Overcoming Peripheral Nerve Gap Defects Using an Intact Nerve Bridge in a Rabbit Model

ABSTRACT

This study investigated the intact nerve bridge technique for overcoming peripheral nerve gap defects in a rabbit model. To create the intact nerve bridge, a 1-cm segment of the peroneal nerve is resected leaving a gap defect. The proximal and distal peroneal nerve stumps are sutured 1 cm apart, in an end-to-side fashion, to the intact tibial nerve epineurium. Four experimental groups were used (n = 10): primary repair of resected segment; intact nerve bridge; nerve autograft; and gap in situ control. Evaluation after 12 weeks included measurement of isometric muscle contraction force, axonal counting, wet muscle weights, and histologic examination. The results of this study support two main conclusions, in a rabbit model: (a) regenerating axons can use the epineurium of an intact nerve to bridge a gap defect; (b) there is no significant difference in the functional recovery between standard nerve autografts and the intact nerve bridge technique.

KEYWORDS

Peripheral nerve injury - gap defect - intact nerve bridge

REFERENCES

• 1 McCallister W V, Cober S R, Norman A, Trumble T E. Using intact nerve to bridge peripheral nerve defects: an alternative to the use of nerve grafts.  J Hand Surg. 2001;  26A 315-325
• 2 Mackinnon S E, Hudson A R, Hunter D A. Histologic assessment of nerve regeneration in the rat.  Plast Reconstr Surg. 1985;  75 384-388
• 3 McCallister W V, Tang P, Trumble T E. Is end-to-side neurorrhaphy effective? A study of axonal sprouting stimulated from intact nerves.  J Reconstr Microsurg. 1999;  15 597-603 , discussion 603-604
• 4 Lundborg G, Dahlin L B, Danielsen N et al.. Nerve regeneration in silicone chambers: influence of gap length and of distal stump components.  Exp Neurol. 1982;  76 361-375
• 5 Brunelli G A, Vigasio A, Brunelli G R. Different conduits in peripheral nerve surgery.  Microsurgery. 1994;  15 176-178
• 6 Lundborg G, Dahlin L B, Daneilson N et al.. Nerve regeneration across an extended gap: a neurobiological view of nerve repair and the possible involvement of neuronotrophic factors.  J Hand Surg. 1982;  7A 580-587
• 7 Zhao Q, Dahlin L B, Kanje M, Lundborg G. Specificity of muscle reinnervation following repair of the transected sciatic nerve. A comparative study of different repair techniques in the rat.  J Hand Surg. 1992;  17B 257-261
• 8 Hie H B, van Nie C J, Vermeulen-van der Zee E. Twitch tension, muscle weight, and fiber area of exercised reinnervating rat skeletal muscle.  Arch Phys Med Rehabil. 1982;  63 608-612
• 9 Ludbrook J. Multiple comparison procedures updated.  Clin Exp Pharmacol Physiol. 1998;  25 1032-1037
• 10 Trumble T. Peripheral nerve transplantation: the effects of predegenerated grafts and immunosuppression.  J Neural Transplant Plast. 1992;  3 39-49
• 11 Trumble T E, Whalen J T. The effects of cryosurgery and cryoprotectants on peripheral nerve function.  J Reconstr Microsurg. 1992;  8 53-58 , discussion 59-60
• 12 Dellon A L, Mackinnon S E. Selection of the appropriate parameter to measure neural regeneration.  Ann Plast Surg. 1989;  23 197-202
• 13 Wilkholm R P, Swett J E, Torigoe Y, Blanks R H. Repair of severed peripheral nerve: a superior anatomic and functional recovery with new “reconnection” technique.  Otolaryngol Head Neck Surg. 1998;  99 353-361
• 14 Devor M, Schonfeld D, Seltzer Z, Wall P D. Two modes of cutaneous reinnervation following peripheral nerve injury.  J Comp Neurol. 1979;  185 211-220
• 15 de Medinaceli L, Freed W J, Wyatt R J. An index of the functional condition of rat sciatic nerve based on measurements made from walking tracks.  Exp Neurol. 1982;  77 634-643
• 16 Tarasidis G, Watanabe O, Mackinnon S E, Strasberg S R, Haughey B H, Hunter D A. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model.  Ann Otol Rhinol Laryngol. 1997;  106 506-512
• 17 Tarasidis G, Watanabe O, Mackinnon S E, Strasberg S R, Haughey B H, Hunter D A. End-to-side neurorrhaphy: a long-term study of neural regeneration in a rat model.  Otolaryngol Head Neck Surg. 1998;  119 337-341
• 18 Bertelli J A, dos Santos A R, Calixto J B. Is axonal sprouting able to traverse the conjunctival layers of the peripheral nerve? A behavioral, motor and sensory study of end-to-side nerve anastamosis.  J Reconstr Microsurg. 1996;  12 559-563
• 19 Mackinnon S E, Dellon A L. A study of nerve regeneration across synthetic (Maxon) and biological (collagen) nerve conduits for nerve gaps up to 5 cm in the primate.  J Reconstr Microsurg. 1990;  6 117-121
• 20 Benito-Ruiz J, Navarro-Monzonis A, Piqueras A, Baena-Montilla P. Invaginated vein graft as nerve conduit: an experimental study.  Microsurgery. 1994;  15 105-15
• 21 Scherman P, Lundborg G, Kanje M, Dahlin L B. Neural regeneration along longitudinal polyglactin sutures across short and extended defects in the rat sciatic nerve.  J Neurosurg. 2001;  95 316-322