Nerve Regeneration through Side-to-Side Neurorrhaphy Sites in a Rat Model: A New Concept in Peripheral Nerve Surgery

Abstract

Despite great improvement and refinements in nerve repair techniques, there were still problems in repair of peripheral nerve injuries for which proximal stumps were not available. In these circumstances for which classic end-to-end neurorrhaphy was impossible, new treatment modalities, benefiting by an adjacent healthy nerve, have been under investigation to overcome this problem. Therefore, end-to-side nerve repair with its modifications came to view and axonal passages through this site were shown. Moreover, the results were unsatisfactory or necessitating sacrifice of another healthy nerve. Three groups, containing 10 rats each, were included in the study. First was the control group, with end-to-end repair of the peroneal nerve. Second was the end-to-side repair group, in which the distal stump of the peroneal nerve trunk was anastomosed to the lateral side of the tibial nerve. The third was the side-to-side repair group. In this technique, 1-mm diameter epineural windows, both from peroneal and tibial nerve trunks facing each other, were removed and side-to-side neurorrhaphy was performed. After 3 weeks, as the second step, the peroneal nerve was sectioned proximally. At 2, 4, 8, 12, 20, and 28 weeks, functional assessment of nerve regeneration was performed by using walking track analysis. The number of myelinated fibers and fiber diameters were measured and an electron microscopic evaluation was carried out. Statistically, both in morphometric and gait analysis, the differences in values between the groups were significant in favor of the control group, followed by the side-to-side group. The study showed that axonal passage was possible with side-to-side technique and the functional results were satisfactory and superior to the end-to-side technique. Continuous supply of neurotrophic factors from their target cells was the probable cause of superior functional return in side-to-side repair, because both joining nerves were intact and healthy during the anastomosis procedure and after 3 weeks. It was concluded that this technique could be indicated in salvage of nerves in cases for which any intermediate segments would be removed, as in tumor ablation surgery, harvesting of nerve grafts, or both.

Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: Experience based on 11 cases

“…12À14 The role of side-to-side anastomosis has been experimentally investigated in rats using walkingtrack analysis, morphometric analysis (counting the number of myelinated fibers and measuring fiber diameters), and electron microscopy. 4 It was shown that axonal passage is possible with the side-to-side technique; the functional results were satisfactory and superior to the end-to-side technique.…”

“…Experimentally, it has been proven through various techniques, including choline-acetyltransferase (ChAT) activity measurement, 2,3 walking-track analysis and electron microscopy, 4 tetanic force measurement and axonal counting, 5 electrophysiologic studies, 6,7 fluorescent double-labeling techniques, 8 immunohistochemical staining for neural cell adhesion molecules (NCAM) to identify populations of denervated muscle fibers, 9 and muscle wet-weight measurements. 10 Although failures have been reported, 11 the clinical results have been encouraging.…”

Two applications of end‐to‐side nerve neurorrhaphy in severe upper‐extremity nerve injuries

“…Many technical varieties as well as the side-to-side technique have been studied. 6 Although some initially resisted believing in its benefits, most began using the technique at last. Recently, reviews of all these studies were published.…”

“…9À11 Here, we present our two cases with severe nerve injuries, with no chance for treatment other than alternative nerve repair techniques. After the experience gained by our several experimental studies on this subject, 6,12À14 we dared to use them clinically and were satisfied with the results.…”

Neurorrhaphy Techniques: Comparative Stereological and Experimental Axonal Study

“…Derived lesions or acquired degenerative diseases of the central nervous system also produce peripheral symptoms (Terzis et al, 1975). Therefore the use of neurorraphy to resume sensorimotor function advanced along with the evolution of the understanding of neurophysiology, anatomy and nerve regeneration, resulting in a more effective level of results obtained with the nerve repair techniques (Yüksel et al, 1999).…”