Abstract
Surgical nerve transfers are used to efficiently treat peripheral nerve injuries, neuromas, phantom limb pain, or improve bionic prosthetic control. Commonly, one donor nerve is transferred to one target muscle. However, the transfer of multiple nerves onto a single target muscle may increase the number of muscle signals for myoelectric prosthetic control and facilitate the treatment of multiple neuromas. Currently, no experimental models are available. This study describes a novel experimental model to investigate the neurophysiological effects of peripheral double nerve transfers to a common target muscle. In 62 male Sprague-Dawley rats, the ulnar nerve of the antebrachium alone (n=30) or together with the anterior interosseus nerve (n=32) was transferred to reinnervate the long head of the biceps brachii. Before neurotization, the motor branch to the biceps' long head was transected at the motor entry point. Twelve weeks after surgery, muscle response to neurotomy, behavioral testing, retrograde labeling, and structural analyses were performed to assess reinnervation. These analyses indicated that all nerves successfully reinnervated the target muscle. No aberrant reinnervation was observed by the originally innervating nerve. Our observations suggest a minimal burden for the animal with no signs of functional deficit in daily activities or auto-mutilation in both procedures. Furthermore, standard neurophysiological analyses for nerve and muscle regeneration were applicable. This newly developed nerve transfer model allows for the reliable and standardized investigation of neural and functional changes following the transfer of multiple donor nerves to one target muscle.
Highlights
Nerve transfers offer a variety of therapeutic possibilities in modern extremity reconstruction, such as treating peripheral nerve injuries, neuromas, phantom limb pain, improving prosthetic control or restoring function following spinal cord injuries (Aszmann et al, 2015;Farina et al, 2017;Dumanian et al, 2019;Van Zyl et al, 2019)
We propose a surgical nerve transfer model to allow the transfer of multiple donor nerves to a single muscle head and we validate this model in the rat forelimb
Slow motion video sequence analysis by a blinded evaluator showed that twelve weeks following the SNT and double nerve transfer (DNT), all animals could consistently reach behind their ears and achieved a maximum score of 5 (Video 1)
Summary
Nerve transfers offer a variety of therapeutic possibilities in modern extremity reconstruction, such as treating peripheral nerve injuries, neuromas, phantom limb pain, improving prosthetic control or restoring function following spinal cord injuries (Aszmann et al, 2015;Farina et al, 2017;Dumanian et al, 2019;Van Zyl et al, 2019). Because of overall faster regeneration and better functional outcomes compared to nerve grafting, this surgical procedure has been able to improve the devastating effects of peripheral nerve and brachial plexus lesions, which have otherwise often led to long-term health impairment and subsequent socioeconomic costs (Mackinnon and Novak, 1999;Terzis and Papakonstantinou, 2000;Bergmeister et al, 2020) They are used in a procedure termed targeted muscle reinnervation (TMR) to improve myoelectric prosthetic control (Kuiken et al, 2009;Kapelner et al, 2016), treat neuromas or phantom limb pain (Mioton et al, 2020). This model allows for reliable analyses with all standard neurophysiological investigations of the motor unit for possible implementation of this concept to clinical application
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