The efficacy of corticosteroid after facial nerve neurorrhaphy: a systematic review and meta-analysis of randomized controlled trial

Abstract Objectives: The benefit of corticosteroids following facial nerve neurorrhaphy in the setting of complete transection is questionable. This systematic review and meta-analysis aimed to evaluate corticosteroid efficacy on facial nerve regeneration and functional recovery after complete disruption and neurorrhaphy. Methods: Randomized controlled trials on both human and animal models from Ovid MEDLINE and Ovid EMBASE studying corticosteroid efficacy in complete facial nerve disruption followed by neurorrhaphy were included. Data were extracted and pooled for meta-analysis. The outcomes were evaluated from electrophysiology, histology, and functional recovery. However, no randomized controlled trial in human was performed. Possibly, performing human trials with histopathology may not be feasible in clinical setting. Results: Six animal studies (248 participants) met inclusion criteria. Electrophysiologic outcomes revealed no differences in latency (Standardized Mean Difference (SMD) = −1.97, 95% CI −7.38 to 3.44, p = 0.47) and amplitude (SMD = 0.37, 95% CI −0.44 to 1.18, p = 0.37) between systemic corticosteroids and controls. When analysis compared topical corticosteroid and control, the results provided no differences in latency (Mean Difference (MD)=0.10, 95% CI −0.04 to 0.24, p = 0.16) and amplitude (SMD = 0.01, 95% CI −0.08 to 0.10, p = 0.81). In histologic outcomes, the results showed no differences in axon diameter (MD = 0.13, 95% CI −0.15 to 0.41, p = 0.37) between systemic corticosteroid and control; however, the result in myelin thickness (MD = 0.06, 95% CI 0.04 to 0.08, p < 0.05) favored control group. When comparing systemic corticosteroid with control in eye blinking, the results favored control (MD= 1.33, 95% CI 0.60 to 2.06, p = 0.0004). Conclusions: This evidence did not show potential benefits of systemic or topical corticosteroid deliveries after facial nerve neurorrhaphy in complete transection when evaluating electrophysiologic, histologic, and functional recovery outcomes in animal models.

Repair of extremity soft tissue defects using anterolateral femoral flaps with versus without anastomosis of anterolateral femoral cutaneous nerve / 中华创伤骨科杂志

Objective:To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods:A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics, The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022. The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps. In the anastomosis groups of 14 cases, there were 7 males and 7 females, with an age of (46.4±15.2) years and a flap size of (22.4±7.3) cm×(8.5±1.3) cm. In the non-anastomosis group of 16 cases, there were 11 males and 5 females, with an age of (39.9±15.8) years and a flap size of (23.0±6.4) cm×(9.0±2.1) cm. The 2 groups were compared in terms of flap survival, Semmes-Weinstein recovery degree and area of monofilament tactile sensation, and time periods for temperature sensation and two-point discrimination.Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing they were comparable ( P>0.05). All the flaps survived completely without vascular crisis. In the anastomosis group, the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%, 50.0%, and 80.0% [(2.5±0.7) months, (6.7±1.1) months, and (11.0±1.2) months] were significantly shorter than those in the non-anastomosis group [(3.6±1.3) months, (8.6±1.4) months, and (15.0±2.2) months], the recovery area at the last follow-up [100.0% (100.0%, 100.0%)] was significantly larger than that in the non-anastomosis group [84.6% (81.7%, 89.9%)], and the time period for recovery of temperature sensation [(3.9±0.7) months] significantly shorter than that in the non-anastomosis group [(6.1±1.1) months] (all P<0.05). The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was (10.4±1.7) months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after (14.7±1.4) months, showing a significant difference between the 2 groups ( P<0.05). Conclusion:In the repair of extremity soft tissue defects using anterolateral femoral flaps, compared with no anastomosis of the cutaneous nerve, anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.

Combination of heterologous fibrin sealant and bioengineered human embryonic stem cells to improve regeneration following autogenous sciatic nerve grafting repair

Peripheral nerve injury is a worldwide clinical problem, and the preferred surgical method for treating it is the end-to-end neurorrhaphy. When it is not possible due to a large nerve gap, autologous nerve grafting is used. However, these surgical techniques result in nerve regeneration at highly variable degrees. It is thus very important to seek complementary techniques to improve motor and sensory recovery. One promising approach could be cell therapy. Transplantation therapy with human embryonic stem cells (hESCs) is appealing because these cells are pluripotent and can differentiate into specialized cell types and have self-renewal ability. Therefore, the main objective of this study was to find conditions under which functional recovery is improved after sciatic nerve neurorrhaphy. We assumed that hESC, either alone or in combination with heterologous fibrin sealant scaffold, could be used to support regeneration in a mouse model of sciatic nerve injury and repair via autografting with end-to-end neurorrhaphy. Methods Five millimeters of the sciatic nerve of C57BL/6 J mice were transected off and rotated 180 degrees to simulate an injury, and then stumps were sutured. Next, we applied heterologous fibrin sealant and/or human embryonic stem cells genetically altered to overexpress fibroblast growth factor 2 (FGF2) at the site of the injury. The study was designed to include six experimental groups comprising neurorrhaphy (N), neurorrhaphy + heterologous fibrin sealant (N + F), neurorrhaphy + heterologous fibrin sealant + doxycycline (N + F + D), neurorrhaphy + heterologous fibrin sealant + wild-type hESC (N + F + W), neurorrhaphy + heterologous fibrin sealant + hESC off (N + F +T), and neurorrhaphy + heterologous fibrin sealant + hESC on via doxycycline (N + F + D + T). We evaluated the recovery rate using Catwalk and von Frey functional recovery tests, as well as immunohistochemistry analysis. Results The experiments indicated that sensory function improved when transgenic hESCs were used. The regeneration of sensory fibers indeed led to increased reflexes, upon stimulation of the paw ipsilateral to the lesion, as seen by von-Frey evaluation, which was supported by immunohistochemistry. Conclusions Overall, the present data demonstrated that transgenic embryonic stem cells, engineered to overexpress FGF-2 in an inducible fashion, could be employed to support regeneration aiming at the recovery of both motor and sensory functions.(AU)

Combination of heterologous fibrin sealant and bioengineered human embryonic stem cells to improve regeneration following autogenous sciatic nerve grafting repair

Background Peripheral nerve injury is a worldwide clinical problem, and the preferred surgical method for treating it is the end-to-end neurorrhaphy. When it is not possible due to a large nerve gap, autologous nerve grafting is used. However, these surgical techniques result in nerve regeneration at highly variable degrees. It is thus very important to seek complementary techniques to improve motor and sensory recovery. One promising approach could be cell therapy. Transplantation therapy with human embryonic stem cells (hESCs) is appealing because these cells are pluripotent and can differentiate into specialized cell types and have self-renewal ability. Therefore, the main objective of this study was to find conditions under which functional recovery is improved after sciatic nerve neurorrhaphy. We assumed that hESC, either alone or in combination with heterologous fibrin sealant scaffold, could be used to support regeneration in a mouse model of sciatic nerve injury and repair via autografting with end-to-end neurorrhaphy. Methods Five millimeters of the sciatic nerve of C57BL/6 J mice were transected off and rotated 180 degrees to simulate an injury, and then stumps were sutured. Next, we applied heterologous fibrin sealant and/or human embryonic stem cells genetically altered to overexpress fibroblast growth factor 2 (FGF2) at the site of the injury. The study was designed to include six experimental groups comprising neurorrhaphy (N), neurorrhaphy + heterologous fibrin sealant (N + F), neurorrhaphy + heterologous fibrin sealant + doxycycline (N + F + D), neurorrhaphy + heterologous fibrin sealant + wild-type hESC (N + F + W), neurorrhaphy + heterologous fibrin sealant + hESC off (N + F +T), and neurorrhaphy + heterologous fibrin sealant + hESC on via doxycycline (N + F + D + T). We evaluated the recovery rate using Catwalk and von Frey functional recovery tests, as well as immunohistochemistry analysis. Results The experiments indicated...

Promoting effect of percutaneous electrical stimulation on nerve regeneration after end-to-side neurorrhaphy in rats / 中国比较医学杂志

Objective To observe and explore the effect and clinical value of percutaneous electrical stimulation on nerve regeneration after end-to-side neurorrhaphy in rats. Methods Thirty-two SPF male S-D rats were randomly divided into four groups ( n = 8 ): group A, the normal control group; group B, with end to end neurorrhaphy of musculocutaneous nerve injury matched to the ulnar nerve; group C, with end to side neurorrhaphy of musculocutaneous nerve injury matched to the ulnar group; and group D, with end to side neurorrhaphy of musculocutaneous nerve injury matched to the ulnar nerve plus postoperative transcutaneous electrical stimulation ( 30 min per day for 6 weeks ) . Electromyography, postoperational nerve conduction velocity, the histological and ultrastructural changes of the nerve fibers were examined, and NF-200 expression in frozen sections was observed using imunohistological staining, to assess the recovery of muscle strength of the diseased side limb and the neuroregeneration in the rats after treatment. Results The amplitude and conduction velocity of the groups C and D were lower than that of the group A, the latency was higher than that of the group A, while the amplitude and conduction velocity of the group D were lower than that of the group C,and the latency was higher than that of the group C. The wet weight ratio of the biceps brachii muscle and the cross-sectional area of muscle fibers in the groups B, C and D were lower than those in the group A, and the recovery of muscle in the group C was the worst. The expression of NF-200 in the rats of groups B, C and D was significantly lower than that in the group A, and the expression of NF-200 in the group D was significantly higher than that in the group C, but still significantly less than that in the group B ( P < 0. 05 ) . Electron microscopy showed mature myelinated fibers in the group B, whereas unmyelinated fibers were the main component and the myelin sheath was poorly developed in the group C. The myelin regeneration in the group D was better than that in the group C, but still some unmyelinated nerve fibers were seen. Conclusions The percutaneous electrical stimulation can effectively promote nerve axonal regeneration and can delay the atrophy of the target muscle after end-to-side neurorrhaphy. Though there is difference compared with the end-to-end neurorrhaphy, the end-to-side neurorrhaphy is still an effective method in clinical repair of peripheral nerve injury.

End-to-side loop neurorrhaphy: axonal comparative stereological study / Neurorrafia de blucle termino-lateral: estudio axonal estereológico comparativo

Accidents or diseases can affect the peripheral part of the nervous system, which raises clinical and surgical therapies, among others. In this context, the technique of end-to-side neurorrhaphy is a treatment option, yet its modification loop needs some additional efficacy studies. The purpose of this study was to compare, among rats, stereological results (axons volume density) after end-to-side neurorrhaphy and after end-to-side loop neurorrhaphy. Thirty Wistar rats were used, divided into six groups (five animals per group), consisting of two control groups (for the fibular and tibial nerves), two study groups for the fibular nerve (one with an end-to-side neurorrhaphy, and the other with an end-to-side loop neurorrhaphy) and two study groups for the tibial nerve (with an end-to-side neurorrhaphy and the other one with an end-to-side loop neurorrhaphy). After 180 days, all groups were sacrificed for axonal stereological analysis (volume density) in distal nerve stumps. There was significant maintenance of neuronal-axonal density in the distal stumps to neurorrhaphy (p<0.005) compared with the normal stumps. The end-to-side loop neurorrhaphy is a therapeutic option as suture technique after complete nerve section, in order to restore most of the axonal functional integrity.

Accidentes o enfermedades pueden afectar a la parte periférica del sistema nervioso, lo que plantea terapias clínicas y quirúrgicas, entre otras. En este contexto, la técnica de neurorrafia término-lateral es una opción terapéutica, sin embargo, su modificación en bucle necesita algunos estudios adicionales de eficacia. El objetivo de este estudio fue comparar, en ratas, resultados estereológicos (densidad de volumen axonal) después de la neurorrafia término-lateral y de la neurorrafia en bucle término-lateral. Fueron utilizadas 30 ratas Wistar, divididas en seis grupos (cinco animales por grupo), siendo dos grupos control (para los nervios fibular y tibial), dos grupos estudio del nervio fibular (uno con neurorrafia término-lateral y otro con neurorrafia en bucle termino-lateral) y dos grupos estudio del nervio tibial (uno con neurorrafia término-lateral y otro con neurorrafia en bucle término-lateral). Después de 180 días, todos los grupos fueron eutanasiados y se realizó el análisis estereológico axonal (densidad de volumen) en muñones nerviosos distales. Hubo un mantenimiento significativo de la densidad neuronal-axonal en los muñones distales a la neurorrafia (p<0,005) en comparación con los muñones normales. La neurorrafia en bucle término-lateral es una opción terapéutica como técnica de sutura después de la sección completa del nervio, con el fin de restaurar la mayoría de la integridad funcional axonal.

Treatment of Recurrent Neuroma after Forearm Amputation: End to End Neurorrhaphy

The neuroma is a tumor of nerve tissue that partially or completely severed through incomplete regeneration process. Neuromas that formed in the stump of a limb following amputation is a cause of the stump pain and can make intractable pain. The authors report a rare case of 36-year-old man with neuroma at stump, which has been recurred three times. This patient was treated with end-to-end neurorrhaphy after resecting neuroma. Follow-up at out-patient clinic showed satisfied result.

Extratemporal fascicular study of facial nerve in human

Peripheral nerves are structures exposed to physical, chemical and mechanical traumas. These lesions can cause a varying magnitude of damages, between which compression, distention and section, which culminate in motor, psychological and aesthetic alterations, mainly with facial expression nerves, like the facial nerve. The objective of this study was to verify the fascicular disposition of the facial nerve through its histology. Ten human cadaver heads, with ages between 53 and 66, were dissected. Extratemporal segments of the facial nerve were collected and routine techniques for histological microscopic evaluation were applied. Results showed that the extratemporal segments of the facial nerve analyzed are oligofascicular and polyfascicular, with a number of 3 to 8 fascicules. We conclude that knowledge on the fascicular organization of nerves, particularly the facial nerve, is paramount in surgical procedures using grafts, interfascicular sutures, among other microsurgeries which involve nerve restoration.

The embracing end-to-side neurorrhaphy in rats / A neurorrafia término-lateral abraçante em ratos

PURPOSE: Compare two new methods with the traditional end-to-side neurorrhaphy. METHODS: Rats were divided into four groups. In A-L group the peroneal nerve was sectioned and the distal stump was connected to the lateral of the tibial nerve (donor) with two 10-0 nylon points. In A-R group two perineurium flaps embraced the donor nerve. In the B-R group a suture embraced the donor nerve. Group B-L was the control. After six months tibial cranial muscle mass and morphometry of the distal stump of the peroneal nerve were evaluated. RESULTS: Muscle mass in groups A-R, A-L and B-R were lower than B-L group (p<0.0001) an equal between themselves (p>0.05). Groups A-R, B-R and A-L had a lower number of nerve fibers when compared with B-L (p=0.0155, p=0.016, p=0.0021). CONCLUSION: The three types of neurorrhaphy showed no differences related to muscle mass and number of nerve fibers suggesting that the embracing with a single suture has great potential due its simplicity and usefulness in deep areas.

OBJETIVO: Comparar dois novos métodos com o método tradicional da neurorrafia término-lateral. MÉTODOS: Os ratos foram separados em quatro grupos. No grupo A-E o nervo peroneal foi seccionado e o coto distal foi suturado à lateral do nervo tibial com dois pontos de nylon 10-0. No grupo A-D duas abas de epi-perineuro abraçaram o nervo doador. No grupo B-D foi realizada sutura com um único ponto abraçando o nervo doador. O grupo B-E foi o controle. Após seis meses foram observados massa do músculo tibial cranial e morfometria do coto distal do nervo peroneal. RESULTADOS: Foi encontrada menor massa muscular nos grupos A-D, A-E e B-D quando comparados com o grupo B-E (p<0.0001) e mesma massa quando comparados entre si (p>0,05). Os grupos A-D, A-E e B-D apresentaram menor número de fibras nervosas quando comparados ao grupo B-E (p=0,0155; p=0,016; p=0,0021) e mesmo número quando comparados entre si. CONCLUSÃO: Os três tipos de neurorrafia não apresentaram diferenças relacionadas à massa muscular e número de fibras nervosas sugerindo que a sutura abraçante com apenas um ponto apresente grande potencial em áreas cirúrgicas mais profundas.

Effect of surgical treatment for patients with large segment defect of ulnar nerve / 国际外科学杂志

Objective To evaluate the clinical effect of surgical operation for recovering the function of ulnar nerve with large segment defect. Methods Twentycases with the large segment defect of ulnar nerve were retrospectively analyzed from September 1999 to December 2006 in the hospital.All the patients were treated by the operation of nerve end-to-side neurorrhaphy . The broken end of ulnar nerve was anastomosed with the median nerve. And observed the recovery of the sensation and motion function of the little finger, interosseous muscles and claw hand, then compared with before. Results All cases were followed up for 8 to 36 months. The mean was 16 months. The sensation and motion function of the little fingers had better restoration after operation. No incision infection, anchylosis or myatrophy was occurred.Excellent(M4 + S4 +) ,Good (M3S3), moderate (M2S2), and poor effects (M1S1) were achieved respectively in 6, 4,2 and 0 cases based on the scale of XU' s grading standard.The excellent and good rate was 83.3%. Conclusion The nerve end-to-side neurorrhaphy was a effective treatment for the patients with large segment defect of ulnar nerve.

Clinical observation of superficial radial nerve transplanting to repair musculospiral nerve defection and functional reconstruction of donor site / 中国综合临床

Objective To observe the effect of superficial radial nerve transplanting to repair musculospiral nerve defection and using end-to-side neurorrhaphy to reconstruct the function of the donor site. Methods Thirtyfour cases underwent superficial radial nerve transplanting to repair musculospiral nerve defection and end-to-side neurorrhaphy was performed to reconstruct the function of the donor site. Results All cases were followed-up for 6 to 18 months,the functional recovery of the recipient of musculospiral nerve was excellent in 23 cases and good in 5 cases,with an excellent and good rate of 82. 53 %. Sensory recovery of donator nerve was excellent in 27 cases and good in 5 cases,with an excellent and good rate of 94. 12%. Conclusions Superficial radial nerve transplanting to repair musculospiral nerve defection and functional reconstruction of donor site is a better choice in treating neurologic defect.

Contribution of the Proximal Nerve Stump in End-to-side Nerve Repair: In a Rat Model

BACKGROUND: The aim of this study was to evaluate the contribution of the proximal nerve stump, in end-to-side nerve repair, to functional recovery, by modifying the classic end-to-side neurorrhaphy and suturing the proximal nerve stump to a donor nerve in a rat model of a severed median nerve. METHODS: Three experimental groups were studied: a modified end-to-side neurorrhaphy with suturing of the proximal nerve stump (double end-to-side neurorrhaphy, Group I), a classic end-to-side neurorrhaphy (Group II) and a control group without neurorrhaphy (Group III). Twenty weeks after surgery, grasping testing, muscle contractility testing, and histological studies were performed. RESULTS: The grasping strength, muscle contraction force and nerve fiber count were significantly higher in group I than in group II, and there was no evidence of nerve recovery in group III. CONCLUSIONS: The contribution from the proximal nerve stump in double end-to-side nerve repair might improve axonal sprouting from the donor nerve and help achieve a better functional recovery in an end-to-side coaptation model.

An experiment study of target muscle and moter endplate on peripheral nerve end-to-side neurorrhaphy / 中国矫形外科杂志

[Objective]To study the effect of End-to-side neurorrhaphy for protection target muscle.[Method]Twenty-six wistar rats were divided into two groups,with 13 in each group,peroneal nerve was transacted on the right side of all the animals,in one group,the proximal end of peroneal nerve was turned back and ligated,the distal end was sutured to the side of tibial nerve with perineurial window,in another group,both ends of the transacted peroneal nerve were turned back and ligated as contrast,no operation was done on the left side.Three months after operation,the peroneal nerve and the tibial muscle were taken for histologic exmination,and the muscle's wet weight was examed.[Result]Significant difference was seen between the two groups in the muscle wet weight,the muscle fiber cross sectional area,the moter endplate area and color(P

Rapid Neurorrhaphy with Titanium Clips / 대한정형외과학회잡지

PURPOSE: To evaluate the usefulness of titanium clips applied for the repair of transected peripheral nerve. MATERIALS AND METHODS: The results of neurorrhaphy using a titanium clip (VCS) was compared with the conventional technique of neurorrhaphy with a nylon suture. In fifteen New Zealand white rabbits, transected sciatic nerves were repaired with VCS clips on one side and interrupted 9-0 nylon suture on the other. RESULTS: The time required for the neurorrhaphy was 14.9+/-3.55 minutes for suture closure and 8.7+/-2.6 minutes for clip closure (p<0.01). Electromyographic studies were performed at 1, 2 and 3 months after the initial operations. No significant differences in the amplitudes of the complex motor action potentials were noted between the groups. In the microscopic study, no significant differences in the numbers and the extents of myelinization of the regenerated axons of both methods of nerorrhaphy were evident. CONCLUSION: The titanium clip that was initially designed for microvascular anastomosis can be applied successfully for the microscopic neurorrhaphy of the peripheral nerve. Microscopic neurorrhaphy with titanium clips can be performed more rapidly than conventional suture repair.

Advantage of a New Epineural Nerve Repair Technique: Oblique Coaptation

In 1999 Kayikcioglu and his colleagues invented the oblique nerve coaptation technique which increases coaptation surface and proved that their technique is superior to conventional vertical coaptation technique. This method is useful but it is not fit for a clinical application because the sciatic nerve was cut obliquely and repaired immediately in their experiment. In that case, we couldn't exclude the possibility of the improved effect by increased orientation of nerve fiber. Using different nerves we could exclude the effect by orientation improvement and prove the superiority of the oblique nerve coaptation technique in functional restoration. Ten Sprague-Dawley rats were used. The tibial nerve and the peroneal nerve were cut randomly to 30 degree and 90 degree on each side. The distal stump of the tibial nerve and the proximal stump of the peroneal nerve were repaired with 10-0 nylon under microscopic view. 12 weeks after nerve coaptation, nerve conduction velocity of extensor digitorum longus muscle, moist weight and histological analysis of extensor digitorum longus muscle, and myelinated axonal count and histological analysis of peroneal nerve were investigated. The results showed the nerves of oblique coaptation(30 degree transection angle) group are more regenerated than those of vertical coaptation(90 degree transection angle) group and nerve conduction velocity and moist weight of extensor digitorum longus muscle are also increased in oblique coaptation group. From these results we came to a conclusion that the oblique nerve coaptation technique is superior to the conventional technique and may be helpful in innervated free flap or nerve graft.

An experimental study of promoting peripheral nerve regeneration through slow-releasing diaphragm with FK506 after end-to-side neurorrhaphy / 中华显微外科杂志

Objective To explore the effect for nerve regeneration with immunosuppresssant FK506 a-round the cut after end-to-side neurorrhaphy of peripheral nerve. Methods There were 40 adult SD rats and were divided into two groups randomly by means. In the experiment group, the right peroneal nerve of SD rat was cut off,then an 1mm epineural window was created on the neighboring tibial nerve,the distal end of peroneal nerve was sutured to the windowed tibial nerve by means of end-to-side attachment, application of slow-releasing diaphragm which was implanted around the nerve anastomosis with FK506. In the contrast group,there were not the FK506 around the cut after end-to-side neurorrhaphy. The tibial and peroneal nerve trunks were labeled by being in jected with fast blue ( KB) and fluorescence golden ( FG) respectively. The labeled cells in the dorsal root ganglia (DRG) and spinal cord were observed by fluorescence microscopy. Results There were a lot of FB labeled cells in the experiment group than in the contrast group in the DRG and spinal cord. Conclusion Immunosuppresssant FK506 could promote nerve regenerative speed and quality after end-to-side neurorrhaphy of peripheral nerve.

Comparrison of End - to - side Loop Neurorrhaphy with Epineurium Versus without Epineurium

The high incidence of pain recurrence in traumatic neuromas continues to be a major problem in about 10% of patients. There are more than 100 techniques that have been proposed, but no single reliable method prevents painful neuroma formation. The end-to-side neurorrhaphy published by Viterbo1, and demonstrated encouraging results in prevention of neuroma with end-to-side loop neurorrhaphy. The aim of this study is to compare with the result that end-to-side loop neurorrhaphy with intact epineurium versus resected epineurium. Thirty Spraque-Dawley rats were divide in two group; control and experirnental group. In control group (n = 20), both sciatic nerve are transected and the ends were left unrepaired. In experimental group A (n = 20), the left sciatic nerve are transected and repaired with end-to-side loop neurorrhaphy with intact epineurium. In experimental group B (n = 20), the right sciatic nerve are transected and repaired after removal of epineurium. After 6 weeks, the cantrol and experimental group are sacrificed and examed grossly and histopathologically. In the control group, there were typical neuromas with irregular disorderly growth of axons, spreading out into the surrounding connective tissue. In experimental group A, there was no gross evidence of neuroma formation. In histology, there was some minirnal pattern of disorganized growth of the axons in the end-to-side surface, in only 1 case, but limited to the sutured area without typical spread out growth pattern. In experimental group B, the aspect were similar to the experimental group A. The end-to-side loop neurorrhaphy prevents disorganized axonal spouting seen in typical neuroma. And the interposing epineural sheath has no specific role in prevention of neuroma.

A Comparative Study of Nerve Regeneration on End-to-Side and End-to-End Neurorrhaphy in Rats

The surgical methods of injured peripheral nerve were limited to end-to-end neurorrhaphy, nerve graft, neurotization, etc. Recently, Several studies were executed about end-to-side neurorrhaphy in peripheral nerve injury. The purpose of this study is to investigate the axonal regeneration of end-to-side neurorrhaphy in rats, as alternative surgical method for peripheral nerve injury comparing with the state of normal, denervated, and end-to-end neurorrhaphy. Sixty female Sprague-Dawley rats were divided into four groups; group I as normal control group, group II as denervated control group, group III as end-to-end neurorrhaphy group, group IV as end-to-side neurorrhaphy group. At postoperative 4, 8, 12, 16, 20 and 24 week, nerve regeneration was assessed through electrophysiologic and histological studies. The results obtained were as follows: 1. In electrophysiologic test, the mean amplitude was higher in normal control group(group I) than either in end-to-end neurorrhaphy group(group III) or in end- to- side neurorrhaphy group(group IV)(p < 0.05). But there is no significant difference between group III and group IV. 2. The mean number of regenerating myelinated nerve fibers was higher in group I than either in group III or in group IV(p < 0.05). But there is no significant difference between group III and group IV, except at postoperative 16 week. 3. The mean number of motor end-plates at postoperative 24 week was 20.5 in group III and 18.2 in group IV, but there is no significant difference between group III and group IV. In conclusion, end-to-side neurorrhaphy through an epineural window could induce distal nerve regeneration by collateral sprouting of main peripheral nerve and positively reflected in functional improvement of the target muscle.

Function of the regenerative axon after peripheral nerve end-to-side neurorrhaphy in rats / 第二军医大学学报

Objective: To compare regeneration of motor fibers with that of sensory fibers by end to side neurorrhaphy and compare the effect of end to side neurorrhaphy with that of end to end neurorrhaphy. Methods: 20 SD rats were randomly divided into two groups: group A and group B. In group A, the right peroneal nerve was sectioned and the distal end was sutured laterally to the tibial nerve; in group B, the right peroneal nerve was sectioned and sutured with end to end neurorrhaphy. All left sides of two groups were used as control. Retrograde transportation of HRP was observed after 28 weeks. Results: The labelled neurons were also found in the anterior horn of the spinal cord and the spinal ganglia. Conclusion: The regenerative nerve fibers had motor fibers as well as sensory fibers by end to side neurorrhaphy. The effect of end to side neurorrhaphy is not as good as that of end to end neurorrhaphy. [

The promotion of nerve regeneration in peripheral nerve by progesterone after terminolateral neurorrhaphy: an experiment study / 中华显微外科杂志

Objective To evaluate the effect of progesterone (PROG) on promoting peripheral nerve collateral growth and nerve regeneration after terminolateral neurorrhaphy (TLN). Methods Thirty-six female SD rats were from nine to ten weeks old and weighed from 250 to 270 grams. They were randomly divided into two groups by different drugs they were administrated, the PROG group and the control group. Both groups were subdivide into three groups respectively, PROG four weeks group, PROG eight weeks group, PROG twelve weeks group, control four weeks group, control eight weeks group and control twelve weeks group. There were six subjects in every subgroups. First, both groups were performed ovariectomy. Then, two weeks later, TLN was operated. In the PROG group, the left peroneal nerve was transected, then an 1mm epineukral window was created on the neighbouring. The distal end of peroneal nerve was sutured to the windowed tibial nerve by means of end-to-side attachment. In the control group, nerve TLN was performed as in the PROG group, 0.2ml (10mg/ml) PROG and tea-oil (the solvent of PROG) was injected by subcutaneous injection for days in PROG group and control group respectively. Electrophysiological, histolgicial and morphological examinations were measured at 4,8, and 12 weeks after the operation. Results Regeneration of peroneal nerve occurred in both groups. All the data were analysed by factorial designed analysis of variance. The output demonstrated that there was a signficant difference in the quality of regeneration of peroneal between PROG group and control group (P