Abstract
IntroductionMotor endplate reinnervation is critical for restoring motor function of the denervated muscle. We developed a novel surgical technique called nerve‐muscle‐endplate band grafting (NMEG) for muscle reinnervation.MethodsExperimentally denervated sternomastoid muscle in the rat was reinnervated by transferring a NMEG from the ipsilateral sternohyoid muscle to the native motor zone (NMZ) of the target muscle. A NMEG pedicle contained a block of muscle (~ 6 × 6 × 3 mm), a nerve branch with axon terminals, and a motor endplate band with numerous neuromuscular junctions. At 3 months after surgery, maximal tetanic muscle force measurement, muscle mass and myofiber morphology, motoneurons, regenerated axons, and axon‐endplate connections of the muscles were analyzed.ResultsThe mean force of the reinnervated muscles was 82% of the contralateral controls. The average weight of the treated muscles was 89% of the controls. The reinnervated muscles exhibited extensive axonal regeneration. Specifically, the mean count of the regenerated axons in the reinnervated muscles reached up to 76.8% of the controls. The majority (80%) of the denervated endplates in the target muscle regained motor innervation.ConclusionsThe NMZ of the denervated muscle is an ideal site for NMEG implantation and for the development of new microsurgical and therapeutic strategies to achieve sufficient axonal regeneration, rapid endplate reinnervation, and optimal functional recovery. NMEG‐NMZ technique may become a useful tool in the treatment of muscle paralysis caused by peripheral nerve injuries in certain clinical situations.
Highlights
Motor endplate reinnervation is critical for restoring motor function of the denervated muscle
We have demonstrated that nerve-muscle- endplate band grafting (NMEG)-native motor zone (NMZ) technique resulted in optimal recovery of muscle force (82% of the control)
The mean count and area of the axons reached up to 76.8% and 75.6% of the controls, respectively, and the majority (80%) of the denervated MEPs regained motor innervation
Summary
Traumatic peripheral nerve injuries (PNIs) to the head/neck and extremity are a significant cause of morbidity and disability in both military and civil circumstances today (Brininger, Antczak, & Breland, 2008; Eser, Aktekin, Bodur, & Atan, 2009; Kretschmer, Antoniadis, Braun, Rath, & Richter, 2001; Noble, Munro, Prasad, & Midha, 1998). The distal stump of an injured nerve is sutured to the side of an intact donor nerve This procedure induces less axon regeneration and functional recovery compared to EEA (De Sa, Mazzer, Barbieri, & Barriera, 2004; Sanapanich, Morrison, & Messina, 2002). A NMEG was implanted into an aneural region in the recipient muscle In this case, regenerating axons from the NMEG pedicle may need more time to reach the most distal muscle fibers and form new motor endplates (MEPs). The purpose of this study was to test our hypothesis that optimal outcomes may be achieved by implanting the NMEG into the NMZ in the target muscle, as such a procedure (NMEG-NMZ) could reduce nerve regeneration distances and facilitate rapid MEP reinnervation. At 3 months after surgery, maximal tetanic force measurement, muscle mass and myofiber morphology, motoneurons, regenerated axons, and axon-endplate connections of the reinnervated muscles were analyzed and compared with those of the contralateral controls
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