A modified end-to-side method for peripheral nerve repair: Large epineurial window helicoid technique versus small epineurial window standard end-to-side technique

Yan, Ji‐Geng; Matloub, Hani S.; Sanger, James R.; Zhang, Linling; Riley, Denise; Jaradeh, Safwan

doi:10.1053/jhsu.2002.32953

Cited by 61 publications

(53 citation statements)

References 14 publications

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“…71 Accordingly, the structure and function of muscles innervated by the donor nerve and the donor nerve itself completely recovered at 6-12 months after surgery. 53,66,69,72,73 Together, these observations support the view that end-to-side nerve coaptation has no major detrimental long-term effect on the donor nerve. This is in accordance with two recent reports of clinical case series, 18,22 in which none of patients had any sensory or motor loss in the innervation zone of the donor nerve, even though perineurial sutures were made after the creation of a perineurial window in the donor nerve.…”

supporting

confidence: 61%

“…51 Similarly, regardless of the way in which the connective tissue sheaths were breached, the majority of other studies demonstrated focal Wallerian degeneration in the donor nerve distal from the site of coaptation at the first few weeks after the end-to-side nerve coaptation, but not 2-3 months later. 32,48,54,57,66,69,70 Accordingly, we found significant focal subepineurial degenerative changes in donor nerves with epiperineurial breaching only at 4 weeks, but not at 8 weeks. As shown in our recent longitudinal study, the differences between the donor and control nerves regarding the number of myelinated axons are not statistically significant beyond 4 months after suturing the end-to-side nerve coaptation without windowing the donor nerve connective tissue.…”

mentioning

confidence: 58%

“…16,51,53,64 Interestingly, if epineurial or perineurial windows were enlarged from 1 to 4 or 5 mm, respectively, then, also, the magnitude of axonal ingrowth into the recipient nerve was increased. 65,66 Subepineurial focal degeneration and demyelination of the donor nerve distal to the site of coaptation in experimental groups Notably, bimodality coefficient > 0.555 indicates that a distribution is bimodal 56 (but see Jackson, P.R., Tucker, G.T., and Woods, H.F. (1989). Testing for bimodality in frequency distributions of data suggesting polymorphisms of drug metabolism -hypothesis testing.…”

Section: Kovač Ič Et Almentioning

confidence: 99%

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Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

Kovačič

Žele²,

Tomšič³

et al. 2012

Journal of Neurotrauma

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The influence of breaching the connective sheaths of the donor sural nerve on axonal sprouting into the end-to-side coapted peroneal nerve was examined in the rat. In parallel, the effect of these procedures on the donor nerve was assessed. The sheaths of the donor nerve at the coaptation site were either left completely intact (group A) or they were breached by epineurial sutures (group B), an epineurial window (group C), or a perineurial window (group D). In group A, the compound action potential (CAP) of sensory axons was detected in *10% and 40% of the recipient nerves at 4 and 8 weeks, respectively, which was significantly less frequently than in group D at both recovery periods. In addition, the number of myelinated axons in the recipient nerve was significantly larger in group D than in other groups at 4 weeks. At 8 weeks, the number of axons in group A was only *15% of the axon numbers in other groups ( p < 0.05). Focal subepineurial degenerative changes in the donor nerves were only seen after 4 weeks, but not later. The average CAP area and the total number of myelinated axons in the donor nerves were not different among the experimental groups. In conclusion, myelinated sensory axons are able to penetrate the epiperineurium of donor nerves after end-to-side nerve coaption; however, their ingrowth into recipient nerves is significantly enhanced by breaching the epiperineurial sheets at the coaptation site. Breaching does not cause permanent injury to the donor nerve.

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supporting

confidence: 61%

mentioning

confidence: 58%

Section: Kovač Ič Et Almentioning

confidence: 99%

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Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

Kovačič

Žele²,

Tomšič³

et al. 2012

Journal of Neurotrauma

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“…First, the minimal injury to donor nerve during the nerve suturing process promoted the releasing of some nerve growth factors, and therefore regeneration occurred (Lutz et al, 2000;Yamauchi et al, 2000). Second, the angle at the coaptation site may have facilitated axons' growth into the recipient nerve (Yan et al, 2002). Third, the surface area of coaptation between the donor nerve and the recipient nerve was increased greatly by trimming the end of the distal stump of L6 VR diagonally, and using the helicoid neurorrhaphy (Yan et al, 2002).…”

Section: Resultsmentioning

confidence: 99%

Re-Innervation of the Bladder through End-to-Side Neurorrhaphy of Autonomic Nerve and Somatic Nerve in Rats

Gao

Dong²,

Li³

et al. 2012

Journal of Neurotrauma

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End-to-side neurorrhaphy is widely used in the peripheral nervous system for nerve repair; however, the application of this technique has been limited to somatic nerves. The feasibility of nerve regeneration through end-to-side neurorrhaphy between autonomic and somatic nerves with different characteristics in the peripheral nervous system is still undetermined. In this study, rats were divided into three groups for different treatments (n = 10 per group). In the end-to-side neurorrhaphy group, left L6 and S1 were transected in the dura, and the distal stump of L6 ventral root was sutured to the lateral face of L4 ventral root through end-to-side coaptation. In the no repair group, the rats did not undergo neurorrhaphy. In the control group, the left L6 dorsal root and S1 roots were transected, respectively, but the L6 ventral root was kept intact. After 16 weeks, the origin and mechanism of nerve regeneration was evaluated by retrograde double labeling technique as well as histological examination and intravesical pressure measurement. Retrograde double labeling indicated that the reconstructed reflex pathway was successfully established and the primary regeneration mechanism involved axon collateral sprouting. Morphological examination and intravesical pressure measurement indicated prominent nerve regeneration and successful re-innervation of the bladder in the neurorrhaphy group, compared with the ''no repair'' group ( p < 0.05). No significant changes were observed in the histology of the donor nerve and the bilateral extensor digitorum longus muscles in the neurorrhaphy group. Nerve regeneration may be achievable for nerve repair through end-to-side neurorrhaphy between autonomic and somatic nerves without apparent impairment of donor somatic nerve.

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“…Firstly, the slight damage to the donor nerve led to the release of some nerve growth factors which promoted regeneration during the nerve anastomosis [66]. The use of helicoid coaptation greatly increased the surface area of donor nerve and the recipient nerve, which contributed to nerve regeneration [67]. In addition, there are other factors that also influenced nerve regeneration including neurotrophic factors, timing of coaptation and the number of Schwann cells at the anastomosis site [68].…”

Section: The Advantages Of Terminolateral Neurorrhaphy Of Autonomic-smentioning

confidence: 99%

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

He¹,

Gao²,

Wen³

2018

Neuropsychiatry

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A modified end-to-side method for peripheral nerve repair: Large epineurial window helicoid technique versus small epineurial window standard end-to-side technique

Cited by 61 publications

References 14 publications

Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

Influence of Breaching the Connective Sheaths of the Donor Nerve on Its Myelinated Sensory Axons and on Their Sprouting into the End-to-Side Coapted Nerve in the Rat

Re-Innervation of the Bladder through End-to-Side Neurorrhaphy of Autonomic Nerve and Somatic Nerve in Rats

Terminolateral Neurorrhaphy between Somatic Nerve and Autonomic Nerve

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