A morphological study of denervation and reinnervation of neuromuscular junction and muscle spindle after sciatic nerve crush in mice / 中华显微外科杂志

Objective:To observe the denervation and reinnervation of the neuromuscular junction (NMJ) and muscle spindle after sciatic nerve crush in mice.Methods:From January, 2019 to October, 2019, 18 C57BL/6 mice were randomly and evenly divided into injured groups (sciatic nerve crush group, 12 mice) and control groups (sham group, 6 mice). Mice in the injured group were sacrificed at day-1, day-2, day-3 and 4 weeks after the sciatic nerve injury. Mice in the control group were sacrificed at day-3 and 4 weeks from the day of experiment. The tibialis anterior muscles with crushed nerve were collected for immunohistochemistry staining by neurofilament (NF), synaptophysin (Syn) and α-bungarotoxin (α-BTX). Data were analysed by unpaired t-test. P<0.05 was considered significant difference. Results:The completely denervation of NMJ reached (92.4±8.85)% at day-3 after the nerve crush, compared with (5.19±1.32)% in the control group ( P<0.05). However, the muscle spindle lost γ-motor neuron innervation at day-2 after the nerve crush and completely denervated at day-3 after the surgery. For the reinnervation, no difference of no reinnervation of NMJ [(3.02±0.78)% vs. (4.22±2.08)%], partial reinnervation of NMJ [(6.44±1.91)% vs. (7.94±2.12)%] and completely reinnervation of NMJ [(90.54±10.44)% vs. (87.84±13.89)%] were observed between the control group and the injured group 4 weeks after the injury. While, for the muscle spindle, only the acetylcholine receptors at each end were partly reinnervated. The innervation of the middle part of the muscle spindle was thin and discontinued without typical spiral winding structure. Conclusion:The denervation speed of NMJ and muscle spindle was comparable after the peripheral nerve injury. The γ-motor neuron lost innervation ahead of the sensory neuron in the muscle spindle. The reinnervation of NMJ is earlier than that of the muscle spindle, and the re-innervation of the γ-motor neuron is prior to the sensory neuron in the muscle spindle.

A Rare Case Of Bilateral Variant Ansa Cervicalis And Review Of Literature

Ansa cervicalis is a nerve loop that is embedded in the anterior wall of carotid sheath of the neck. It is formed bydescendent hypoglossi and descendens cervicalis. It supplies the infrahyoid muscles. During routine dissection,a rare variant in the morphology of Ansa cervicalis was observed in adult male cadaver. The variant ansacervicalis exhibited two loops, and was present bilaterally. The formation, course and relations of the nerve loopis complex. During literature search, we came across studies which propose different classifications. Hence wehave added a note on the different classifications.Ansa cervicalis is important since it can be used in nerve-nerve anastomosis, nerve-muscle pedicle implantationin relation to reconstructive surgeries of larynx. Hence, the knowledge of variations in the formation, anddistribution is relevant. It can affect the outcome during reinnervation surgeries following recurrent laryngealparalysis and surgeries around this area of neck.

Selective Reinnervation of Posterior Cricoarytenoidmuscles by Upper Root of Unilateral Phrenic Cerve / 听力学及言语疾病杂志

Objective To study the experimental results of selective reinnervation of posterior cricoarytenoid(PCA) muscles by upper root of unilateral phrenic nerve.Methods Eight beagle dogs were used in this experiment.The left recurrent laryngeal nerves (RLNs) were severed and anastomosed with upper root of phrenic nerve, and the intralaryngeal adductor branch was cut and sutured into the belly of the ipsilateral PCA muscle. The right RLNs were kept intact, and were used as control group.Videolaryngoscopy and electromyography (EMG) were performed at preoperative, immediately after surgery and 6 months after surgery.After completion of all physiologic testings,the dogs were sacrificed and bilateral PCA muscles and intralaryngeal part of recurrent laryngeal nerves were harvested, then histological examination was carried out.The laryngeal nerve was stained with toluidine blue and the morphology of the axons was observed under light microscope.Results Preoperatively, the movement of bilateral vocal folds were normal in all dogs.The left vocal folds were fixed immediately after surgery, 6 months after surgery, the left vocal folds in all 8 dogs recovered inspiratory abductive movement.Spontaneous and evoked electrical activities of the reinnervated PCA muscles could be recorded in all cases during inspiration preoperatively.The left PCA muscles were electrical silent during normal inspiration, and evoked activities were not induced immediately after surgery.Spontaneous electrical activities and evoked electrical activities were recorded 6 months after surgery, and had no significant difference when compared with those of postoperative (P>0.05).There was no significant difference in the cross-sectional area of the bilateral posterior cricoarytenoid muscles fibers after the masson staining.Muscle collagen relative cross-sectional area and collagen relative cross-sectional area and muscle/collagen cross-sectional area ratio difference were not statistically significant(P>0.05).Nerve pulp numbers of left and right sides of the recurrent laryngeal nerves had no significant difference (P>0.05).Conclusion Selective reinnervation of posterior cricoarytenoid muscles by the upper root of unilateral phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent and avoid aberrant regeneration.

Treatment of bilateral vocal cord paralysis by hemi-phrenic nerve transfer / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the surgical effect of reinnervation of bilateral posterior cricoarytenoid muscles(PCA) with left hemi-phrenic nerve and endoscopic laser arytenoid resection in bilateral vocal cord fold paralysis(BVFP) and to analyze the pros and cons of the two methods.@*Methods@#One hundred and seventeen BVFP patients who underwent reinnervation of bilateral PCA using the left hemi-phrenic nerve approach (nerve group, n=52) or laser arytenoidectomy(laser group, n=65) were enrolled in this study from Jan.2009 to Dec.2015.Vocal perception evaluation, video stroboscopy, pulmonary function test and laryngeal electromyography were preformed in all patients both preoperatively and postoperative1y.Extubution rate was calculated postoperative1y.@*Results@#Most of the vocal function parameters in nerve group were improved postoperatively compared with preoperative parameters, albeit without a significant difference(P>0.05), while laser group showed a significant deterioration in voice quality postoperative1y(P<0.05). The two groups showed significant difference in voice quality postoperative1y(P<0.05). Videostroboscopy showed that vocal fold on the operated side in both groups could abduct to various extent postoperatively, which showed significant difference when compared with preoperative abductive movements (P<0.05). But the amplitude in nerve group was larger than that in laser group (P<0.05). 89% of the patients in nerve group were inhale physiological vocal cord abductions. Postoperative glottal closure showed no significant difference in nerve group (P>0.05), while showed various increment in laser group(P<0.05). Differences between the two groups were statistically significant(P<0.05). The pulmonary function in both groups was better after operation, reaching the reference value. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. The decannulation rate were 88.5% and 81.5% in nerve group and laser group respectively. In both groups, patients presented aspiration symptoms postoperatively, and rdieved soon, except 2 patients in laser group suffered repeated aspiration.@*Conclusions@#Reinnervation of bilateral PCA muscles using left hemi-phrenic nerve can restore inspiratory vocal fold abduction to a satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity, and do not affect swallowing function, greatly improving the quality of life of the patients.

Dynamic observation of corneal reinnervation after small incision lenticule extraction at cap by confocal microscope / 中华实验眼科杂志

Background Corneal reinnervation of subbasal nerve plexus have been found after small incision lenticule extraction(SMILE).However,there were few reports about corneal reinnervation mode and dynamic changes at the corneal cap in different time points postoperation.Objective The aim of this study was to evaluate the corneal reinnervation at the cap margin after SMILE.Methods The clinical data of 32 myopic eyes of 16 patients who received SMILE incision lenticule extraction surgery in Affiliated Eye Hospital of Shandong Medical College from April 2014 to April 2015 were retrospectively analyzed.The following-up was carried in 1 week,1 month,3 months and 6 months after surgery,and in-vivo confocal microscopy was used to acquire images of the central corneal subbasal nerve plexus before and after surgery,with the scan range of 0.4 mm×0.4 mm,from which nerve density and nerve tortuosity were evaluated using Image-Pro Plus imaging analysis software.The overall length of nerve fibers at the central cornea was measured to assess the subbasal nerve density,and the repair of nerve fibers at cap was observed.Results The corneal subbasal nerve density was (19 687.45 ± 1 147.59),(10 500.46 ± 1 056.22),(12 833.40-± 1 047.98),(13 564.04-± 1 173.01) and (14 661.35-±941.92) μm/mm2 in preoperation and postoperative 1 week,1 month,3 months,6 months,respectively,with a significant difference among different time points (F =319.44,P=0.000),and the corneal subbasal nerve densitis in postoperative time points were significantly reduced in comparison with the preoperation,and corneal subbasal nerve densities were gradually increased after surgery as the extending of time,showing significant differences between different time points (all at P＜ 0.01).Abundant corneal subbasal nerve fibers were seen with the near normal morphology after surgery.However,the fragments and disaggregation of nerve fibers were found at the incision of cap margins,and some nerve fibers extended toward the inner cap at the non-incision of cap margins 1 week after surgery.In 3-6 months after SMILE,the continuous extension of nerve fibers was exhibited under the confocal microscope.Conclusions Six months after surgery,less invasive SMILE technique can remain the superficial corneal nerve fibers.Corneal innervation shows a radiate mode from peripheral cornea outside toward inside of the cap.The subbasal never fiber density is gradually increased with the extending of time after SMILE.

Herpes Zoster Lesions on Reconstructed Breast Skin: Rare Objective Proof of Reinervation

Blazed up Herpes zoster lesions have been described in very few patients after free and pedicled flap transfer for reconstructive purpose. Although sensory recovery after flap reconstructions has been studied extensively most studies addressed subjective perceptions of sensation. Objective investigations of spontaneous reinervation of free and pedicled flaps are rare. We would like to present a witnessed herpes zoster infection of a latissimus dorsi skin flap 2 years after breast reconstruction.

Early Parasympathetic Reinnervation Is Not Related to Reconnection of Major Branches of the Vagus Nerve after Heart Transplantation

BACKGROUND AND OBJECTIVES: Bicaval heart transplantation (HTx) may promote parasympathetic reinnervation. However, the prevalence and timing of reinnervation have not been fully investigated. Heart rate variability (HRV) and direct vagal stimulation were used to evaluate the presence of parasympathetic reinnervation after bicaval HTx. SUBJECTS AND METHODS: A total of 21 patients (time after HTx 0.52-4.41 years, mean 1.8±1.2 years) who received a bicaval HTx was enrolled. Reinnervation was evaluated using HRV values from 24-hour Holter recordings. A cross-sectional analysis of the HRV at 0.5-1, 1-2, and >2 years after HTx was performed. We also applied high-frequency electrical stimulation (16.7 Hz, 1 msec pulse width, ≤10 V) to the cardiac branches of the vagus nerve at the level of the superior vena cava in eight patients at 6 and 12 months after HTx. RESULTS: The degree of parasympathetic reinnervation corresponded to the time after HTx. The HRV analysis revealed that the root mean square of the successive differences between consecutive RR-intervals (RMSSD) and high-frequency power were significantly higher during the late period (>2 years) compared with the early period (0.5-1 year) after HTx. None of the eight patients who underwent direct vagal stimulation responded during the stimulation at 6 and 12 months, whereas incremental trends in HRV parameters were observed, which indicated that parasympathetic reinnervation began within 1 year after HTx. CONCLUSION: Parasympathetic reinnervation seemed to begin in the early period (<1 year) after bicaval HTx. Reconnection of major branches of the vagus nerve may not be related to early reinnervation.

Neurorrhaphy techniques: comparative stereological and experimental axonal study / Técnicas de neurorrafia: estudio experimental estereológico axonal comparativo

There is a great variety of injuries that affect peripheral nerves derived from acquired or congenital degenerative diseases affecting the central nervous system that cause loss of sensorimotor functions. The objective of this work was to perform an end-to-side or side-to-side experimental axonal stereological study in order to compare volume density of axons, endouneuro and myelin sheath (and muscle mass) in peroneal and tibial nerves, with anastomosis contact from 0.25 cm to 0.50 cm. After approval of the Ethics Committe, 20 male Wistar rats were divided into four groups of five rats each (G1= end-to-side neurorrhaphy; G2= side-to-side neurorrhaphy of 0.25 cm; G3= side-to-side neurorrhaphy of 0 cm and G4= Control of normality). After 180 days, fragments of peroneal and tibial nerves were collected for histological and stereological study. In comparative stereological experimental study between neurorraphies, the volume density of axons, myelin sheath of tibial and fibular nerves, as well as the post-surgical muscle mass, remains the same in end-to-side and side-to-side neurorraphies, regardless of contact area of anastomosis. It can be inferred, as surgical repair options, both end-to-side neurorrhaphy to recover and prevents atrophy of the endplate as side-to-side neurorraphy that is independent of the distance between the nerve stumps.

Gran variedad de lesiones atingen a los nervios periféricos, derivadas de enfermedades adquiridas o degenerativas congénitas que afectan la parte central del sistema nervioso y que ocasionan pérdida de funciones sensoriomotoras. El objetivo de ese trabajo fue realizar un estudio experimental estereológico axonal post neurorrafias termino-lateral o latero-lateral para comparar densidad de volumen de axones, endoneuro y vaina de mielina (así como masa muscular) en nervios fibular y tibial, con unión de contacto entre 0,25 cm y 0,50 cm. Tras la aprobación del comité de ética, fueran utilizados 20 ratones machos de la raza Wistar divididos en cuatro grupos de 5 ratones cada uno (G1= Neurorrafia término lateral; G2= Neurorrafia latero lateral de 0,25 cm; G3= Neurorrafia latero lateral de 0,50 cm y G4= Control). Posteriormente, fragmentos de los nervios tibiales y fibulares fueron procesados para estudios histológicos y estereológicos. En el estudio experimental estereológico comparativo entre neurorrafias termino-lateral y latero-lateral, la densidad de volumen de axones, endoneuro y vaina de mielina de nervios tibial y fibular y también la masa muscular post quirúrgica se mantuvo equitativa, independientemente del área de unión de contacto. Podemos inferir como opciones de reparación quirúrgica, que el tratamiento de la neurorrafia termino-lateral y latero-lateral previnen la atrofia de placa motora, independiente de la distancia entre los muñones nerviosos.

Effective reinnervation of the quadriceps femoris by spinal ventral root cross-anastomosis in rats / Reinervação efetiva do quadríceps femoral pela anastomose cruzada via raiz espinhal ventral em ratos

PURPOSE: To study the effective recovery of the quadriceps femoris by spinal ventral root cross-anastomosis in rats. METHODS: End-to-end anastomosis was performed between the left L1 and L3 ventral roots using autogenous nerve graft ,and the right L1 and L3 roots were left intact. In control animals, the left L3 ventral root was cut and shortened, and anastomosis was not performed. Six months postoperatively, the movement of low extremities was detected by electrophysiological examination, hindlimb locomotion and basso, beattie and bresnahan (BBB) scoring at one, three, seven, 14, 21 and 28 days after SCI. Fluorescence retrograde tracing with TRUE BLUE (TB) and HE staining were performed to observe the nerve regeneration. RESULTS: Six months after surgery, the anastomotic nerve was smooth and not atrophic. The amplitudes of action potential were 7.63±1.86 mV and 6.0±1.92 mV respectively before and after the spinal cord hemisection. The contraction of left quadriceps femoris was induced by a single stimulation of the anastomotic nerve. The locomotion of left hindlimb was partially restored after spinal cord hemisection while creeping and climbing. In addition, there was significant difference in the BBB score at one, three and seven days after SCI. TB retrograde tracing and neurophysiologic observation indicated efficient reinnervation of the quadriceps femoris. CONCLUSION: The cross-anastomosis between spinal ventral root can partially reconstruct the function of quadriceps femoris following SCI and may have clinical implication for the treatment of human SCI.

OBJETIVO: Investigar a recuperação efetiva do músculo quadríceps femoral pela anastomose cruzada via raiz espinhal ventral em ratos. MÉTODOS: Anastomose término-terminal foi realizada entre as raízes ventrais L1 e L3 à esquerda usando enxerto autógeno de nervo e, à direita, as raízes L1 e L3 foram mantidas intactas. Nos animais controles, à esquerda, a raiz ventral de L3 foi cortada e encurtada sem realização de anastomose. Após seis meses, o movimento das extremidades posteriores foi estudado por exame eletrofisiológico, e pelo escore de basso, beattie e bresnahan (BBB) com um, três, sete, 14, 21 e 28 dias após SCI. Fluorescência retrograde feita com TRUE BLUE (TB) e coloração com HE foram realizadas para observar a regeneração do nervo. RESULTADOS: Seis meses após a cirurgia, a anastomose do nervo estava lisa e sem atrofia. As amplitudes dos potenciais de ação foram 7,63±1,86 mV e 6,0±1,92 mV respectivamente antes e após a hemisecção da medula espinhal. A contração do músculo quadríceps femoral foi induzida por um único estímulo do nervo anastomosado. A locomoção do membro posterior esquerdo foi parcialmente restaurada após hemisecção da medula espinhal ao rastejar e escalar. Ademais, houve diferença significante no escore BBB nos dias um, três e sete após SCI. O traçado da TB retrógrada e a observação neurofisiológica indicaram reinervação eficiente do quadríceps femoral. CONCLUSÃO: A anastomose cruzada entre as raízes espinhais ventrais podem reconstruir parcialmente a função do quadríceps femoral após SCI e pode ter implicação clínica para o tratamento da SCI.

Laryngeal reinnervation using ansa cervicalis for iatrogenic unilateral vocal fold paralysis / 中华普通外科杂志

ObjectiveTo evaluate long-term outcome of laryngeal reinnervation using the main branch of the ansa cervicalis for the treatment of unilateral vocal fold paralysis (UVFP) caused by thyroid surgery. MethodsFrom Oct.1990 to Jan.2010,a total of 325 UVFP patients who underwent main branch of ansa cervicalis-to-recurrent laryngeal nerve (RLN) anastomosis were enrolled in the study.We retrospectively analyzed the efficacy of the reinnervation surgery using videostroboscopy,vocal function assessment (acoustic analysis,perceptual evaluation and maximum phonation time ),and laryngeal electromyography. ResultsVideostroboscopy showed that the glottic closure,vocal fold edge,vocal fold position,phase symmetry and regularity were significantly improved postoperatively. The vocal function parameters (GRBAS scale,jitter,shimmer,noise to harmonics ratio and maximum phonation time) were also significantly improved postoperatively ( P ＜ 0.01 ),as compared to corresponding preoperative values.Voice recovered to a normal level in 93.5％(304/325)patients,and the effective rate was 98.8％ (321/325). Postoperative laryngeal electromyography confirmed successful reinnervation of laryngeal muscle. CondusionsLaryngeal reinnervation using the main branch of ansa cervicalis is a feasible and effective approach for treatment of UVFP patients caused by thyroid surgery,with satisfactory long-term results.

A preliminary study on the reinnervation effect of the Riche-Cannieu anastomosis / 中华显微外科杂志

ObjectiveTo study whether the abductor pollicis brevis been effected by the reinnervation of the Riche-Cannieu anastomosis in the median nerve injury cases.MethodsCollect 43 cases (29male,14 female,mean age 32.6)corresponds with the study needs: (1)The traumatic median nerve injury (proved by the results of electrophysiological examine and the clinic diagnose)on or below the forearm.(2)The existence of RCA was verified by the electrophysiological examine results,and the amplitude of electric potential was under 1mv.(3) Rule out the cases with the other injure of nerve or nervous system disease and cervical vertebra disease,diabetes patient.The analysis base on the results of 43 case's periodical examine,the periodical criteria as following: within 2-4th week,within the 2-4thmonth and 1 year after the injury.Results Forty-three cases had not obvious recovery indication of the median nerve under the clinical and electrophysiological aspect,eight cases of abductor pollicis brevis function improved quickly in 3 months,the relevant CMAP amplitude of Riche-Cannieu anastomosis increased apparently,the EMG (Electromyography)results of abductor pollicis brevis ameliorated accordingly.ConclusionIn the case of RCA combined with the median nerve injury,the abductor pollicis brevis fibra might be dominated by RCA reinnervation when losing domination of median nerve,the reinnervation process will much faster than the regeneration process of the broken nerve.

Neurectomia digital em eqüinos: comparação das técnicas guilhotina e stripping / Digital neurectomy in horses: comparison of guillotine and stripping techniques

Compararam-se as dificuldades transcirúrgicas e as complicações pós-operatórias das técnicas guilhotina (TG) e stripping (TS) para a neurectomia digital em eqüinos. Sob anestesia com halotano, quatro éguas tiveram os nervos digitais de um dos membros torácicos e um dos pélvicos submetidos à TG, enquanto os nervos digitais dos membros colaterais foram submetidos à TS. Os tempos cirúrgicos médios de TG e TS foram semelhantes. O comprimento médio do fragmento do nervo removido foi três vezes maior em TS (P<0,001). Independente da técnica utilizada, houve perda total da sensibilidade nos talões de todos os membros dentro dos quatro primeiros meses da cirurgia. Após 14 meses, houve retorno da sensibilidade em 37 por cento dos membros em TG e 18,8 por cento em TS (P=0,06). Ao exame de palpação para identificação de neuromas dolorosos, houve episódios de sensibilidade discreta em um maior número de cotos nervosos proximais operados com TS, 53,6 por cento contra 6,4 por cento dos operados com TG (P=0,003). Ambas as técnicas foram satisfatórias por não apresentarem maiores complicações durante ou após a cirurgia. Considerou-se que TG apresentou menor potencial para produzir reinervação e neuromas dolorosos.

The surgical difficulties and the postoperative complications of two techniques for equine digital neurectomy, the guillotine (TG) and the stripping (TS), were evaluated. Four mares under halothane anesthesia were submitted to the TS in the digital nerves of a thoracic and a pelvic limbs, and TG in the contralateral limbs. The mean surgical times for TG and TS were similar. The mean transected nerve length was three times greater in TS (P<0.001). In both techniques, total lost of sensibility was observed in all heel bulbs during the first four months. After 14 months, sensibility returned to 37 percent limbs in treated by TG, and 18.8 percent in those treated by TS (P=0.06). Discreet painful sensation was identified by the response of digital palpation of the neuroma in a greater number of nerve stumps where TS was performed, 53.6 percent versus 6.4 percent of those operated by TG (P=0.003). No major complications were observed during or after surgery and both techniques were considered satisfactory. TG was considered with less potential to produce painful neuromas and reinnervation.

Remodeling of skin nerve fibers during wound healing / 中国矫形外科杂志

[Objective]To observe changes of skin reinnervation during burn wound healing and determine remodeling of nerve fibers.[Method]Wound tissue and scars were harvested.Collagen was determined with modified Masson trichrome staining and nerve fibers were labeled with neuro filament protein by immunofluorescent technique.Three dimension reconstruction of nerve fibers regenerated was observed under laser scanning confocal microscope.[Result]The CVF(collagen volume fraction) increased during the process of wound healing.The regenerated nerve fibers were sparse,short and small,which was significant lower the normal control.The skin reinnervation improved during the wound healing process and came to peak NVF(nerve fiber volume fraction) in proliferative stage.Disintegration and fragmentation were observed frequently in samples from proliferative stage,which seldom occurred during mature stage.[Conclusion]The remodeling of skin nerve fibers comprises a sequential process of increasing number,shape distortion during wound healing and then disintegration,number decrease and normal shape.

The Relationship between Functional Recovery and Reorganization of Nucleus Ambiguus Following Laryngeal Reinnervation in Rats / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ideally, treatment for vocal cord paralysis should restore normal physiologic and dynamic movement of the vocal fold. Recently, numerous studies of laryngeal reinnervation have been designed to restore function of the paralyzed larynx. None of these approaches have been consistently successful, probably due to synkinesis and an inadequate number of regenerated axons. In previous study, we confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. In this study, the relationship between functional recovery and reorganization of nucleus ambiguus following laryngeal reinnervation in rats was evaluated by retrograde double tracing technique and electron microscope. MATERIALS AND METHOD: Transections and primary anastomosis were done on left recurrent laryngeal nerves of 86 healthy male Sprague-Dawley rats. Rats were then randomly assigned to 2 groups (the group A: stimulation with PEMS, the group B: non-stimulation with PEMS). Functionally recovered status was confirmed with laryngo-videostroboscopy and laryngeal EMG. And then, functional reorganization of laryngeal motoneuron in the nucleus ambiguus (NA) was evaluated using retrograde double tracing techniques. Morphological changes of the degeneration and regeneration processes following injury was observed by electron microscopy. RESULTS: 20 rats (63%) in group A and 5 rats (17%) in the group B showed recovery of vocal fold motion. The functional reorganization of laryngeal motor neurons in the NA was observed in the rats with functional recovery (n=8), but not in the rats without functional recovery (n=8). In the electron microscopic finding, the nerve fibers of functional recovered rats were relatively well regenerated. But the configuration of the nerve fibers of non-functionally recovered rats was markedly irregular and the total axon population was smaller than that of the recovered rats, except for some cases. CONCLUSION: This study shows that failure of functional recovery of vocal fold movement following laryngeal reinnervation is probably due to not only the misdirected reinnervation, but also the incomplete axonal regeneration.

CLINICAL STUDY OF ARTIFICIAL BLADDER REFLEX ARC ESTABLISHED BY ACHILLES TENDON REFLEX / 解放军医学杂志

To explore the possibility of bladder reinnervation and artificial triggering voiding established by Achilles tendon reflex after spinal cord injuries above cone. Bilateral anterior roots of S 1 and main bladder innervating roots (S 2 or S 3) in 8 patients were severed intradurally and then anastomosed to establish artificial reflex arc of "Achilles tendon spinal cord bladder". After followed up for an average of 2 8 years, it was found that the patients were free from nocturnal incontinence, with micturition frequency of 5～6/d, and the urinary volume varied from 250 to 500 ml each time. The results suggested that artificial reflex arc of "Achilles tendon spinal cord bladder" could restore bladder function in patients with spinal cord injuries above cone

The Effects of Pulsed Electromagnetic Stimulation on Functional Recovery Following Laryngeal Reinnervation in the Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Ideal treatment for vocal cord paralysis is to restore normal movement of the vocal cord and to bring back the natural voice. Pulsed electromagnetic stimulation (PEMS)has been known to bring early nerve regeneration as well as better functional recovery. The purpose of this investigation is to learn the effect of PEMS on regeneration of the recurrent laryngeal nerve. MATERIALS AND METHOD: Using 36 healthy male Sprague-Dawley rats, we made transections on their left recurrent laryngeal nerves and performed primary anastomosis under the operating microscope. Rats were divided into an experimental group and a control group, each having 18 rats by random sampling. For the experimental group, PEMS was carried out three hours a day and five days a week for twelve weeks. For the control group, PEMS was not given while other conditions were kept the same as in the experimental group. The extent of functional recovery was observed for each group by performing videostroboscopic examination once every week. After twelve weeks, a test for the functional recovery was performed electrophysiologically through laryngeal electromyography during respiration. RESULTS: After the twelve-week experiment, 14 out of 18 rats survived in the group which received PEMS while 8 out of 18 rats stayed alive in the control group. Ten rats (71%)in the PEMS performed group and 3 rats (38%)in the control group showed recovery of vocal cord movement, but it did not reveal any significant difference statistically. However, the time it took for functional recovery was 3.93+/-0.27 weeks and 7.87+/-0.85 weeks for the PEMS performed group and the control group, respectively. And the difference was statistically significant. CONCLUSION: This investigation confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. Further studies to understand the mechanism of action of these effects as well as the local stimulation rather than the total body stimulation seem to be necessary.

Postoperative Sensibility Test in Patients Undergoing Reconstruction of Donor Defect of Flap Surgery with an Acellular Allograft Dermal Matrix ( AlloDerm )

Numerous choices exist for closing any wound, so the surgical challenge is that of selecting the optimal method. It is necessary to balance multiple factors, including recipient site requirements, donor site morbidity, operative complexity, and patient factors. Limiting the donor site morbidity is emphasized in the aphorism "Never rob Peter to pay Paul unless Peter can afford it. Certainly, documented cases exist in which donor site morbidity exceeds the original recipient problem, necessitating a second procedure to reconstruct the donor site. The flap survived and the wound was closed, but the donor site was often worse than the original defect. Numerous donor site complications are often overlooked while one concentrates on the successful flap transfer. The standard method for grafting donor wound after harvesting of a flap uses thick split-thickness skin grafts. This method, however, creates an additional comlication-prone wound at the donor sites. Donor sites for grafting can be painful and may develop infection, hypertrophic scarring, blistering. The problem of donor sites scar hypertrophy occurs most frequently when a graft is taken at more than 0.012 inch thick, leaving a residual dermal bed is too thin. AlloDerm processed allograft dermis was developed as a permanent dermal transplant for full thickness wounds. Between 1997 and 1999, we have applied AlloDerm grafts and ultra-thin autografts on 11 patients with donor sites after harvesting flaps. All the composite AlloDerm /autograft were noted to be firmly adherent except 2 cases, which showed focal loss of the grafts and was healed after second graft. AlloDerm exhibited a high percentage take and supported an overlying ultra thin split-thickness skin autograft, applied simultaneously. By providing a dermal replacement, the grafted dermal matrix permitted a thin autograft from the donor site. The ultra-thin autografts leave donor sites that heal faster and with fewer complication. AlloDerm dermal transplants exhibit excellent elastisity and good pigmentation with minimal scarring or wound contracture. Sensory reinnervation after the composite AlloDerm/autograft was not fully recovered. The reason was that these grafts were placed on the bone or tendon exposed sites which were not sufficiently well- innervated graft bed. The high reproducibility of excellent results with this composite graft, coupled with the reduced trauma and rapid healing of donor sites associated with ultra-thin autograft STSG, has made composite grafting with the use of AlloDerm dermal transplants our new method of choice for treatment of donor defects of flap surgery.

Electrophysiological Properties of Reinnervated Motor Units by Transplant of Embryonic Spinal Cord in Rat / 대한정형외과학회잡지

OBJECTIVE: Recently, we have demonstrated that embryonic ventral spinal cord motor neurons(ESMNs), transplanted into the distal stump of the axotomized tibial nerve, can grow into the denervated gastrocnemius muscle and form neuromuscular junctions. Our interest in study was to see whether these newly formed neuronal connections are physiologically active, and to electrophysiologically characterize the reinnervated motor units. MATERIAL AND METHODS: Three to eight weeks after transplantation rats were prepared for electrophysiological recording. Motor unit (MU) action potential and gross EMG were monitored. In eleven out of sixteen transplanted animals single unit and gross EMG were recorded after electrical stimulation of the transplant site. Total of 63 motor units were analyzed for their stimulus threshold (ST), latency and stimulus intensity, which is required to produce maximum firing. RESULTS: ST intensities activating MUs were significantly higher in transplanted animals than in controls. Maximum firing of MUs occurred at less than 1.2×T in the control but greater variation was observed in the transplanted animals ranging from 1.1×T to 1.6×T. No significant differences were found in the latencies of MU's firing following stimulation. MU firing was reversibly blocked by infusion of succinylcholine. CONCLUSION: we characterized the temporal, morphological and electrophysiological parameters of denervated skeletal muscle reinnervated by dissociated grafts of embryonic ventral spinal cord cells. MUs reinnervated by the embryonic motoneuronal transplant were physiologically active, with some properties similar to the MUs of the normal.