Nerve regeneration through an epineurial sheath: Its functional aspect compared with nerve and vein grafts

Abstract

Although nerve graft is still the only reliable choice in repair of defects in peripheral nerve structure, it has the disadvantage of donor nerve morbidity and of sometimes being unavailable. It has long been researched in alternate nerve grafts with other materials. Studies have shown that nerves could regenerate across short nerve gaps through various conduits, such as veins, pseudosheaths, and bioabsorbable tubes. Despite encouraging studies, their functional results remain unclear. The present study used 40 rats, in which nerve grafts, vein grafts, and epineurial tubes were placed into 1-cm gaps in sciatic nerves created by resection. In one group, sciatic nerves were denuded of the surrounding epineurium, to assess the possible morbidity caused by epineurial sheath technique. At 2, 4, 8, 12, 20, and 28 weeks, functional assessment of nerve regeneration was performed using walking track analysis. The number of myelinated fibers and fiber diameters was measured and electron microscopic evaluation performed. Functionally, the index values were very close to each other in nerve graft and epineurial sheath groups. Morphometric analysis showed significance between the groups. The result of denuded sciatic nerve group was the same as the base track values. It was concluded that the ready availability of epineurial sheath as a conduit to span short nerve gaps could eliminate the morbidity associated with nerve graft harvest and capitalize on the potential benefits of neurotrophism in directing nerve regeneration.

Contribution of the Proximal Nerve Stump in End-to-side Nerve Repair: In a Rat Model

“…The nerve tissues were prepared for optical microscopy 7,8,12,14). Axonal counts were performed by a single laboratory technician, blinded to the specimen identity.…”

La réparation de pertes de substance des nerves digitaux avec la technique de la greffe veineuse plus interposition de tissu nerveux. Étude prospective et randomisée

“…Dans ces cas, la reconstruction au moyen de greffe ou procédure assimilée a de meilleurs résultats [3] et représente une option fiable et préférée par la plupart des chirurgiens [4,5].…”

Diverse types of epineural conduits for bridging short nerve defects. An experimental study in the rabbit

“…In another study an epineurial tube has been employed in rats to bridge short nerve defects. 24 In this study the epineurial tube was not filled with any material to prevent wall collapse but the epineurium tube led to improved functional and morphological results compared with vein autografts. 24 The rabbit experimental model was chosen because it has a welldeveloped epineurium, which can be harvested without significantly injuring the nerve.…”