Nerve Anastomosis Research Articles

Mesenchymal Stem Cell Therapy to Promote Sensory and Motor Nerve Function in a Limb Transplant Model.

Introduction: Hand and leg transplantation (Tx) in military/civilian populations is increasingly needed to improve the quality of life of individuals. Optimizing nerve regeneration and preventing immune rejection are vital to successful outcomes in limb Tx. As a first step, our objective was to investigate whether bone marrow derived mesenchymal stem cells (MSCs) can improve nerve regeneration and function. Methods: We performed orthotopic syngeneic hind-limb transplants in Lewis (RT1. Al) rats. Osteosynthesis of femur was performed using intramedullary pin and bone cement. The donor and recipient vessels were anastomosed using the vascular cuff technique. The sciatic nerve ends were approximated using 10-O nylon sutures. Rats received syngeneic MSC (5x106; passage ≤8; n=8) or vehicle (n=7) locally (nerve, bone and vascular anastomoses sites) and intravenously. Following Tx ( ≥2 weeks) laser doppler and radiologic analysis were performed to assess limb vascularization and fusion of native and graft femoral ends. Sensory function of the transplanted limb was assessed by cutaneous pain reaction test and motor function by walking track analysis every 1-2 weeks until 26 weeks post-Tx. Results:Ex vivo expanded Rat MSCs were CD29+, CD31-, CD34-, CD44+, CD45low, CD90+, MHC Class I+, Class II- and were pluripotent: differentiated in to adipocytes, osteocytes and chondrocytes in ex vivo cultures. Limb Tx was highly successful (100% survival). Four weeks post-Tx sensory nerve function was <0.3 on a scale of Grade 0 to 3 (0=No function; 3=Normal function). By 8 weeks in vehicle group it was 2.2±0.7 (tibial), 1.2±0.5 (peroneal) and 1.7±0.9 (sural), and in MSC group it was 2.6±0.4 (tibial), 1.0±0.9 (peroneal) and 1.7±0.9 (sural). Overall sensory function was higher but not significant in MSC group compared to vehicle group at 4, 8, 16 and 24 weeks post-Tx. Walking track analysis (for motor nerve function) did not produce clear foot prints to calculate Sciatic Function Index (SFI), so a novel grading system for available foot prints was developed. Radiology and laser doppler analysis revealed normal bone fusion and vascularization, respectively. Gastrocnemius muscle was atrophied (P<0.05) and animals developed flexion-contractures in the transplanted limb. Conclusion: The limb transplantation procedure was highly successful, sensory function was recovered (>70%) and MSC therapy appears to promote transplanted limb nerve functional recovery.

Results of Hemihypoglossal-Facial Nerve Anastomosis in the Treatment of Facial Nerve Paralysis after Failed Stereotactic Radiosurgery for Vestibular Schwannoma

Abstract Vestibular schwannoma treatment with stereotactic radiosurgery (SRS) carries a risk of facial nerve (CNVII) palsy that is lower than that with microneurosurgery. The results of hemihypoglossal-facial nerve anastomosis (HHFA) have not been described yet in CNVII palsy after failed stereotactic radiosurgery (SRS). Here we report a case series of the first four consecutive patients (three women; average age 58.5, age range: 46-74), who underwent HHFA due to failed SRS. All patients were admitted because of progressive peripheral facial nerve palsy. Three patients received retrosigmoid craniotomy due to tumor enlargement that resulted in facial nerve paralysis. All patients achieved satisfactory (House-Brackmann grade III) CNVII regeneration. No or minimal tongue atrophy occurred on the side of the anastomosis. Patients reported no problems with phonation or swallowing, except for the patients with preexisting lower cranial nerve deficits. HHFA effectively treats facial palsy after failed SRS with minimal risk of tongue atrophy and minimal morbidity. The results of the treatment are comparable to those achieved with patients without previous SRS.

The effect of patient age on the success of laryngeal reinnervation.

The objective of the study was to investigate the influence of patient age on the efficacy of laryngeal reinnervation with ansa cervicalis in unilateral vocal fold paralysis (UVFP) patients. We retrospectively reviewed 349 consecutive UVFP cases of laryngeal reinnervation with ansa cervicalis to the recurrent laryngeal nerve anastomosis. Preoperative and postoperative videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT) and laryngeal electromyography (EMG) data were collected. Gender, age, preoperative EMG status [preoperative voluntary motor unit recruitment (VMUR)] and denervation duration were analyzed in previous multivariable logistic regression analysis. Stratification analysis was performed on patient age in the present study. All patients were divided into four groups according to their age: Group A included patients with an age less than 30 years; Group B, 30-44 years; Group C, 45-59 years; Group D, ≥60 years. Stratification analysis on patient age showed significant differences between Group A and D, Group B and D, Group C and D (P < 0.05), but no significant difference between Group A and B, Group A and C, Group B and C (P > 0.05), respectively, with regard to parameters including glottal closure, overall grade, shimmer, noise-to-harmonics ratio; but there are no significant differences among the four groups with regard to jitter. However, for MPT and postoperative VMUR, there are significant differences among the four groups expect between Group A and B. In addition, glottal closure, perceptual and acoustic parameters, MPT values and VMUR data, were significantly improved postoperatively in each age group (P < 0.01). The data from this study indicate that patient age is an influential factor of the surgical outcome of laryngeal reinnervation for UVFP patients. Laryngeal reinnervation is less effective when patient age is more than 60 years.

Overall satisfaction, sexual function, and the durability of neophallus dimensions following staged female to male genital gender confirming surgery: the Institute of Urology, London U.K. experience.

Background and purposeWhat factors influence transgender men’s decisions to undergo (and to not undergo) specific genital gender confirming surgeries (GCS) has not been described in the literature. Sexual function outcomes related to clitoral transposition and penile prosthesis placement is also not well described. Durability of neophallus dimensions after phalloplasty has not been described. A better understanding of these factors is necessary for pre-op counseling. We sought to assess patient genital-GCS related satisfaction, regret, pre/post-op sexual function, genital preferences, and genital measurements post-op.Materials and methodsWe evaluated ten female to male transgender patients who had previously undergone suprapubic pedicle-flap phalloplasty [suprapubic phalloplasty (SP); N=10] and 15 who had undergone radial artery forearm-flap phalloplasty [(RAP); N=15; 5/15 without and 10/15 with cutaneous nerve to clitoral nerve anastomosis] at our center (UK). We queried patients’ surgery related preferences and concerns, satisfaction, and sexual function pre/post-surgery, and accounted for whether patients had undergone clitoral transposition and/or cutaneous-to-clitoral nerve anastomosis. We measured flaccid and (where applicable) erect length and girth using a smart-phone app we designed.ResultsMean age at surgery and follow-up for those that underwent SP was 35.1 and 2.23 years, and 34 and 6.8 for those that underwent RAP. Mean satisfaction scores were 9.1/10 and 9/10 for those that underwent SP and RAP, respectively. No patient (0%) regretted starting genital-GCS surgery. All (100%) patients that could achieve orgasm before GCS with clitoral transposition could achieve orgasm after surgery, and the vast majority reported preserved quality of erogenous sensation by our transposition technique. All (100%) RAP and 9/10 SP patients reported masturbation with their phallus. Inflatable penile prosthesis placement was not associated with decreased erogenous sensation/orgasm. Penile dimensions were relatively stable through follow-up for both groups. Our App length measurements correlated with a ruler within ±<4.5%.ConclusionsFemale-to-male genital-GCS offered in 3-stages was associated with high overall satisfaction and no regret among our sample. Sexual function appears to be preserved after both clitoral transposition and inflatable prosthesis placement, and consolidation of erogenous sensation to the phallus was described as important to all subjects. Discussion of patient’s pre-op sexual function, as well as specific concerns and preferences related to specific genital-GCS surgeries is important.

Facial nerve anastomosis for facial paralysis resulting from surgery of cerebellopontine angle tumors

Objective To evaluate the efficiency and functional improvement of the facial nerve anastomosis for facial paralysis after cerebellontine angle (CPA) tumor surgery.Methods The clinical data of seven patients with facial paralysis after CPA tumors surgery underwent nerve anastomosis were analyzed retrospectively.House-Brackmann (H-B) grading was used to evaluate the pre-,post-operative and follow-up status.The end-end anastomosis of facial nerve was performed in one case,and facial-hypoglossal nerve anastomosis in six.Results All patients were followed-up.The mean time of follow-up was 23 months (ranged from 1 to 48 months).Among seven cases,the facial nerve function was improved in five cases,unchanged in one,and could not be evaluated in one because of short-time follow-up.The postoperative HB grades were Ⅱ in one case,Ⅲ in two and Ⅳ in two.Conclusions Facial nerve anatomosis was a useful treatment for facial paralysis after CPA tumors resection and could improve the facial function. Key words: Facial nerve injuries; Facial Palsy; Cerebellopontine angle; Nerve anastomosis

Hypoglossal-facial nerve reconstruction with predegenerated nerve graft for treatment of complete facial palsy

Objective To study the hypoglossal-facial nerve anastomosis method combined with predegenerated nerve graft for the treatment of facial palsy in adult rats after facial nerve injury.Methods 30adult male Fisher 344 rats were grouped into A (intact),B (injury),C (reconstruction at 1 week after injury),and D (reconstruction at 9 weeks after injury).The treatment was assessed by the angle α analysis,electrophysiological examination,electron microscopy analysis and retrograde labeling.Results The group D was found a higher recovery of facial symmetry compared to group C (P ＜ 0.01).MAPs displayed significantly greater amplitude and surface values in the group D compared with group C (P ＜ 0.05).Analysis of semithin sections showed numerous regenerating myelinated axons and there were 1 239 ± 192 和 559 ± 224 myelinated axons in group C and group D,respectively.The analysis of ultrathin sections found that the majority (＞90％) of myelinated axons were 1.0 ～6.5 μm in their greatest diameter (including the thickness of their myelin).Among these axons,41％ in group C were larger than 3 μm in their greatest diameter,as compared with only 29％ in group D.There were significantly more double-labeled (CTB-Alexa555 and FG) hypoglossal motoneurons in the rats treated immediately as compared with the number in rats treated after a delay of 9 weeks (P ＜ 0.05).Conclusions The hypoglossal-facial nerve anastomosis method combined with predegenerated nerve graft was effective for the treatment of complete facial palsy in adult rats after facial nerve injury. Key words: Facial nerve injuries ; Anastomosis,surgical; Graft; Rats

Control release of growth factors combined with small gap anastomosis promotes sciatic nerve regeneration after transaction in rats

Objective The nerve regeneration after peripheral nerve injury is slow and the degree of functional recovery is limited followed by a higher disability rate.How to accelerate the rate of nerve regeneration and improve the degree of nerve repair is a clinical challenge.This study aimed to investigate the role and the mechanism of growth factors gel combined with small gap nerve anastomosis in the regeneration of sciatic nerve injury in rats by nerve growth factor (NGF) and basic fibroblast growth factor (bFGF) gel injecting into silicon chamber which bridged the transection of nerve.Methods A total of twenty seven SD rats were chosen randomly,with a sharp blade to cut off the right hind leg sciatic nerve.Group A with silicon tube containing NGF and bFGF gel to bridge the nerve proximal and distal ends (gap 3 mm),Group B with silicon tube containing saline to bridge the nerve proximal and distal ends (gap 3 mm),Group C with the direct suture of the nerve proximal and distal ends.Eight weeks after surgery,the sciatic nerve function index,neural electrophysiology,muscle wet weight and histological,immunohistochemical were observed.Results The sciatic nerve function index,nerve conduction velocity and muscle wet weight,the density of nerve fiber regeneration,myelinization in group A were better than those in group B and C(P ＜ 0.05).Conclusions Small gap nerve anastomosis method can provide a good regeneration microenvironment for the rat sciatic nerve regeneration,and the combined strategy of growth factor gel with small gap nerve anastomosis appears to have more positive effect on nerve repair. Key words: Sciatic nerve ; Wounds and injuries ; Crowth factors ; Nerve regeneration; Rats

Hypoglossal-facial nerve reconstruction combined with NT-3 gene therapy for complete facial palsy

Objective To study the hypoglossal-facial nerve anastomosis combined with neurotrophic factor gene therapy for the treatment of complete facial palsy in adult rats after facial nerve injury.Methods 30 adult male Fisher 344 rats were grouped into A (intact),B (injury),C (reconstruction) and D (reconstruction combined with NT-3 gene therapy).The treatment outcomes were assessed by the angle α analysis and electrophysiological examination.The expression of NT-3 gene was measured by the quantitative RT-PCR and the viral vector transduction was assessed through the fluorescence microscope.Results The group D was found a higher recovery of facial symmetry compared to group C (P ＜0.01).The NT-3 mRNA expression in group D was 10-fold higher than that measured in group C after 1 week of transduction.A reduction in NT-3 mRNA expression was detected in group D 4 months after transplantation from a 10-fold increase to a 4-fold increase compared with group C.MAPs displayed significantly greater amplitude and surface values in group D compared with group C (P ＜ 0.05).Conclusions The combination of hypoglossal-facial nerve anastomosis and NT-3 gene therapy was promising for its potential application in treating facial palsy in humans. Key words: Facial nerve injuries ; Anastomosis, surgical; Genes; Rats

Extradural Nerve Anastomosis Technique for Bladder Reinnervation in Spinal Cord Injury

An anatomic study of extradural spinal root in 9 embalmed cadavers. To ascertain the anatomical parameters of the extradural spinal root and to demonstrate the feasibility of spinal root anastomoses without opening the spinal dura mater. Intradural anastomosis of the spinal root has made breakthrough progress in treating neurogenic bladder in spinal cord injury. However, because of the complex surgical procedures and extensive bony destruction, its clinical use is not widely promoted. Nine formalin-fixed cadavers were used. The distance between the nerve root outlet and ganglion center, the neighboring nerve root-outlet distance, and the gross anatomy of the extradural spinal root were measured with a surgical microscope. The number of nerve fibers from the T7 to S4 ventral roots (VRs) was calculated by immunohistochemical staining. The longest and shortest lengths of the extradural spinal root were observed at the S4 and T7 levels, with average values of 33.29 and 6.06 mm, respectively. The longest distance between the adjacent nerve root outlets was observed at L1-L2 (mean, 29.16 mm), and shortest at S3-S4 (mean, 11.79 mm). After leaving the dural sac, the spinal root descends in the spinal canal until reaching the corresponding intervertebral foramina, and the motor nerve roots still lie ventrally to the sensory nerve roots. The largest and smallest numbers of nerve fibers were observed at the L3 and S4 levels (mean, 9169 and 1356, respectively). The dorsal roots and VRs can both be successfully harvested and identified outside the dural sac. The S1 VR can be anastomosed to the S2 VR extradurally without nerve grafts. For extradural neuroanastomosis of the thoracic VRs to the S2 VR, a nerve graft is required. In addition, there are a sufficient number of nerve fibers for functional bladder recovery at the T7-T12 and S1 levels. This study supports the feasibility of extradural spinal root anastomosis as a modified surgical method for treating neurogenic bladder. N/A.

Effect of duration of denervation on outcomes of ansa‐recurrent laryngeal nerve reinnervation

To investigate the efficacy of laryngeal reinnervation with ansa cervicalis among unilateral vocal fold paralysis (UVFP) patients with different denervation durations. We retrospectively reviewed 349 consecutive UVFP cases of delayed ansa cervicalis to the recurrent laryngeal nerve (RLN) anastomosis. Potential influencing factors were analyzed in multivariable logistic regression analysis. Stratification analysis performed was aimed at one of the identified significant variables: denervation duration. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time (MPT), and laryngeal electromyography (EMG) were performed preoperatively and postoperatively. Gender, age, preoperative EMG status and denervation duration were analyzed in multivariable logistic regression analysis. Stratification analysis was performed on denervation duration, which was divided into three groups according to the interval between RLN injury and reinnervation: group A, 6 to 12 months; group B, 12 to 24 months; and group C, > 24 months. Age, preoperative EMG, and denervation duration were identified as significant variables in multivariable logistic regression analysis. Stratification analysis on denervation duration showed significant differences between group A and C and between group B and C (P < 0.05)-but showed no significant difference between group A and B (P > 0.05) with regard to parameters overall grade, jitter, shimmer, noise-to-harmonics ratio, MPT, and postoperative EMG. In addition, videostroboscopic and laryngeal EMG data, perceptual and acoustic parameters, and MPT values were significantly improved postoperatively in each denervation duration group (P < 0.01). Although delayed laryngeal reinnervation is proved valid for UVFP, surgical outcome is better if the procedure is performed within 2 years after nerve injury than that over 2 years.

The Comparison of Histological Results of Experimentally Created Facial Nerve Defects Repaired by 2 Different Anastomosis Techniques

The objective of this study was to compare the histological regeneration characteristics of nerve fibers at the anastomosis lines performed by classic suture technique or a tissue adhesive (N-butyl-2-cyanoacrylate). The control group consisted of 7 rabbits. The 21 rabbits were randomly divided into 3 groups based on the harvesting week. In the study group following preparation of facial nerve bilaterally, a 0.5-cm segment of facial dorsal buccal nerve was resected, and the defect was repaired with a nerve graft, which was harvested from sural nerve of the same side by 8-0 nylon suture technique and by application of N-butyl-2-cyanoacrylate on the other side. Electron microscopic examination at consecutive second, fourth, and sixth days (corresponding to 4th, 8th, and 12th week in human subjects) revealed increased nerve degeneration findings in N-butyl-2-cyanoacrylate group when compared with microsuture repair technique. We conclude that N-butyl-2-cyanoacrylate is not an appropriate material for nerve anastomosis.

Side-to-End Hypoglossal to Facial Anastomosis With Transposition of the Intratemporal Facial Nerve

To describe results in a large series of patients using a recent variation of hypoglossal-facial nerve anastomosis (HFA) in which the intratemporal facial nerve segment is used, obviating the need for a sensory nerve "jump graft." Retrospective chart review. Tertiary neurotologic referral center. Nineteen patients (12 female/7 male subjects) with facial paralysis because of posterior fossa surgery for tumor (n = 15), Bell's palsy (n = 1), facial neuroma (n = 1), hemangioma (n = 1), and trauma (n = 1) who underwent HFA from 1997 to 2011, with at least 1-year follow-up. Mean age at surgery is 47.4 years (range, 11.2-83 yr). Mean follow-up is 4.0 years. Side-to-end hypoglossal to facial anastomosis with transposition of the intratemporal facial nerve (swingdown HFA). House-Brackmann (H-B) facial nerve grade. Seven patients (36.8%) achieved an H-B Grade III, 9 patients (47.4%) a grade IV, and 3 patients (15.8%) a grade V at last follow-up. No patients complained of dysphagia, dysarthria, or had evidence of oral incompetence. One patient complained of mild tongue weakness. Age at time of HFA (p ≤ 0.049, III younger than V) and time from facial nerve injury to HFA (p ≤ 0.02, III<IV and V) were significant factors for ultimate facial nerve outcome. All patients with an H-B III result had HFA within 6 months of injury. Other factors were not significant. The HFA swingdown technique is a safe and effective method to restore facial nerve function in patients with facial paralysis and obviates the need for an interposition jump graft.

Repairation the composite tissue defects of heel by using the free iliac flap with nerve anastomosis

Objective To investigate the clinical effects of reconstruction by using the free iliac flap with nerve anastomosis to repair the composite tissue defects of heel.Methods From March 2009 to August 2012,five cases with the composite tissue defects of heel,including 2 cases with the bottom defects and 3 cases with the tibial defects of heel,were repaired by the free iliac flap,and the feeling of the heel were reconstructed by nerve anastomosis of the flap.The ventral wound were sutured simply.Results All iliac flaps survived and the wound healed in one stage.Patients were followed up from 6 months to 12 months.Appearance and function recovered and the feeling recovered from S2-S3.The foots walked freely.The skin of iliac abdomen were scarred and lead to hyperpigmentation.Conclusion Using the free iliac flap with nerve anastomosis could repair the bone and soft tissue defects of heel and reconstruct the sensation of warmth and sense of pain of the heel.With the characteristics of hidden wound and little damage,the clinical effects was satisfied. Key words: Iliac flap; Cutaneous nerve; Heel; Composite tissue defects

Changes in electrical response function and myosin heavy chain isoforms following denervation and reinnervation of bilateral posterior cricoarytenoid muscles in dogs

Conclusions: Both electrical response function and mRNA expression of myosin heavy chain (MyHC) types 2X, 1, and Neonatal of bilateral posterior cricoarytenoid (PCA) muscle changed after denervation or reinnervation in canines. Objectives: There is a need to investigate the electrical response function MyHC alteration of denervation or reinnervation in the bilateral PCA muscle of large animals. Methods: MyHC isoforms expression profile and PCA muscle function outcome were detected by real-time reverse transcribed-polymerase chain reaction and muscle response to functional electrical stimulation, 9 weeks after denervation and reinnervation with ansa–recurrent laryngeal nerve anastomosis in dogs. Results: Denervation produced up-regulation of MyHC-1 and MyHC-Neonatal messenger ribonucleic acid (mRNA) expression. Reinnervation caused a decrease of MyHC-2X mRNA expression. The electrical voltage threshold of vocal fold movement and maximum abduction of denervation were greater than that of the reinnervated or control group. The denervated vocal abduction maximum of response to electrical stimulation was less than that in reinnervation or control groups.

Transverse cervical and great auricular nerve distribution in the mandibular area: A study in human cadavers

The angle of the jaw is innervated by the auricular branch of the superficial cervical plexus (SCP). Cervical cutaneous nerves of the CP carry the sensation from the antero-lateral cervical skin. It is clinically relevant to identify the cervical cutaneous nerve distribution and the nerve point using superficial landmarks but published studies describing the emerging patterns and cervical cutaneous nerve branch distributions in the mandible are rare. The overlap between the cervical and trigeminal and facial nerve distributions and anastomoses is highly variable. The objective of this study was to characterize the distribution of the SCP nerves in the different parts of the mandible. Two hundred and fifty fresh and formalin-fixed human cadaver heads were microdissected to observe the distribution of the transverse cervical (TCN) and great auricular (GAN) nerves. Two main groups (G1 and G2) based on the emergence of the TCN and GAN behind the posterior edge of the sternocleidomastoid muscle and three types (T1, T2, and T3) based on their distribution in the different mandibular parts were observed. Statistical analysis showed that parameters related to the mandibular side (P = 0.307), gender (P = 0.218), and group (P = 0.111) did not influence the facial distribution of these nerves. The only parameter influencing the distribution was the type of nerve (GAN and TCN) (P < 0.001). In the face, the SCP reached the mandible in 97% of cases, its distribution and extent were subject-dependent. These results confirmed that the SCP could supply accessory innervation to the mandible through the TCN.

Experimental research on end-to-side anastomosis of peripheral nerves and effect of FK506 on end-to-side anastomosis.

To study the effects of end-to-side anastomosis of initially-denatured nerves at different times. 60 male Wistar albino rats were used to fabricate animal models for the experiment on end-to-side anastomosis of peripheral nerves and 50 female Wistar albino rats were used to fabricate animal models for the experiment on the effect of FK506 on end-to-side anastomosis. Bilateral common peroneal nerve, tibialis anterior muscle electrophysiological and histological examinations, tibialis anterior muscle wet muscle weight determination, and motor end plate examination were performed 3 months after operation. All recovery rates of action potential, single muscle contraction force and tetanic contraction force of the FK506 experimental group are significantly higher than those of the control group and the sectional area of muscle fiber is also higher than that of the control group of normal saline. The best time for end-to-side anastomosis of nerves should be controlled within 2 weeks and the effect of end-to-side anastomosis of nerves will gradually become unsatisfactory. FK506 plays a role in promoting functional rehabilitation following nerve end-to-side anastomosis (Tab. 7, Fig. 4, Ref. 31).

周围神经损伤的外科处理

目的：探讨周围神经损伤的外科处理技术及手术疗效。方法：临床各种神经损伤病例共36例，其中采用神经松解术治疗25例，神经吻合术8例，取腓肠神经桥接手术3例。所有病例术后均行神经营养药物及康复治疗。结果：经2~3年随访，其中优21例，良5例，中5例，差5例，观察其中疗效评价为中、差者均为神经移植患者及部分神经吻合患者。结论：周围神经损伤诊断一经成立，原则上手术越早越好。处理臀盖下结构以及胸廓出口周围对医师技术要求较高。主张早期、足量使用神经营养药物并进行早期功能锻炼。Objective: To explore the surgical technique and curative effect of peripheral nerve injury. Methods: Altogether 36 cases with every kinds of peripheral nerve injury were treated by operation. 25 cases were treated by lytic operation, 8 cases were treated by anastomosis, and 3 cases were treated by nerve transplantation with sural nerve. All cases were treated by nerve nutrition drugs and recovery therapy. Results: The follow-up ranged from 2 to 3 years. Excellent results were obtained in 21 cases, good in 5 cases, fair in 5 cases and poor in 5 cases. The cases with poor or fair results were mainly because of nerve transplantation or nerve anastomosis. Conclusions: As soon as the diagnosis of peripheral nerve injury was confirmed, operation should be begun immediately. The technique of control the structure under greatest gluteal muscle and surrending thorax exit is difficult to surgeon. To emphasize using nerve nutrition drugs earlier and full dose, earlier functional exercise also be emphasized.

Chemically extracted acellular allogeneic nerve graft combined with ciliary neurotrophic factor promotes sciatic nerve repair.

A chemically extracted acellular allogeneic nerve graft can reduce postoperative immune rejection, similar to an autologous nerve graft, and can guide neural regeneration. However, it remains poorly understood whether a chemically extracted acellular allogeneic nerve graft combined with neurotrophic factors provides a good local environment for neural regeneration. This study investigated the repair of injured rat sciatic nerve using a chemically extracted acellular allogeneic nerve graft combined with ciliary neurotrophic factor. An autologous nerve anastomosis group and a chemical acellular allogeneic nerve bridging group were prepared as controls. At 8 weeks after repair, sciatic functional index, evoked potential amplitude of the soleus muscle, triceps wet weight recovery rate, total number of myelinated nerve fibers and myelin sheath thickness were measured. For these indices, values in the three groups showed the autologous nerve anastomosis group > chemically extracted acellular nerve graft + ciliary neurotrophic factor group > chemical acellular allogeneic nerve bridging group. These results suggest that chemically extracted acellular nerve grafts combined with ciliary neurotrophic factor can repair sciatic nerve defects, and that this repair is inferior to autologous nerve anastomosis, but superior to chemically extracted acellular allogeneic nerve bridging alone.

The Effect of Low-Dose Tacrolimus on Recurrent Laryngeal Nerve Regeneration in Pigs: A Pilot Study

Objective: The functional neurotrophic effects of systemic tacrolimus in a sub-immunosuppressive regimen in the minipig model of laryngeal reinnervation were investigated. Methods: Right recurrent laryngeal nerve transection and phrenic-abductor branch of recurrent laryngeal nerve anastomosis were performed in two minipigs that were administered low-dose oral tacrolimus (0.125 mg/kg) for one month. Vocal cord abduction at four months was rated by two blinded expert assessors on a four-point Likert scale from poor (1) to complete (4), and compared with five fully matched historical control animals that received the same surgery but no other interventions. Results: Right vocal cord abduction was more complete in tacrolimus-treated animals than controls (mean abduction score 2.3 vs. 1.5, p=0.019). Conclusion: Tacrolimus may have an important role in laryngeal reinnervation following allograft transplantation, and low-dose regimens may have applications in cranial and peripheral nerve injuries or in the reinnervation of tissue-engineered laryngeal constructs, but further studies are required.

Neurovascular antropylorus perineal transposition using inferior rectal nerve anastomosis for total anorectal reconstruction: preliminary report in humans

Technical feasibility of inferior rectal nerve anastomosis to the anterior vagus branch of the perineally transposed antropyloric valve for total anorectal reconstruction has been previously demonstrated in cadavers. To the best of our knowledge, the present study is the first report of using this procedure in humans. Eight patients [mean age 35.5years (range 15-55years); (male/female=7:1)] underwent the procedure. The antropyloric valve with its anterior vagus branch was mobilized based on the left gastroepiploic arterial pedicle. The antral end was anastomosed to the distal colon. The anterior vagus nerve was anastomosed by epineural technique to the inferior rectal nerve in the perineum. A diverting proximal colostomy was maintained for 6months. Anatomical integrity of the graft (on magnetic resonance imaging scans), its arterial pedicle (on computed tomography angiogram) and neural continuity (on ultrasound and pyloric electromyography) were assessed. Functional assessment was performed using barium retention studies, endoscopy, manometry and fecal incontinence scores. Tension-free end-to-end anastomosis of the anterior vagus nerve to the right (n=7) and left (n=1) inferior rectal nerve was achieved. An intact left gastroepiploic pedicle, a healthy graft and neural continuity were visualized on perineal ultrasound. Electromyographic activity was noticed on neural stimulation. Endoscopy and barium studies showed voluntary antral contraction and contrast retention, respectively, in all patients. The mean resting and squeeze pressures were 26.25mmHg (range 16-62mmHg) and 50.25mmHg (range 16-113mmHg), respectively. St. Mark's incontinence scores varied between 7 and 12. There were no major surgical complications. Pudendal (inferior rectal) innervation of the perineally transposed antropylorus in total anorectal reconstruction is feasible and may improve outcomes in selected patients with end-stage fecal incontinence.