Histomorphometric Studies in Patients with Facial Palsy Treated by Functional Muscle Transplantation: New Aspects for the Surgical Concept

Frey, Manfred; Happak, Wolfgang; Girsch, Werner; Bittner, Reginald E.; Gruber, Helmut

doi:10.1097/00000637-199104000-00013

Cited by 75 publications

(51 citation statements)

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“…18 According to literature and this study, axonal regeneration even through long nerve grafts is possible without any connection to a target organ. [7][8][9]14 We found less myelinated nerve fibers in the distal end of the long nerve grafts than in the distal end of the short ones. Nevertheless, the number of fibers observed in the long nerve grafts increased fourfold in comparison with the number of ingrowing fibers of the motor nerve of the vastus medialis (Figs.…”

Section: Discussionmentioning

confidence: 58%

“…Irreversible unilateral facial palsy, for example, is treated by cross-facial nerve grafting and free gracilis muscle transplantation with microneurovascular anastomoses in two steps. 2,6,8,13 Another example is the treatment of irreversible lesions of the brachial plexus by a crossover nerve grafting and subsequent replacement of the denervated muscles by free muscle grafting. 4 In experimental studies in sheep and rabbits excellent neurotization of long nerve grafts has been described.…”

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confidence: 99%

“…7,9,14 In contrast, histomorphometric data of the distal end of cross-facial nerve grafts reveal that only 10-20% of the original facial nerve fibers are present at the desired distal destination. 8 Unfortunately, there is no further insight into the later process of nerve regeneration after the free gracilis transplantation. It is not known whether the number of regenerated nerve fibers in the distal end of the graft will increase under the promoting influence of the connected muscle target organ.…”

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The impact of a muscle target organ on nerve grafts with different lengths?A histomorphological analysis

et al. 1998

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Section: Discussionmentioning

confidence: 58%

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confidence: 99%

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confidence: 99%

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The impact of a muscle target organ on nerve grafts with different lengths?A histomorphological analysis

et al. 1998

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“…By taking every opportunity to obtain biopsies from the nerves and the muscles involved in neuromuscular reconstructions, we have gathered more and more quantitative insights into clinical regenerative processes , 4 and thus we understand the cia1 nerve branches of the healthy side, original nerve fibre population in the nerve grafts guiding the regenerating fibres from the healthy to the paralysed side, regenerated and myelinated nerve fibres in the distal end of the cross-face nerve graft at the time of connection to the free muscle transplant and the pattern of muscle fibres in the gracilis muscle at the time of transplantation and after functional recovery. Seven patients with this kind of complete evaluation were included in this study.…”

Section: Microsurgery 17:80-88 1996mentioning

confidence: 99%

Role of a muscle target organ on the regeneration of motor nerve fibres in long nerve grafts: A synopsis of experimental and clinical data

et al. 1996

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The importance of the muscle target organ as a promoting factor for nerve fibre regeneration in nerve grafts is still a subject of controversial discussion. In the last few years we published uniform results of experimental series in sheep and rabbits in which we investigated the biology of nerve fibre regeneration in long nerve autografts without connection to a target organ. Surprisingly, we found excellent regeneration of myelinated nerve fibres without the influence of a target organ through the whole length of the nerve graft, with an increase in the number of nerve fibres up to fourfold at the distal end. In the sheep series the additional contact with a muscle target organ for 6 months had a variable effect on the fibre population in the distal end of the nerve graft. The results of our planimetric analyses of nerve biopsies in patients with facial paralysis, who were treated by cross-face nerve grafting and free muscle transplantation, are extremely divergent from the results of our experimental series. Instead of an increase, we found a decrease in number of regenerating nerve fibres arriving at the distal end of the cross-face nerve graft down to 20%. Species-specific differences in the biology of nerve regeneration are discussed, together with their implications for the complex clinical situation of nerve grafting with or without the influence of a target organ.

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“…However, because of the difficulty of harvesting the clinically transplanted muscle biopsies, there are only a few reports [15] showing the morphology of clinically transplanted muscles, and an immunohistochemical evaluation of clinically transplanted muscles has never been reported. In the present study, we examined nine biopsies of transplanted muscles harvested at the time of the secondary operation.…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical Analysis of Clinically Transplanted Muscles

Harii

Asato

Yamada

1998

Journal of Surgical Research

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Backgrounds. Although a number of studies have examined the morphology and function of experimentally transplanted muscles, immunohistochemi-cal evaluation of clinically transplanted muscles has not been reported. The purpose of this study was to examine clinically transplanted muscles at long periods after transplantation with biochemical markers specific for satellite cell activation and muscle regeneration. Materials and Methods. Nine biopsies of muscles transplanted to the paralyzed face were examined. In five cases, the gracilis muscles were transplanted about 1 year after cross face nerve grafting. The other four cases underwent one-stage latissimus dorsi (LD) muscle transplantation. Twelve to 162 months after transplantation, muscle biopsies were harvested in nine cases. In eight cases, secondary corrections of facial expression including debulking of the grafted muscle were required, while another muscle was transplanted in one case because of the failed first operation. As control, six specimens of normal LDs were examined as well. Monoclonal an-tibodies were employed to visualize myosin heavy chain (MHC) isoforms (slow, fast, and embryonic) and MyoD protein. Results. Although one specimen exhibited only small, atrophic fibers indicating failed reinnervation, the remaining eight specimens showed regularly distributed fibers and type grouping indicating successful reinnervation. There was no statistically significant difference in fiber area and lesser diameter between normal LDs and transplanted LDs. However, even in these successfully reinnervated muscles, intermediate and small fibers expressing embryonic MHC and small cells expressing MyoD were observed, suggesting that satellite cells were activated for repair of the adjacent fibers. Conclusions. Muscle adaptation (presumably to dener-vation), which is a regenerative change accompanied by activation of satellite cells, was still seen even long periods after transplantation. It is concluded that, in micro-neurovascular human skeletal muscle transfers, there is a wide variation in the time required for reinnervation of individual muscle fibers, and it may be that human muscle fibers cannot be properly reinnervated after de-nervation has continued for a certain period such as 12 months.

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Histomorphometric Studies in Patients with Facial Palsy Treated by Functional Muscle Transplantation: New Aspects for the Surgical Concept

Cited by 75 publications

References 0 publications

The impact of a muscle target organ on nerve grafts with different lengths?A histomorphological analysis

The impact of a muscle target organ on nerve grafts with different lengths?A histomorphological analysis

Role of a muscle target organ on the regeneration of motor nerve fibres in long nerve grafts: A synopsis of experimental and clinical data

Immunohistochemical Analysis of Clinically Transplanted Muscles

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