Protective distal side-to-side neurorrhaphy in proximal nerve injury—an experimental study with rats

Abstract

BackgroundSide-to-side neurorrhaphy may protect the denervated end organ and preserve the initial connection with proximal stump. We examined the effect of protective side-to-side anastomosis on nerve and end organ regeneration in proximal nerve injury model.MethodsThe left common peroneal nerve of 24 Sprague Dawley rats was proximally transected. In groups B and C, side-to-side neurorrhaphy was performed distally between the peroneal and tibial nerves without (group B) and with (group C) partial donor nerve axotomy inside the epineural window. Group A served as an unprotected control. After 26 weeks, the proximal transection was repaired with end-to-end neurorrhaphy on all animals. Regeneration was followed during 12 weeks with the walk track analysis. Morphometric studies and wet muscle mass calculations were conducted at the end of the follow-up period.ResultsThe results of the walk track analysis were significantly better in groups B and C compared to group A. Groups B and C showed significantly higher wet mass ratios of the tibialis anterior and extensor digitorum longus muscle compared to group A. Group C showed significantly higher morphometric values compared to group A. Group B reached higher values of the fibre count, fibre density, and percentage of the fibre area compared to group A.ConclusionsProtective distal side-to-side neurorrhaphy reduced muscle atrophy and had an improving effect on the morphometric studies and walk track analysis. Distal side-to-side neurorrhaphy does not prevent the regenerating axons to grow from the proximal stump to achieve distal nerve stump.

Insights on the Choice and Preparation of the Donor Nerve in Corneal Neurotization for Neurotrophic Keratopathy: A Narrative Review

“…The first sensory improvements are observed 6 months postoperatively and can continue up to 3 years [16,17]. Nerve endings can be connected through an end-to-end (E-E), end-to-side (E-S), or side-to-side (S-S) neurorrhaphy [23][24][25][26]. The E-E technique has shown overall better functional recovery, associated with increased nerve fiber count, area, and density [24].…”

Peroneal Nerve Repair with Cross-Bridge Ladder Technique: Parallel End-to-Side Neurorrhaphies

“…Current techniques in nerve repair have inconsistent results, and the wide variety of options makes it challenging to identify a clear superiority of any one strategy at this time. 16 17 …”

“…This technique has been explored in animal models and found to be protective against significant muscle atrophy and can lead to improved functional outcomes. 16 …”

“… 14 However, research regarding these different techniques has failed to demonstrate the consistent superiority of any technique. 14 15 16 17 Therefore, this article aims to explore the utility of the cross-bridge ladder technique (H-shaped), which has shown promising results in animal models and may be underutilized in clinical studies. This technique uses one or more nerve grafts placed in parallel between a donor and recipient nerve in an end-to-side fashion without transection of the donor or recipient nerves.…”

Somatic Nerve Reconstruction and Reinnervation

“…[9] established a model by ligating and fixing the proximal peroneal nerve transection of the right common peroneal nerve in New Zealand rabbits and opening a window of the outer membrane of distal and ipsilateral tibial nerves and anastomosing them with lateral suture, concluding that this method can effectively protect the motor end plate function of the denervated muscles. STS neurorrhaphy [10] is a remedial treatment for damaged nerves that cannot be repaired by conventional methods, such as high injury or incomplete injury such as brachial plexus lower trunk or sciatic nerve injury.…”