Abstract
BackgroundSide-to-side neurorrhaphy may protect the denervated end organ and preserve the initial connection with proximal stump. We examined the effect of protective side-to-side anastomosis on nerve and end organ regeneration in proximal nerve injury model.MethodsThe left common peroneal nerve of 24 Sprague Dawley rats was proximally transected. In groups B and C, side-to-side neurorrhaphy was performed distally between the peroneal and tibial nerves without (group B) and with (group C) partial donor nerve axotomy inside the epineural window. Group A served as an unprotected control. After 26 weeks, the proximal transection was repaired with end-to-end neurorrhaphy on all animals. Regeneration was followed during 12 weeks with the walk track analysis. Morphometric studies and wet muscle mass calculations were conducted at the end of the follow-up period.ResultsThe results of the walk track analysis were significantly better in groups B and C compared to group A. Groups B and C showed significantly higher wet mass ratios of the tibialis anterior and extensor digitorum longus muscle compared to group A. Group C showed significantly higher morphometric values compared to group A. Group B reached higher values of the fibre count, fibre density, and percentage of the fibre area compared to group A.ConclusionsProtective distal side-to-side neurorrhaphy reduced muscle atrophy and had an improving effect on the morphometric studies and walk track analysis. Distal side-to-side neurorrhaphy does not prevent the regenerating axons to grow from the proximal stump to achieve distal nerve stump.
Highlights
The regenerative results have often been unsatisfactory in proximal nerve injuries
The success of proximal nerve repair depends both on the capacity of regenerating axons to arrive to distal stump [23] and the capacity of the distal nerve stump to support the neural regeneration before muscle atrophy occurs
The effect of early distal side-to-side anastomosis was studied in the proximal nerve injury model
Summary
The regenerative results have often been unsatisfactory in proximal nerve injuries. This has been considered a consequence of the degenerative changes of the nerve due to the delay of the growing axons to reach their end organs. Basal lamina tubes begin to degrade and will be substituted with connective tissue [25, 35]. Muscle atrophy proceeds because of lack of reinnervation. It has been presumed that timely reinnervation of the distal nerve and end organ could solve the problem. Side-to-side neurorrhaphy may protect the denervated end organ and preserve the initial connection with proximal stump. We examined the effect of protective side-to-side anastomosis on nerve and end organ regeneration in proximal nerve injury model
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