Vein graft conduits versus conventional suturing in peripheral nerve reconstructions

Heijke, Guda C.M.; Pj, Klopper; Dutrieux, Richard P.

doi:10.1002/micr.1920140908

Cited by 38 publications

(35 citation statements)

References 16 publications

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“…13À15 Others reported that contact between vein graft endothelial cells and regenerating axons stimulates connective tissue development and fibrosis which causes nerve constriction, impairing axon regeneration. 16,17 Standard artery tubulization did not show positive results and should not be applied in peripheral nerve repair. Artery endothelial basement membrane provides a large diameter conduit, therefore, 1 the contact surface for regenerating axons or Schwann cells becomes very small.…”

Section: à18mentioning

confidence: 91%

Inside‐out vein graft and inside‐out artery graft in rat sciatic nerve repair

et al. 2003

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Although veins and arteries present similar wall structures, there are differences which may be relevant in peripheral nerve reconstruction. Inside-out vein grafts (IOVG) have been satisfactorily used to repair both motor and sensitive nerves. However, the inside-out artery graft (IOAG) is a new technique and not fully investigated. Our study presents comparative morphological data on nerve regeneration achieved with IOVG and IOAG in the repair of Wistar rat sciatic nerves. Jugular veins and aorta arteries were harvested from donor animals and used "inside-out" to bridge a 10-mm gap. Animals were sacrificed at 10 weeks to evaluate nerve regeneration. Both techniques presented great variability in nervous tissue, though some animals showed satisfactory results. Different intensities of scarring processes might have interfered with nerve regeneration. Although IOVG and IOAG techniques showed similar morphometric results, in general, IOVG presented a closer-to-normal nerve organization than IOAG.

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Section: à18mentioning

confidence: 91%

Inside‐out vein graft and inside‐out artery graft in rat sciatic nerve repair

et al. 2003

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“…19,20 In a previous study, we demonstrated in an animal model by means of immunohistologic staining and analyzing the amount of ingrowing axons the poor results of the autologous venous tube procedure compared with conventional suturing in nerve reconstruction. 21 However, recently better results were obtained by vein conduits filled with fresh skeletal muscle. The results are similar to those obtained with traditional nerve grafts in cases with a substance loss of as much as 2 cm.…”

Section: Microsurgery 21:84-95 2001mentioning

confidence: 99%

Processed porcine collagen tubulization versus conventional suturing in peripheral nerve reconstruction: An experimental study in rabbits

Heijke

Doorn

et al. 2001

Microsurgery

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In peripheral nerve reconstruction, various procedures are used. One of the procedures that received the most interest in the past decade is the tubulization technique for small nerve gaps. A disadvantage in the use of non-biodegradable tubes is that the material often has to be removed owing to its mechanical properties. Some investigators, in exploring the use of collagen tubes, being a natural biodegradable material, found either allogenicity or xenogenicity and immune responses that may inhibit nerve regeneration. Processed porcine collagen (PPC) is a new inert and biodegradable material that has a favorable effect on wound healing, as demonstrated by experiments on other tissues. The aim of our study was to compare the healing of nerve sutures with PPC tubes with conventional end-to-end sutures. In our experiments, we reconstructed the saphenous nerves of 27 rabbits. In series 1 (n = 12) and 2 (n = 12), PPC tubes were slid over an end-to-end nerve suture without or with a 10-mm nerve gap, respectively. In series 3 (n = 12), conventional suturing was performed in the collateral saphenous nerves of the animals of series 1. Epineurial suturing was performed. Three other non-operated saphenous nerves served as controls. The healing was studied after 3, 6, and 12 months in sections stained by monoclonal antibodies and by conventional histologic staining. Morphometric analysis of the regenerating axons was done by using confocal scanning laser microscopy (CLSM). Data analysis was carried out using a software program especially developed for this purpose. All results were evaluated statistically. Our results showed that during the healing period in the distal nerve stump, the number of axons of the PPC procedure with a 10-mm gap was significantly higher than that in the procedure without a gap. At 12 months, the mean number of axons of all procedures was significantly lower than in the non-operated nerve, and the mean axon diameter in all distal stumps did not differ significantly from that of the non-operated nerve. In the distal nerve stump, the ratio of total axon area to total fascicle area in the PPC procedure with a gap was significantly higher than that in the conventional suturing procedure. After 12 months, there was no significant difference between the percentages of axon outgrowth of the PPC procedure without a gap, the conventional suturing procedure, and the non-operated nerve (100%). The percentage of axon outgrowth in PPC with a gap was significantly higher than in the other procedures.

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“…5À9 However, in a previous study, we demonstrated by means of immunohistochemical staining and morphometric analysis of the number of outgrowing axons the poor results of the autologous venous tubulus procedure compared with conventional suturing in sensory nerve reconstruction in rabbits. 10 Because of the donor-site morbidity of autotransplants, the use of non-biological material became popular in the past decade. 4,11,12 Campbell et al 13 and Bassett et al 14 had favorable results with Millipore tubes in nerve reconstruction.…”

Section: Microsurgery 21:306à316 2001mentioning

confidence: 99%

Silicone rubber tubulization in peripheral sensory nerve reconstruction: An experimental study in rabbits

Heijke

Baljet

et al. 2001

Microsurgery

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Silicone rubber (polydimethyl siloxane) tubes are used clinically in peripheral nerve reconstruction. A disadvantage of this procedure is that the material often has to be removed owing to its mechanical properties. The aim of our study was to investigate the healing of reconstructed sensory nerves tubulized by silicone rubber in an animal model. In our experiments, we reconstructed the saphenous nerves in 27 rabbits. In series 1 (n = 12), silicone rubber tubes were slid over a nerve suture without a gap. In series 2 (n = 12), silicone rubber tubes were slid over a 10-mm nerve gap. In series 3 (n = 12), conventional suturing was performed in the collateral saphenous nerves of the animals of the series 1. Epineurial suturing was performed. Three other collateral nonoperated saphenous nerves served as controls. The healing was studied after 3, 6, and 12 months. Morphometric analysis of the regenerating axons was performed by using our new method for quantification of nerve fibers in cross sections stained by immunohistochemistry and using confocal laser scanning microscopy. Data analysis was carried out using a software program especially developed for this purpose. Our results showed in the silicone procedures that at 12 months significantly fewer axons per fascicle area were present compared with conventional suturing. However, mean axon diameters in the distal nerve stump of the silicone procedures did not differ significantly compared with the conventional suturing procedure. The ratio of total axon area to total fascicle area in the distal nerve stumps of the silicone procedure without gap was significantly smaller compared with the conventionally sutured nerve. The percentage outgrowing axons from the proximal nerve stump into the distal one in the silicone rubber procedure without gap was 57%. This was significantly higher than in the silicone rubber procedure with 10-mm gap (48%). However, in conventional suturing, the percentage of outgrowing axons (99%) was significantly higher than in both tubulization procedures. It appeared that tubulization by silicone rubber of sutured nerves without gap did not enhance axon regeneration. Conventional suturing gave significantly better results. If a gap was present, the use of a silicone rubber tube was preferable to non-suturing.

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Vein graft conduits versus conventional suturing in peripheral nerve reconstructions

Cited by 38 publications

References 16 publications

Inside‐out vein graft and inside‐out artery graft in rat sciatic nerve repair

Inside‐out vein graft and inside‐out artery graft in rat sciatic nerve repair

Processed porcine collagen tubulization versus conventional suturing in peripheral nerve reconstruction: An experimental study in rabbits

Silicone rubber tubulization in peripheral sensory nerve reconstruction: An experimental study in rabbits

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