Histological analysis of low-intensity laser therapy effects in peripheral nerve regeneration in Wistar rats / Avaliação histológica dos efeitos da laserterapia de baixa potência sobre os processos de regeneração nervosa periférica em ratos Wistar

Purpose: Analyze the influence of low-intensity laser therapy in the sciatic nerve regeneration of rats submitted to controlled crush through histological analysis. Methods: Were used 20 Wistar rats, to analyze the influence of low-intensity laser therapy in the sciatic nerve regeneration, where the injury of the type axonotmesis was induced by a haemostatic clamp Crile (2nd level of the rack). The animals were randomly distributed in 2 groups. Control group (CG n = 10) and Laser group (LG n = 10). These were subdivided in 2 subgroups each, according to the euthanasia period: (CG14 _ n = 5 and CG21 _ n = 5) and (LG14 _ n = 5 and LG21 _ n = 5). At the end of treatment, the samples were removed and prepared for histological analysis, where were analyzed and quantified the following findings: Schwann cells, myelinic axons with large diameter and neurons. Results: In the groups submitted to low-intensity laser therapy, were observed an increase in the number of all analyzed aspects with significance level. Conclusion: The irradiation with low intensity laser (904nm) influenced positively the regeneration of the sciatic nerve in Wistar rats after being injured by crush (axonotmesis), becoming the nerve recovery more rapid and efficient.

Objetivo: Verificar a influência da terapia com laser de baixa potência na regeneração histológica do nervo ciático de ratos submetidos à neuropraxia controlada. Métodos: Foi utilizada a amostra de 20 ratos da linhagem Wistar, para verificar a influência da terapia com laser de baixa intensidade na regeneração nervosa periférica, onde a lesão do tipo axoniotmese foi induzida por meio de preensão com pinça hemostática de Crile. Os animais foram distribuídos randomicamente dois grupos. Grupo controle (CG n = 10), e Grupo laser (LG n = 10). Cada um destes grupos foi subdividido em dois subgrupos dependendo do período da eutanásia: (CG14 - n = 5 e CG21 - n = 5) e (LG14 - n = 5 e LG21 - n = 5). Ao final do tratamento, amostras do nervo foram retiradas e analisadas histologicamente, nas quais foi adotado na pesquisa a análise do número de neurônios, de células de Schwann (CS) e de axônios mielínicos de grande diâmetro. Resultados: Nos grupos submetidos à terapia com laser de baixa potencia foi observado aumento do número de todos os aspectos analisados com diferença estatisticamente significante. Conclusão: A irradiação com o laser de baixa intensidade (904nm) influenciou positivamente na regeneração do nervo ciático de ratos da linhagem Wistar pós neuropraxia controlada (axonotmese), tornando a recuperação nervosa mais rápida e eficiente.

Complication Rate and Pitfalls of Temporary Bridging External Fixator in Periarticular Communited Fractures

BACKGROUND: A second staged operation using temporary bridging external fixation (TBEF) has been widely used in patients with periarticular complex fracture, yet few papers have been published on the related complications. The purpose of this study was to report the complication rate and pitfalls directly related to TBEF through a retrospective study and to suggest some solutions. METHODS: Fifty-nine cases that were treated by using TBEF were studied among 195 periarticular complex fractures. We retrospectively collected the clinical and radiological data and then the study data was evaluated for 1) cases with unsatisfactory restoration of length, 2) cases with deep infection caused by half pins invading the zone of definitive fixation, and 3) neurovascular injuries related to half pins. RESULTS: Complications were observed in 7/59 cases (11%). Problems related to the achievement of length were observed in one case of distal tibia fracture and 2 cases of distal femur fracture. Half pin related infection was observed in 2 cases of distal femur fracture. Neurovascular injury (medial calcaneal nerve injury in a distal tibia fracture) was observed in 2 cases. Among 7 complications, four were related to using TBEF in distal femur fracture. This is because the abundant leg muscles have strong deforming force and infection might be increased due to frequent irritation by the half pins. CONCLUSIONS: TBEF is a simple procedure with several advantages. However, complications might be observed if certain principles are not followed. It is thought that many complications due to TBEF can be reduced if the half pins are not inserted in the zone of injury, restoration of length is fully achieved and the neurovascular characteristics are carefully considered. In particular, much more caution is needed in the distal femur, which has abundant muscles surrounding it.

Psychogenic dystonia induced by peripheral trauma: case report

The origin of dystonia is a point of discussion since its first description. A cause-and-effect relationship between brain injury and subsequent movement disorder is well established, but the existence of such a relationship following peripheral injury has not been universally accepted. This paper has the objective to report a patient with fixed dystonic posture of the hand after peripheral trauma.

A origem da distonia continua sendo controversa como nas suas primeiras descrições. A relação de causa e efeito entre traumatismo craniano e distúrbios do movimento está bem estabelecida, no entanto, a existência de tal relação após trauma periférico não é amplamente aceita. Este trabalho tem por objetivo relatar um paciente com postura distônica fixa da mão após trauma periférico.

Microcirurgia das lesões traumáticas de nervo periférico do membro superior: [revisão] / Microsurgical treatment to repair injuries of the peripheral nerves in upper limb: [review]

Apesar da grande quantidade de publicações e surgimento de novos dados laboratoriais e clínicos relacionados aos conceitos da regeneração dos nervos periféricos, estas lesões são ainda um dos mais desafiadores e difíceis problemas cirúrgicos reconstrutivos. O emprego da microcirurgia tem melhorado os resultados do reparo de nervo, principalmente nas lesões agudas, contudo para reduzir as sequelas é importante a compreensão dos mecanismos, princípios técnicos e de reabilitação. Os autores realizaram revisão da literatura com enfoque para o reparo neural e a reabilitação pós-operatória.

Despite the large number of publications and development of laboratory and clinical concepts related to the regeneration of peripheral nerves, these injuries remain one of the most challenging and difficult surgical reconstructive problems. The microsurgery use has improved the outcome of nerve repair, especially in acute injuries, but to get reduce the consequences it is important to understand the mechanisms, technical principles and rehabilitation. The authors review the literature about neural repair, and rehabilitation after surgery.

Neuropatía compresiva del nervio musculocutáneo en tenistas profesionales / Musculocutaneous nerve entrapment in professional tennis players

Los nervios periféricos cursan en íntima relación con tejidos blandos como músculos, fascias, tendones y huesos (superficies de contacto). Los movimientos repetitivos y la consiguiente reacción inflamatoria en caso de roce excesivo por hipertrofia asimétrica o sobrecarga de un músculo, pueden ocasionar dolor agudo y/o pérdida de movimiento neural por las adherencias residual es de dicha inflamación. En los deportistas, los nervios periféricos son susceptibles a las lesiones por la excesiva demanda fisiológica que recae tanto en las estructuras neurológicas como en los tejidos blandos que las rodean. Los mecanismos comunes de lesión son la compresión, tracción, isquemia y laceración. Según la clasificación de Seddon basada en los cambios neurofisiológicos, la severidad de las lesiones nerviosas aumenta desde la neuropraxia a la axonotmesis y neurotmesis. Afortunadamente, la mayor parte de las lesiones nerviosas en el hombro en deportistas son de primer grado o neuropraxias que consisten en un bloqueo de la conducción con presencia de estructuras neurales intactas, incluyendo los axones y el tejido conectivo de recubrimiento. El pronóstico para una recuperación completa en estos casos es excelente.

Effects of Exercise on Affected and Unaffected Hindlimb Muscles in Rats with Neuropathic Pain Induced by Unilateral Peripheral Nerve Injury

PURPOSE: The purpose of this study was to examine the effects of exercise on muscle weight and Type I and II fiber cross-sectional area of affected and unaffected hindlimb muscles in rats with neuropathic pain induced by unilateral peripheral nerve injury. METHODS: Neuropathic pain was induced by ligation and cutting of the left L5 spinal nerve. Adult male Sprague-Dawley rats were randomly assigned to one of two groups: The Pain+Exercise (PE) group (n=21) and the Sham+Exercise (SE) group (n=20). All rats had 28 sessions of treadmill exercise at grade 10 for 30 minutes, twice/day at 10 m/min for 14 days. Body weight, food intake and activity were measured every day. At 15 days all rats were anesthetized and soleus, plantaris and gastrocnemius muscles were dissected. Muscle weight and Type I, II fiber cross-sectional area of the dissected muscles were measured. RESULTS: The PE group showed significant increases (p<.05), as compared to the SE group for body weight and total diet intake, muscle weight of the unaffected soleus and plantaris, and in Type I and II fiber cross-sectional area of unaffected three muscles and affected plantaris. CONCLUSION: Exercise for 14 days attenuates unaffected soleus, plantaris and gastrocnemius muscle atrophy in neuropathic pain model.

Should complete stripping operation to the ankle be avoided in the treatment of primary varicose veins due to greater saphenous vein insufficiency? / Deve-se evitar a flebo-extração completa até o tornozelo no tratamento das varizes primárias por insuficiência da veia safena magna?

PURPOSE: The most preferred method for the treatment of primary varicose veins due to greater saphenous vein (GSV) insufficiency is saphenofemoral high ligation and thigh stripping of the GSV, and ambulatory phlebectomy. Stripping is usually ended at the knee level to prevent nerve injury in the calf. However, different surgical modalities may be used depending on the surgeon's choice and experience. METHODS: We present the results of complete stripping of the GSV to the ankle and ambulatory phlebectomies performed by a single surgeon. Ninety-six patients (102 limbs) who underwent standardized surgical procedure were participated in this study. Median follow-up time was 3.4 years. RESULTS: All complaints due to varicose veins were resolved in all extremities. Some temporary complications observed were resolved fully during follow-up. Permanent paresthesia which was the most important complication was found only in two patients (2 percent). No recurrence was observed. CONCLUSION: The risk of saphenous nerve injury in the calf should not to be considered a reason to avoid complete stripping of the GSV to the ankle. If it is applied carefully and with appropriate technique, complete stripping still seems to be a good treatment option.

OBJETIVO: O método de escolha para o tratamento das varizes primárias devido a insuficiência da veia safena magna (VSM) é a ligagura safenofemoral e a fleboextração em coxa e a flebectomia ambulatorial. A fleboextração é geralmente feita ao nível do joelho para prevenir a lesão neurológica no tornozelo. Diferentes modalidades operatórias, no entanto, podem ser utilizadas dependendo da escolha e da experiência do cirurgião. MÉTODOS: Apresentamos os resultados da fleboextração completa da VSM até o tornozelo e flebectomias ambulatoriais realizadas por um único cirurgião. Noventa e seis pacientes (102 membros) que foram submetidos a procedimento cirúrgico padrão participaram deste estudo. A mediana do tempo de seguimento foi 3,4 anos. RESULTADOS: Todas as queixas devido a varizes foram resolvidas em todos os pacientes. Algumas complicações temporárias observadas foram resolvidas totalmente durante o tempo de seguimento. Parestesia permanente que foi a complicação mais grave ocorreu apenas em dois pacientes (2 por cento). Não observamos recurrência. CONCLUSÃO: O risco da lesão do nervo safeno no tornozelo não deve ser considerada uma razão para evitar-se a fleboextração completa da VSM até o tornozelo. Se é aplicada cuidadosamente e com a técnica apropriada, fleboextração ainda parece ser uma boa opção de tratamento.

Traumatic lesions of internal saphenous nerve and branches / Lesões traumáticas do nervo safeno interno e seus ramos

OBJECTIVE: To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. METHOD: Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. RESULTS: In two cases there were almost total pain resolution, and in other case improvement only. CONCLUSION: Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

OBJETIVO: Apresentar lesões raras do nervo safeno interno interno, que muitas vezes, simulam doenças vasculares dos membros inferiores. MÉTODO: Três pacientes foram operados e acompanhados por um período de oito meses. A técnica cirúrgica consistiu na neurotomia dos ramos infrapatelar e descendente do nervo safeno interno. RESULTADOS: Nos dois primeiros casos houve quase desaparecimento total da dor em pouco tempo e no terceiro apenas melhora. CONCLUSÃO: O tratamento cirúrgico dá bons resultados neste tipo de lesão do nervo safeno interno e poderia ser útil como alternativa ao tratamento conservador.

Muscle graft as a substitute for peripheral nerve graft in rats / Enxerto de músculo como substituto de nervo periférico em ratos

PURPOSE: To evaluate the applicability of the use of autogenous muscle treated in various ways, as a substitute of the nerve grafts. METHODS: Rats were divided into seven groups that received, as a treatment for a standard nerve injury, the following types of grafts: fresh muscle, muscle fixed with 10 percent formaldehyde, muscle frozen in a freezer, muscle frozen in refrigerator, nerveless muscle, peripheral nerve and a group was without any treatment. It assessed the histological appearance of the nerve fibers in the segment repaired. RESULTS: The evaluation of the segment nervous repaired showed nerve fibers through the graft in almost all groups, but the methodology employed has not adequately characterized the differences between the groups. CONCLUSION: This study showed the migration of nerves fibers through all grafts used.

OBJETIVO: Avaliar a aplicabilidade do uso de músculo autógeno, tratado de diversas maneiras, em substituição aos enxertos de nervo. MÉTODOS: Os ratos foram separados em sete grupos que receberam, como tratamento a uma lesão nervosa padronizada, os seguintes tipos de enxertos: músculo fresco, músculo fixado com formol 10 por cento, músculo congelado em freezer, músculo congelado em refrigerador, músculo denervado, nervo periférico e um grupo ficou sem qualquer tratamento. Foi avaliado o aspecto histológico das fibras nervosas no segmento reparado. RESULTADOS: A avaliação do segmento nervoso reparado mostrou que existiam axônios em quase todos os grupos, mas a metodologia empregada não possibilitou caracterizar adequadamente as diferenças entre os grupos. CONCLUSÃO: Este estudo mostrou a migração de axônios por meio de todos os enxertos utilizados.

Morphological identification of cell death in dorsal root ganglion neurons following peripheral nerve injury and repair in adult rat

Axotomy causes sensory neuronal loss. Reconnection of proximal and distal nerve ends by surgical repair improves neuronal survival. It is important to know the morphology of primary sensory neurons after the surgical repair of their peripheral processes. Animals [male Wistar rats] were exposed to models of sciatic nerve transection, direct epineurial suture repair of sciatic nerve, autograft repair of sciatic nerve, and sham operated. After 1 and 12 weeks of the surgery, the number of L5 dorsal root ganglion [DRG] and ultrastructure of L4-L5 DRG neurons was evaluated by fluorescence and electron microscopy, respectively. Nerve transection caused sensory neuronal loss and direct epineurial suture but no autograft repair method decreased it. Evaluation of morphology of the neurons showed classic features of apoptosis as well as destructive changes of cytoplasmic organelles such as mitochondria, rough endoplasmic reticulum and Golgi apparatus in primary sensory neurons. These nuclear and cytoplasmic changes in primary sensory neurons were observed after the surgical nerve repair too. The present study implies that the following peripheral nerve transection apoptosis as well as cytoplasmic cell death contributes to neuronal cell death and reconnection of proximal and distal nerve ends dose not prevent these processes

Effect of Dehydroepiandrosterone on Affected and Unaffected Hindlimb Muscles in Rats with Neuropathic Pain Induced by Unilateral Peripheral Nerve Injury

PURPOSE: The purpose of this study was to examine the effect of DHEA (Dehydroepiandrosterone) on muscle weight and Type I and II fiber cross-sectional area of affected and unaffected hindlimb muscles in rats with neuropathic pain induced by unilateral peripheral nerve injury. METHODS: Neuropathic pain was induced by ligation and cutting of the left L5 spinal nerve. Adult male Sprague-Dawley rats were randomly assigned to one of two groups: The DHEA group (n=10) had DHEA injections daily for 14 days, and the Vehicle group (n=10) had vehicle injections daily for 14 days. Withdrawal threshold, body weight, food intake and activity were measured every day. At 15 days all rats were anesthetized and soleus, plantaris and gastrocnemius muscles were dissected from the both hindlimbs. Body weight, food intake, activity, muscle weight and Type I, II fiber cross-sectional area of the dissected muscles were measured. RESULTS: The DHEA group showed significant increases (p<.05), as compared to the vehicle group for muscle weight of the unaffected plantaris, and in Type II fiber cross-sectional area of the gastrocnemius muscle. The DHEA group demonstrated a higher pain threshold than the vehicle group whereas total diet intake and activity score were not significantly different between the two groups. CONCLUSION: DHEA administration for 14 days attenuates unaffected plantaris and gastrocnemius muscle atrophy.

S100ß and fibroblast growth factor-2 are present in cultured Schwann cells and may exert paracrine actions on the peripheral nerve injury / S100ß e fator de crescimento de fibroblasto-2 estão presentes nas células de Schwann cultivadas e exercem ações parácrinas na lesão do nervo

PURPOSE: The neurotrophic factor fibroblast growth factor-2 (FGF-2, bFGF) and Ca++ binding protein S100ß are expressed by the Schwann cells of the peripheral nerves and by the satellite cells of the dorsal root ganglia (DRG). Recent studies have pointed out the importance of the molecules in the paracrine mechanisms related to neuronal maintenance and plasticity of lesioned motor and sensory peripheral neurons. Moreover, cultured Schwann cells have been employed experimentally in the treatment of central nervous system lesions, in special the spinal cord injury, a procedure that triggers an enhanced sensorymotor function. Those cells have been proposed to repair long gap nerve injury. METHODS: Here we used double labeling immunohistochemistry and Western blot to better characterize in vitro and in vivo the presence of the proteins in the Schwann cells and in the satellite cells of the DRG as well as their regulation in those cells after a crush of the rat sciatic nerve. RESULTS: FGF-2 and S100ß are present in the Schwann cells of the sciatic nerve and in the satellite cells of the DRG. S100ß positive satellite cells showed increased size of the axotomized DRG and possessed elevated amount of FGF-2 immunoreactivity. Reactive satellite cells with increased FGF-2 labeling formed a ring-like structure surrounding DRG neuronal cell bodies.Reactive S100ß positive Schwann cells of proximal stump of axotomized sciatic nerve also expressed higher amounts of FGF-2. CONCLUSION: Reactive peripheral glial cells synthesizing FGF-2 and S100ß may be important in wound repair and restorative events in the lesioned peripheral nerves.

OBJETIVO: O fator neurotrófico fator de crescimento de fibroblastos-2 (FGF-2, bFGF) e a proteína ligante de Ca++ S100ß são expressos pelas células de Schwann dos nervos e por células satélites do gânglio da raiz dorsal (GRD). Estudos recentes indicam a importância das moléculas nos mecanismos parácrinos relacionados à manutenção neuronal e à plasticidade de neurônios periféricos motores e sensoriais. Além disso, células de Schwann cultivadas têm sido empregadas experimentalmente no tratamento de lesões no sistema nervo central, especialmente na lesão da medula espinal, a qual mostrou uma melhora da função sensoriomotora. Estas células são ainda propostas no reparo do nervo lesado com perda de tecido. MÉTODOS: Usamos a dupla marcação imunohistoquímica e o Western blot para caracterizar melhor in vitro e in vivo a presença das proteínas nas células de Schwann e nas células satélites do GRD assim como sua regulação nessas células após a compressão do nervo ciático de ratos. RESULTADOS: FGF-2 e S100ß estão presentes nas células de Schwann do nervo ciático e nas células satélites do GRD. Células satélites do GRD axotomizado positivas para S100ß possuíam quantidade aumentada de imurreatividade da FGF-2. Células satélites reativas apresentando maior quantidade de FGF-2 formaram um anel ao redor dos corpos neuronais do GRD. Células de Schwann do coto proximal à axotomia do nervo ciático e positivas para S100ß também expressaram quantidades aumentadas de FGF-2. CONCLUSÃO: As células gliais periféricas ao sintetizar FGF-2 e S100ß podem ser importantes no reparo de cicatrização e em eventos restaurativos nas lesões do nervo.

Primary below knee amputation in the management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury associated with bone loss and tibial nerve injury

Compound comminuted fractures of lower tibia and fibula are very common in Iraq these days due to missile injuries [bullets and blasts], it could be associated with bone loss and neurovascular injury this will interfere with the patients rehabilitation and leads to major social and economic burden on the patient, his family and the community. To prove that primary below knee amputation in management of compound comminuted fracture lower tibia and fibula due to high velocity missile injury and complete tibial nerve injury is superior to limb salvage. This is a prospective comparative study including 25 patients age 30-60 years presented to the emergency department in Medical City with a history of missile injury during the period 2005-2007 they had compound comminuted fractures of lower tibia and fibula [Gustilo grade II, III] all of them had different degrees of bone loss [more than 5 cm] and all of them had complete tibial nerve injury and 10 of them had associated posterior tibial artery injury which is irreparable. We divided our patients in to two groups the first one [9 patients four of them had also associated vascular injury] we did primary below knee amputation, while the second group [16 patients six of them had vascular injury] who refused amputation we did wound exsion and application of external fixation. Both groups followed up clinically and radiologically for one year. Group I the patients rehabilitated early and a prosthesis were used after one and a half month and the patients return to their original work or changing their work and have almost normal life, group II all of them had prolonged course of treatment with economic and social problems. Primary below knee amputation is a very good option for patients with history of compound comminuted fractures of lower tibia and fibula [grade II and III] associated with bone loss and tibial nerve injury. Decreasing rehabilitation time and early return back to work also less cost and less social problems

Neuropatias traumáticas: aspectos cirúrgicos / Traumatic neuropathies: surgical aspects

Objetivos: apresentar a nossa série de pacientes e a nossa experiência com os vários tipos de lesões dos nervos periféricos. Métodos: foi feito um estudo retrospectivo com análise de 114 pacientes operados de 15 anos. Os pacientes foram divididos em dois grupos segundo a etiologia da lesão do nervo, lesões compressivas e outros tipos de lesões. Resultado: dos 114 pacientes operados obtivemos 76% de bons resultados, 21% de resultados regulares e 12% de maus resultados. Conclusão: obtivemos bons resultados devido ao fato de que 39% dos casos eram de neuropatias compressivas, nas quais o traamento cirúrgico é o ideal. Esses bons resultados originam-se do fato de que nossos pacientes foram selecionados e operados em até 60 dias após a lesão.

Uso da nanotecnologia no reparo das lesões traumáticas de nervos / Nanotechnology and repair of peripheral nerve injuries

A nanotecnologia tem permitido avanços revolucionários nos últimos anos em diversas áreas da Ciência, incluindo a medicina, onde o impacto de novas aquisições se faz presente também na neurocirurgia.Trabalhos experimentais têm demonstrado diversas possibilidades do uso de artefatos obtidos a partir da nanotecnologia no tratamento das lesões traumáticas de nervos periféricos. Isto inclui desde a construção de dispositivos semi-sintéticos que substituem a estrutura de um nervo até a manipulação direta dos axônios. O objetivo deste estudo é apresentar ao neurocirurgião uma revisão sobre as principais técnicas de manufatura de nanomateriais e suas aplicações atuais e futuras no manejo das patologias traumáticas dos nervos periféricos.

Over the last several years, nanotechnology has made possible revolutionary advances in several áreas of Science, including medicine, where the impact of new acquisitions also has occurred in neurosurgery.Experimental researchs have demonstrated several possibilities for the treatment of peripheral nerve traumatic lesions with artefacts obtained from nanotechnology. This have included the construction of semi-synthetic devices that replace the structure of the nerve and the direct manipulation of axons. The goal of this study is to present a review to the neurosurgeon about nanomaterials manufacture techniques and its current and future applications in peripheral nerve injury.

Conceptos actuales en al cirugía de los nervios periféricos. Parte III: ¿Cuándo se debe operar un nervio lesionado? / Actual concepts in peripheral nerves injury. Part III: When to operate on the peripheral nerve injuries?

Objetivo. Uno de los factores más importantes que determina el pronóstico de recuperación de una lesión de nervio periférico es el momento en el cual ésta es reparada. El objetivo de este trabajo es determinar el intervalo correcto que debe transcurrir desde que se produce una lesión hasta se aborda quirúrgicamente. Estudios seleccionados. Son los citados en las referencias. Síntesis de los datos. Se describen las clasificaciones actualmente empleadas, y se citan los diferentes mecanismos fisiopatológicos que provocan las lesiones. En base ellos, se establecen dos grandes grupos: lesiones cerradas y abiertas. Las primeras son las que generalmente requieren una conducta inicial expectante y una cirugía en diferido no antes de los tres meses de transcurrido el trauma. En cambio, las lesiones abiertas, cortantes o contuso-cortantes, se deben explorar en forma rápida para efectuar una reconstrucción cuando es factibel, o limpiar y reparar los bordes del nervio seccionado cuando no es posible efectuar una reparación directa sin injerto interpuesto en agudo. Existen algunas excepciones a estos principios de manejo, que también son analizadas en esta presentación. Conclusiones. La indicación precisa del momento adecuado para reparar un nervio lesionado se basa en algunos simples principios de clasificación y fisiopatología del trauma a los nervios periférico.

Laserterapia para a regeneração de lesões nervosas: revisão de literatura / Lasertherapy to the regeneration of nervous lesions: review of the literature

As lesões dos nervos periféricos são relativamente comuns e têm uma etiologia variada, sendo o trauma uma das principais causas. As agressões às estruturas nervosas podem levar a um comprometimento das funções rotineiras do indivíduo. Buscando a recuperação das funções, a Laserterapia vem sendo empregada com o propósito de acelerar o processo regenerativo e devolver mais precocemente a função. Este trabalho tem como objetivo fazer uma revisão de literatura sobre o uso do laser para esta função determinada.

The lesions of the peripheral nerves are relatively common and they have a varied etiology, being trauma one of the most common causes. The aggressions to the nervous structures can damage the habitual functions of the patient. This away, Lasertherapy has been used with the aim to accelerate the regenerative processes and to restore the individualÆs functions quickly. This paper reviews the literature on the use of the Lasertherapy for this determined function.

The turnover distal epineurial sheath tube for repair of peripheral nerve gaps.

BACKGROUND AND OBJECTIVE: Autologous nerve grafting is the conventional technique for bridging nerve gaps. However, the drawback of this technique is the morbidity associated with the left over donor site. The purpose of the present study was to investigate the effects of the turnover distal epineurial sheath tube as an alternative to nerve grafting for the repair of nerve gaps. MATERIAL AND METHOD: The experimental model included 14 male Wistar rats. The left and right sciatic nerves were resected and the 14 left sciatic nerve gaps were reconstructed using conventional autologous nerve grafts while the other 14 right sciatic nerve gaps were reconstructed with turnover distal epineurial sheath tubes. All the repaired sciatic nerves were harvested for histologic and quantitative histomorphometric evaluation at the 11th week after the operations. RESULTS: There were no statistical differences in quantitative evaluation of Schwann cells between the conventional nerve grafting group and the distal epineurial sheath tube group (p > 0.05). CONCLUSION: The turnover distal epineurial sheath tube provides a suitable conduit between two stumps, eliminates donor-site morbidity, reduces the operating time, and might be an alternative modality to nerve grafting for nerve gap repair.

Avaliação qualitativa e quantitativa das lesões agudas por esmagamento do nervo isquiático do rato / Qualitative and quantitative evaluation of rats' acute injuries caused by ischiatic nerve smashing

Nervos isquiáticos de ratos esmagados com cargas diferentes foram estudados com o auxílio da microscopia de luz. Pesos de 500 g, 1.000 g, 5.000 g, 10.000 g, e 15.000 g foram utilizados por 10 minutos num dispositivo portátil especialmente desenvolvido para este estudo. As análises morfológicas e morfométricas das fibras mielínicas mostraram que a lesão produzida às fibras neurais e ao tecido neural foi diretamente proporcional à carga aplicada e que uma carga de 500 g é suficiente para produzir um dano severo, com lesão importante das estruturas do endoneuro.

Rats' ischiatic nerves smashed with different loads were studied with the aid of light microscopy. Weights of 500 g, 1,000 g, 5,000 g, 10,000 g, and 15,000 g were used for 10 minutes in a portable device, especially developed for this study. Morphological and morphometrical analyses of myelinic fibers showed that the injury produced on neural fibers and on neural tissue was directly proportional to the load applied and that a load of 500 g is enough to produce a severe damage, with an important injury of endoneural structures.