The embracing end-to-side neurorrhaphy in rats

Fausto Viterbo,Fábio Oliveira Maciel,Ana Gabriela Salvio,Beatriz Lotufo Griva

doi:10.1590/s0102-86502012000300010

Abstract

Compare two new methods with the traditional end-to-side neurorrhaphy. Rats were divided into four groups. In A-L group the peroneal nerve was sectioned and the distal stump was connected to the lateral of the tibial nerve (donor) with two 10-0 nylon points. In A-R group two perineurium flaps embraced the donor nerve. In the B-R group a suture embraced the donor nerve. Group B-L was the control. After six months tibial cranial muscle mass and morphometry of the distal stump of the peroneal nerve were evaluated. Muscle mass in groups A-R, A-L and B-R were lower than B-L group (p<0.0001) an equal between themselves (p>0.05). Groups A-R, B-R and A-L had a lower number of nerve fibers when compared with B-L (p=0.0155, p=0.016, p=0.0021). The three types of neurorrhaphy showed no differences related to muscle mass and number of nerve fibers suggesting that the embracing with a single suture has great potential due its simplicity and usefulness in deep areas.

Highlights

Since Viterbo et al.[1,2,3] introduced the End-to-Side Neurorraphy (ETS) concept without lesion in the donor nerve, many studies were published[4,5].When there is the proximal and distal stump after a nerve section it is possible to perform the surgical repair with the Endto-End Neurorraphy (ETE)
In experimental studies in rats, the peroneal nerve was sectioned and its distal stump was sutured to the lateral face of the intact tibial nerve, with and without the epi-perineurium removal
A single nylon 10-0 point went through the epineurum of the peroneal nerve, passed behind the tibial nerve, came back and passed in the front of this nerve, and went through the epineurum of the peroneal nerve again like a loop, in a way that when fixed, this point approximated the extremity of the peroneal nerve distal stump to the tibial nerve (Figure 3)

Summary

Introduction

When there is the proximal and distal stump after a nerve section it is possible to perform the surgical repair with the Endto-End Neurorraphy (ETE). In this process there is the union of the endoneurium conduits, making the nerve fibers regeneration easier[6]. In many clinical situations the proximal stump is not available, making the end-to-end neurorraphy impossible In these cases, an option is the end-to-side neurorraphy, introduced by Viterbo et al.[1], without lesion of the donor nerve. The proximal stump was put away and buried in the subjacent muscle It was noticed growth of the axons from an intact nerve into the distal stump of a receptor nerve. Later studies proved these initial findings[7,8]

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