grooming test at 4, 8, 12 and 16 weeks, and compound muscle action potentials (CMAP), biceps tetanic muscle contraction force, muscle weight and MCN axon histomorphologic analysis at 16 weeks were assessed.
Results Grooming test was significantly better in group C and D at 8 weeks (p = 0.02 and p = 0.04) and still superior at 16 weeks. There was no significant difference in CMAP, tetanic muscle contraction force, or muscle weight. The axon counts showed all experimental arms were significantly higher than the unoperated arms. Although the axon count was lowest in group C and highest in group D (p = 0.02), the nerve morphology tended to be better in group C overall.
Conclusion Distal sensory SETS transfer to a long nerve graft showed benefits of functional muscle recovery and better target nerve morphology. Proximal sensory inputs do not benefit the outcomes at all.
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Affiliation(s)
- Bassem W. Daniel
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taipei, Taiwan
- Freiburg University Medical Center, Freiburg, Germany
| | - Teun Giesen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
- Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
| | - Johnny Chuieng-Yi Lu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
| | - Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taipei, Taiwan
| | - David Chwei-Chin Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Horen SR, Hamidian Jahromi A, Konofaos P. Direct Neurotization: Past, Present, and Future Considerations. Ann Plast Surg 2022; 88:308-312. [PMID: 34611091 DOI: 10.1097/sap.0000000000003006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Direct neurotization is a method that involves direct implantation of nerve fascicles into a target tissue, that is, muscle fibers, skin, cornea, and so on, with the goal of restoring aesthetic, sensation and or functional capacity. This technique has been implemented since the early 1900s, with numerous experimental and clinical reports of success. Applications have included both sensory and motor neurotization of muscle, as well as protective sensory provision for other organs. These techniques have been used to restore corneal sensation, repair brachial plexus injuries, reestablish tongue movement and function through direct tongue neurotization, and reinnervate multiple facial muscles in patients with facial paralysis. Most recently, these methods have even been used in conjunction with acellular cadaveric nerve grafts to directly neurotize skin. Indications for direct neurotization remain limited, including those in which neural coaptation is not feasible (ie, surgical or traumatic damage to neuromuscular junction, severe avulsion injuries of the distal nerve); however, the success and wide-range application of direct neurotization shows its potential to be implemented as an adjunct treatment in contrast to views that it should solely be used as a salvage therapy. The purpose of the following review is to detail the historic and current applications of direct neurotization and describe the future areas of investigation and development of this technique.
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Affiliation(s)
- Sydney R Horen
- From the Division of Plastic & Reconstructive Surgery, Rush University Medical Center (RUMC), Chicago, IL
| | - Alireza Hamidian Jahromi
- From the Division of Plastic & Reconstructive Surgery, Rush University Medical Center (RUMC), Chicago, IL
| | - Petros Konofaos
- Department of Plastic Surgery, University of Tennessee Health Science Center (UTHSC), Memphis, TN
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5
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Lu JY, Chang TJ, Hsieh WC, Hsiao JC, Daniel B, Chuang DC. Can sensory protection improve the functional outcome in delay repaired rat brachial plexus injury? Formos J Surg 2022. [DOI: 10.4103/fjs.fjs_233_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang H, Zhi J, Ning B, Zhang S. Research progress on limb spasmolysis, orthopedics and functional reconstruction of brain-derived paralysis. Journal of Neurorestoratology 2021. [DOI: 10.26599/jnr.2021.9040019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Brain-derived paralysis is a disease dominated by limb paralysis caused by various brain diseases. The damage of upper motor neurons can lead to spastic paralysis of the limbs in different parts. If it cannot be treated in time and effectively, it will severely affect the motor function and ability of daily living. Treating limb spastic dysfunction in patients with brain-derived paralysis is a global problem. Presently, there are many alternative surgical methods. This article mainly reviews the treatment of limb spastic dysfunction with brain-derived paralysis, focusing on three aspects: limb spasmolysis, orthopedics, and functional reconstruction. Among them, the transposition of the peripheral nerve helps limb function with spastic paralysis and can effectively alleviate limb spasticity.
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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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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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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Chang H, Hwang S, Lim S, Eo S, Minn KW, Hong KY. Long-term Fate of Denervated Skeletal Muscle After Microvascular Flap Transfer. Ann Plast Surg 2018; 80:644-7. [DOI: 10.1097/sap.0000000000001397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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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. Eur J Plast Surg 2018. [DOI: 10.1007/s00238-017-1313-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gesslbauer B, Furtmüller GJ, Schuhfried O, Roche AD, Sporer M, Aszmann OC. Nerve grafts bridging the thenar branch of the median nerve to the ulnar nerve to enhance nerve recovery: a report of three cases. J Hand Surg Eur Vol 2017; 42:281-285. [PMID: 27803377 DOI: 10.1177/1753193416675069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We report a nerve graft procedure bridging the thenar branch of the median nerve to the ulnar nerve in three patients with ulnar nerve transection and defect at the mid-forearm. Ulnar nerve function was evaluated with electroneurography and quantitative sensory-motor testing before and after surgery, and at a 6-year follow-up. After surgery all patients showed electroneurographic evidence of median nerve innervation of the intrinsic muscles normally innervated by the ulnar nerve. The average strength was Grade 4 in the intrinsic muscles originally supplied by the ulnar nerve at the final follow-up. Our results indicate that the thenar branch of the median nerve may support ulnar nerve regeneration and so help prevent intrinsic muscles from irreversible atrophy, but our report is preliminary. This procedure should be validated by future clinical data, especially those with complete ulnar nerve transection at or above the elbow. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B Gesslbauer
- 1 Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - G J Furtmüller
- 3 Vascularized Composite Allotransplantation Laboratory, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Schuhfried
- 4 Department of Physical Medicine and Rehabilitation, Medical University of Vienna, Vienna, Austria
| | - A D Roche
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - M Sporer
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
| | - O C Aszmann
- 1 Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
- 2 Christian Doppler Laboratory for Restoration of Extremity Function, Medical University of Vienna, Vienna, Austria
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jaeger MRDO, Silva JLB, Bain J, Ely PB, Pires JA, Ferreira LM. A gastrocnemius heterotopical transplant model with end-to-side neurorraphy. Acta Cir Bras 2014; 29 Suppl 2:50-4. [PMID: 25229515 DOI: 10.1590/s0102-8650201400140010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To present an animal model to assess the effects of end-to-side innervation in the heterotopically transplanted model with reduced chances of neural contamination. METHODS The medial portion of the gastrocnemius muscle in wistar male rats was isolated and its pedicle dissected and performed a flap in the abdominal portion. To prevent neural contamination in the abdominal region, the muscle was wrapped with a Goretex(r) sheet. The specimens were divided into 2 groups (G). In G1 was performed an end-to-end suture between tibial nerve of the gastrocnemius and femoral motor nerve and between the saphenous sensory nerve and the motor nerve. In G2 was performed a end-to-side suture between the tibial nerve and the motor femoral and between the tibial nerve and saphenous motor nerve. The specimens were evaluated 60 days later to check the structure of the neurorraphy. Sections were obtained proximal and distal to the coaptation site. RESULTS The medial gastrocnemius muscle had the advantage of maintaining visible mass after 60 days. No disruption of the coaptation site was found. No major injury to the donor nerve was seen in group 2. CONCLUSION The proposed model is simple, reproduciple and prevent the neural contamination in the flap in end-to-side suture.
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Beck-Broichsitter BE, Becker ST, Lamia A, Fregnan F, Geuna S, Sinis N. Sensoric protection after median nerve injury: babysitter-procedure prevents muscular atrophy and improves neuronal recovery. Biomed Res Int 2014; 2014:724197. [PMID: 25133176 DOI: 10.1155/2014/724197] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/05/2014] [Accepted: 06/10/2014] [Indexed: 11/17/2022]
Abstract
The babysitter-procedure might offer an alternative when nerve reconstruction is delayed in order to overcome muscular atrophy due to denervation. In this study we aimed to show that a sensomotoric babysitter-procedure after median nerve injury is capable of preserving irreversible muscular atrophy. The median nerve of 20 female Wistar rats was denervated. 10 animals received a sensory protection with the N. cutaneous brachii. After six weeks the median nerve was reconstructed by autologous nerve grafting from the contralateral median nerve in the babysitter and the control groups. Grasping tests measured functional recovery over 15 weeks. At the end of the observation period the weight of the flexor digitorum sublimis muscle was determined. The median nerve was excised for histological examinations. Muscle weight (P < 0.0001) was significantly superior in the babysitter group compared to the control group at the end of the study. The histological evaluation revealed a significantly higher diameter of axons (P = 0.0194), nerve fiber (P = 0.0409), and nerve surface (P = 0.0184) in the babysitter group. We conclude that sensory protection of a motor nerve is capable of preserving muscule weight and we may presume that metabolism of the sensory nerve was sufficient to keep the target muscle's weight and vitality.
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Heaton JT, Sheu SH, Hohman MH, Knox CJ, Weinberg JS, Kleiss IJ, Hadlock TA. Rat whisker movement after facial nerve lesion: evidence for autonomic contraction of skeletal muscle. Neuroscience 2014; 265:9-20. [PMID: 24480367 DOI: 10.1016/j.neuroscience.2014.01.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/03/2014] [Accepted: 01/19/2014] [Indexed: 11/25/2022]
Abstract
Vibrissal whisking is often employed to track facial nerve regeneration in rats; however, we have observed similar degrees of whisking recovery after facial nerve transection with or without repair. We hypothesized that the source of non-facial nerve-mediated whisker movement after chronic denervation was from autonomic, cholinergic axons traveling within the infraorbital branch of the trigeminal nerve (ION). Rats underwent unilateral facial nerve transection with repair (N=7) or resection without repair (N=11). Post-operative whisking amplitude was measured weekly across 10weeks, and during intraoperative stimulation of the ION and facial nerves at ⩾18weeks. Whisking was also measured after subsequent ION transection (N=6) or pharmacologic blocking of the autonomic ganglia using hexamethonium (N=3), and after snout cooling intended to elicit a vasodilation reflex (N=3). Whisking recovered more quickly and with greater amplitude in rats that underwent facial nerve repair compared to resection (P<0.05), but individual rats overlapped in whisking amplitude across both groups. In the resected rats, non-facial-nerve-mediated whisking was elicited by electrical stimulation of the ION, temporarily diminished following hexamethonium injection, abolished by transection of the ION, and rapidly and significantly (P<0.05) increased by snout cooling. Moreover, fibrillation-related whisker movements decreased in all rats during the initial recovery period (indicative of reinnervation), but re-appeared in the resected rats after undergoing ION transection (indicative of motor denervation). Cholinergic, parasympathetic axons traveling within the ION innervate whisker pad vasculature, and immunohistochemistry for vasoactive intestinal peptide revealed these axons branching extensively over whisker pad muscles and contacting neuromuscular junctions after facial nerve resection. This study provides the first behavioral and anatomical evidence of spontaneous autonomic innervation of skeletal muscle after motor nerve lesion, which not only has implications for interpreting facial nerve reinnervation results, but also calls into question whether autonomic-mediated innervation of striated muscle occurs naturally in other forms of neuropathy.
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Affiliation(s)
- James T Heaton
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, United States.
| | - Shu Hsien Sheu
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02114, United States
| | - Marc H Hohman
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Christopher J Knox
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Julie S Weinberg
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
| | - Ingrid J Kleiss
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States; Department of Otorhinolaryngology and Head & Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tessa A Hadlock
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States
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Jaeger MR, Braga-Silva J, Gehlen D, Pereira-Filho Gde A, Zettler CG, de Souza MA, Veas JR, Sebben A. End-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation. Ann Plast Surg 2011; 67:391-6. [PMID: 21587041 DOI: 10.1097/SAP.0b013e3182126816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study was to experimentally compare end-to-end and end-to-side neurorrhaphy in perineural window model after motor nerve lesion, evaluating which one was the most effective to preserve nerves. Also, differences in motor and sensorial nerve regeneration were tested to verify differences in nerve regeneration. METHODS A total of 20 adult male Wistar rats were randomly assigned to 5 groups, and, in each one, a different treatment was performed: besides the control group, and end-to-end or end-to-side graft with motor or sensorial nerves was performed. Silastic sheet was used as a mechanical barrier to prevent innervation from adjacent nerves. After 16 weeks, the specimens were histologically assessed and wet weight was evaluated as a direct parameter of atrophy. RESULTS The end-to-end neurorrhaphy group presented the best results in terms of mass preservation, but it did not differ significantly from the control group. Motor nerves presented similar results in muscular atrophy. The end-to-side neurorrhaphy group with sensory nerve as donor showed the worst results. CONCLUSIONS The use of sensory nerves to preserve skeletal muscle trophism is not justified, since, according to our model, it affects 50% to 80% of the muscle mass in a period of 16 weeks. End-to-side neurorrhaphy was demonstrated to be an option for re-enervation of a nerve-deprived motor muscle in selected cases.
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Zhang S, Ji F, Tong D, Li M. Side-to-side neurorrhaphy for high-level peripheral nerve injuries. Acta Neurochir (Wien) 2012; 154:527-32. [PMID: 22231778 DOI: 10.1007/s00701-011-1264-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/21/2011] [Indexed: 01/14/2023]
Abstract
Background The results of peripheral nerve repair, especially for high-level peripheral nerve injuries, have been unsatisfactory. The method of side-to-side neurorrhaphy was developed in our laboratory from 1994 to 2002. This method involves suturing the injured nerve to a nearby donor nerve in a side-to-side manner. This study was performed to assess the clinical results of side-to-side neurorrhaphy in patients with high-level peripheral nerve injuries. Methods Twenty-five patients with various types of high-level peripheral nerve injuries who underwent side-to-side neurorrhaphy were studied. The British Medical Research Council (BMRC) scale was used to assess recovery of nerve function. Results Average follow-up duration was 3.2 years. Before surgery the patients had a nerve function of M0/S0 to M1/S1. After side-to-side neurorrhaphy, 7 patients had a score of M3/S4, 8 patients a score of M3/S3 and 10 patients a score of M2/S3. The total useful recovery rate (BMRC grade ≥3) was 60% for motor function and 100% for sensory function. Side-to-side neurorrhaphy did not result in any significant loss of donor nerve function. There was significant correlation between both the type of injury and the time interval between injury and surgery and motor nerve function. Age, gender and location of the injured nerve did not correlate with sensory or motor nerve function. Conclusion Side-to-side neurorrhaphy appears to be promising as a feasible method for repair of high-level peripheral nerve injuries.
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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Elsohemy A, Butler R, Bain JR, Fahnestock M. Sensory protection of rat muscle spindles following peripheral nerve injury and reinnervation. Plast Reconstr Surg 2009; 124:1860-8. [PMID: 19952642 DOI: 10.1097/PRS.0b013e3181bcee47] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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
Denervation as a consequence of nerve injury causes profound structural and functional changes within skeletal muscle and can lead to a marked impairment in function of the affected limb. Prompt reinnervation of a muscle with a sufficient number of motion-specific motor axons generally results in good structural and functional recovery, whereas long-term denervation or insufficient or improper axonal recruitment uniformly results in poor functional recovery. Only nerve transfer has been highly efficacious in changing the clinical outcomes of patients with skeletal muscle denervation, especially in the case of proximal limb nerve injuries. Rapid reinnervation with an abundant number of motor axons remains the only clinically effective means to restore function to denervated skeletal muscles.
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Affiliation(s)
- Samuel C Lien
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, 2130 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0340, USA
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Zhao C, Veltri K, Li S, Bain JR, Fahnestock M. NGF, BDNF, NT-3, and GDNF mRNA expression in rat skeletal muscle following denervation and sensory protection. J Neurotrauma 2005; 21:1468-78. [PMID: 15672636 DOI: 10.1089/neu.2004.21.1468] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Poor muscle and nerve functional recovery after nerve damage is a serious clinical problem, particularly if there is prolonged delay before nerve-muscle contact is reestablished. Our previous studies showed that sensory nerve cross-anastomosis (sensory protection) provides support to the denervated muscle. In the present study, we analyzed neurotrophic factor mRNA expression by RT-PCR in denervated rat gastrocnemius muscle receiving sensory protection with the saphenous nerve, compared to normal innervated muscle, to denervated muscle, and to denervated muscle repaired immediately with the peroneal (motor) nerve, after periods of 3 days to 3 months. No significant differences in mRNA levels of beta-actin, nerve growth factor, brain-derived neurotrophic factor or neurotrophin-3 were found between the sensory protection treatment and the denervated or the motor repair groups. However, sensory protection resulted in levels of muscle glial cell line-derived neurotrophic factor mRNA expression that were lower than in denervated muscle and higher than in muscle given immediate motor repair. These results demonstrate that glial cell line-derived neurotrophic factor mRNA is elevated following denervation but is partially down-regulated by sensory protection. Our study suggests that sensory protection provides a modified trophic environment by modulating neurotrophic factor synthesis in muscle.
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Affiliation(s)
- Chunnian Zhao
- Department of Psychiatry, McMaster University, Ontario, Canada
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