End-to-Side Neurorrhaphy with Removal of the Epineurial Sheath

Abstract

Terminolateral neurorrhaphies were used up to the beginning of this century. After that, they were no longer reported. We tested the efficacy of a new type of end-to-side neurorrhaphy. A group of 20 rats had the peroneal nerve sectioned, and the distal ending was sutured to the lateral face of the tibial nerve after removing a small epineural window. All experiments were made on the right side, the left one remaining untouched in half the animals of each group. The other half was denervated by sectioning and inverting the endings of the peroneal nerves. In this way, tibial cranial muscles were either normal or denervated on the left side and reinnervated through end-to-side neurorrhaphies on the right side. After 7.8 months, the animals were subjected to electrophysiologic tests, sacrificed, and the nerves and muscles were taken for histologic examination. A response of the tibial cranial muscle was obtained in 90 percent of the animals. The distal ending of the peroneal nerve showed an average of 861 nerve fibers. The average areas of the reinnervated tibial cranial muscles were (microns 2) 1617.81 for M2n (when the contralateral side was normal) and 1579.19 for M2d (when the contralateral was denervated). We conclude that the terminolateral neurorrhaphy is functional, conducting electrical stimuli and allowing the passage of axons from the lateral surface of a healthy nerve, to reconstitute the distal segment of a sectioned nerve. The absence of an incision on the axons of the donor nerve was no impediment to axonal regeneration or to the passage of electrical stimuli. The results demonstrate the possibility of using end-to-side and terminolateral neurorrhaphies for reconstituting neural lesions when only a distal end is available; the reinnervation can be obtained from the lateral face of a healthy nerve.