Neuroma prevention by end-to-side neurorraphy: an experimental study in rats

Aszmann, Oskar C.; Korak, Klaus J.; Rab, Matthias; Grünbeck, M.; Lassmann, Hans; Frey, Manfred

doi:10.1016/s0363-5023(03)00379-4

Cited by 43 publications

(29 citation statements)

References 21 publications

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“…Apart from these findings we did not detect neuromatous signs on proximal peroneal nerve endings within end-to-side repair regions, which were thought to be potential sites for neuroma development, and also at proximal tibial nerve endings in group V. Our Figure 8 Appearance of neuroma at the cross-section from the proximal tibial nerve in group VI (×24,000, EM). findings, which are in compliance with those of previous studies mentioned in literature [2,3,10,13,15], reinforce evidences related to effectiveness of end-to-side neurorrhaphy of proximal nerve stump to the adjacent nerve in the management of neuroma, thanks to axonal transport achieved within this region.…”

Section: Discussionsupporting

confidence: 92%

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Ayan¹,

Bora²,

Karakaplan

et al. 2007

Hand (New York, N,Y.)

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Objective Neuroma is a psychologically and physically disabling problematic condition without any current standard therapy. For that reason, we investigated whether endto-side anastomosis of the proximal end of the transected nerve into the adjacent nerve will prevent the development of neuroma in different types of nerve injuries. Study design In this study, hind legs of 18 Sprague-Dawley female rats were used. Six groups were formed. In group I, peroneal nerves were transected and its proximal end was attached end-to-side through the epineural window to the adjacent tibial nerve. In group II, contrary to group I, an epineural window was created in the tibial nerve and the same number of sutures were employed. In group III, tibial nerve was transected proximal to the end-to-side repair site, whereas in group IV, distal segment of the nerve was cut, and an end-to-end repair procedure was repeated. In group V, unlike group I, an approximately 1-cm segment was resected and removed distal (from tibial nerve) to the endto-side repair site. In group VI, an epineural window was created in the tibial nerve and the same number of sutures were used, and also a 1-cm distal nerve segment was resected. The rats were followed for 2 months, and then all of the groups were evaluated histopathologically, and weights of the posterior muscle groups of hind legs were evaluated. Findings and Conclusions No neuroma formation was observed in the proximal stumps of peroneal nerve segments in end-to-side repair sites in groups I, III, IV, and V, and proximal stumps of the tibial nerve in group V. In group VI, neuroma formation was observed in the proximal end of the tibial nerve. When weights of the posterior muscle groups of hind legs in groups I and II were comparatively assessed, statistically significant difference HAND (2007) was not detected. In conclusion, based on histological data obtained for proximal nerve ends and segments distal to the end-to-side repair sites, we think that end to side neurorrhaphy of the proximal end of the damaged nerve to adjacent nerve will prevent the development of neuroma without injuring the intact nerve segment.

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Section: Discussionsupporting

confidence: 92%

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Ayan¹,

Bora²,

Karakaplan

et al. 2007

Hand (New York, N,Y.)

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“…End-to-side neurorrhaphy technique has also been described for the treatment of this clinical condition (Al-Qattan, 2000;Aszmann et al, 2003). A new pathway and target organ was provided to axons of the injured nerve, in order to prevent neuroma.…”

Section: Clinical Applicationsmentioning

confidence: 99%

“…A new pathway and target organ was provided to axons of the injured nerve, in order to prevent neuroma. Whether the regenerating sensory axons lead to paresthesia or dysesthesia is not cleared yet (Aszmann et al, 2003). According to a recent paper, the end-to-side "jump grafts" bypass a neuroma in-continuity, maintaining functional units within the nerve lesion to facilitate functional regeneration (Adelson et al, 2004).…”

Section: Clinical Applicationsmentioning

confidence: 99%

End-to-Side Nerve Repair in Peripheral Nerve Injury

Beris

Lykissas

Korompilias

et al. 2007

Journal of Neurotrauma

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In peripheral nerve injury, end-to-side neurorrhaphy has been reported as an alternative in cases that the proximal nerve stump is not accessible. Several hypotheses have been proposed to explain peripheral nerve regeneration after end-to-side neurorrhaphy. Recent evidence suggests that nerve regeneration occurs by collateral sprouting. Although a great number of humoral factors have been identified, molecular mechanism of nerve regeneration after end-to-side neurorrhaphy has not been completely clarified yet. The goal of this technique is to provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. End-to-side technique has been investigated in detail in both experimental and clinical studies. Only a limited number of reported cases in clinical practice, until today, can reveal that end-to-side technique may become a viable means of repairing peripheral nerves in certain clinical situations.

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“…End‐to‐side neurorrhaphy was first described as an alternative approach for the treatment of facial palsy,5 but the approach was neglected until Viterbo et al,23–26 beginning in 1992, reintroduced end‐to‐side technique in studies in animals and afterwards in patients with facial nerve palsy. Since then, several other investigators have carried out experimental and clinical studies on end‐to‐side neurorrhaphy 1, 3, 12, 18, 19, 21, 27, 28, 32, 33. This study was conducted to determine collateral sprouting capability in an end‐to‐side repair model with long regenerative distance between two end‐to‐side neurorrhaphies.…”

mentioning

confidence: 99%

Can end‐to‐side neurorrhaphy bridge large defects? An experimental study in rats

et al. 2007

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This study was undertaken to evaluate collateral sprouting capability in an end-to-side repair model with long regenerative distance. Forty-five rats were used and divided into four groups, according to the reparative procedure following peroneal nerve division: (A) "double" end-to-side neurorrhaphy with a regenerative distance of 0.6 cm; (B) "double" end-to-side neurorrhaphy with a regenerative distance of 1.2 cm; (C) end-to-end neurorrhaphy; and (D) nerve stumps buried into neighboring muscles. In all animals the contralateral healthy side served as a control. Functional assessment of nerve regeneration was performed at intervals up to 5 months using the Peroneal Function Index (PFI). Evaluation 150 days after surgery included peroneal and tibial nerve histologic and morphometric examination and wet weights of the tibialis anterior muscle. Functional evaluation and axonal counting data demonstrated that there was no statistically significant difference between groups A and B, or between groups A and C. There was no functional or histologic evidence of donor nerve deterioration. In conclusion, the present study confirms that "double" end-to-side neurorrhaphy may be useful for the repair of divided human nerves with long gaps.

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Neuroma prevention by end-to-side neurorraphy: an experimental study in rats

Cited by 43 publications

References 21 publications

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

End-to-Side Nerve Repair in Peripheral Nerve Injury

Can end‐to‐side neurorrhaphy bridge large defects? An experimental study in rats

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