2009, Number 2
<< Back Next >>
Acta Ortop Mex 2009; 23 (2)
Sliding of the distal epineural sheath to cover nerve defects
Murilo NE, Giostri MGS, Santos PS, Sáenz CE, Silveira GAR, Tambara FR
Language: Spanish
References: 25
Page: 74-79
PDF size: 448.29 Kb.
ABSTRACT
Autologous nerve grafting is the most referred technique for bridging neural gaps. The aim of this study was to evaluate the effects of distally sliding the epineurial sheath to cover a defect created in the left sciatic nerve of the rat. Twenty male Wistar rats were divided into three groups:
sham (n = 6), in which the sciatic nerve was dissected but left intact;
conventional suture (CS, n = 7), in which a transverse section of the sciatic nerve was followed by an epineurial suture;
sliding of the distal epineurial sheath (SDES, n = 7), in which a 5 mm resection of the nerve was conducted, followed by a circumferential cut in the distal epineurium, and the epineurial sheath was slid down and sutured into the distal end of the epineurium of the proximal stump. After 12 weeks, histomorphometric analyses of the number of myelinated nerve fibers, mean cross-sectional axonal area and total fiber diameter (G-ratio) were carried out. There was no statistical differences between CS and SDES (p › 0.05, ANOVA). However, an increase in the number of myelinated nerve fibres (p ‹ 0.001, ANOVA) and decreases in the mean axonal area (p ‹ 0.001, ANOVA) and in the G-ratio were observed in SDES or SC groups when compared to sham, although with no statistical differences between the SDES and SC. It could be suggested this technique is efficient to cover nerve gaps in rats.
REFERENCES
IJkema J, Jansen K, Gramsbergen A, Meek MF: Transection of peripheral nerves, bridging strategies and effect evaluation. Biomaterials 2004; 25(9): 1583-92.
Birch R, Raji AR: Repair of median and ulnar nerves. Primary suture is best. J Bone Joint Surg Br 1991; 73(1): 154-7.
Meek MF, Coert JH: Clinical use of nerve conduits in peripheral-nerve repair: review of the literature. J Reconstr Microsurg 2002; 18(2): 97-109.
Siemionow M, Sari A: A contemporary overview of peripheral nerve research from the Cleveland Clinic microsurgery laboratory. Neurol Res 2004; 26(2): 218-25.
Barcelos AS, Rodrigues AC, Silva MD, Padovani CR: Inside-out vein graft and inside-out artery graft in rat sciatic nerve repair. Microsurgery 2003; 23(1): 66-71.
Meek MF, den Dunnen WF, Schakenraad JM, Robinson PH: Evaluation of several techniques to modify denatured muscle tissue to obtain a scaffold for peripheral nerve regeneration. Biomaterials 1999; 20(5): 401-8.
Weber RA, Breidenbach WC, Brown RE, Jabaley ME, Mass DP: A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans. Plast Reconstr Surg 2000; 106(5): 1036-45; discussion 1046-8.
Stanec S, Stanec Z: Ulnar nerve reconstruction with an expanded polytetrafluoroethylene conduit. Br J Plast Surg 1998; 51(8): 637-9.
Dahlin LB, Anagnostaki L, Lundborg G: Tissue response to silicone tubes used to repair human median and ulnar nerves. Scand J Plast Reconstr Surg Hand Surg 2001; 35(1): 29-34.
Atabay KHC, Heil BV, et al: The use of «sliding epineural sheath tube» for repair of peripheral nerve defects. Plast Surg Forum 1995; 18: 121-3.
Ayhan S, Yavuzer R, Latifoglu O, Atabay K: Use of the turnover epineurial sheath tube for repair of peripheral nerve gaps. J Reconstr Microsurg 2000; 16(5): 371-8.
Belkas JS, Shoichet MS, Midha R: Peripheral nerve regeneration through guidance tubes. Neurol Res 2004; 26(2): 151-60.
Chatdokmaiprai C, Suwansingh W, Worapongpaiboon S: The turnover distal epineurial sheath tube for repair of peripheral nerve gaps. J Med Assoc Thai 2006; 89(5): 663-9.
Mackinnon SE, Hudson AR, Hunter DA: Histologic assessment of nerve regeneration in the rat. Plast Reconstr Surg 1985; 75(3): 384-8.
Geuna S, Gigo-Benato D, Rodrigues A de C: On sampling and sampling errors in histomorphometry of peripheral nerve fibers. Microsurgery 2004; 24(1): 72-6.
Urso-Baiarda F, Grobbelaar AO: Practical nerve morphometry. J Neurosci Methods 2006; 156(1-2): 333-41.
Terzis JK, Sun DD, Thanos PK: Historical and basic science review: past, present, and future of nerve repair. J Reconstr Microsurg 1997; 13(3): 215-25.
Hall S: Axonal regeneration through acellular muscle grafts. J Anat 1997; 190 (Pt 1): 57-71.
Kingham PJ, Terenghi G: Bioengineered nerve regeneration and muscle reinnervation. J Anat 2006; 209(4): 511-26.
Battiston B, Geuna S, Ferrero M, Tos P: Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005; 25(4): 258-67.
Yavuzer R, Ayhan S, Latifoglu O, Atabay K: Turnover epineural sheath tube in primary repair of peripheral nerves. Ann Plast Surg 2002; 48(4): 392-400.
Terenghi G: Peripheral nerve regeneration and neurotrophic factors. J Anat 1999; 194 (Pt 1): 1-14.
Yoshii S, Oka M, Ikeda N, Akagi M, Matsusue Y, Nakamura T: Bridging a peripheral nerve defect using collagen filaments. J Hand Surg [Am] 2001; 26(1): 52-9.
De Sa JM, Mazzer N, Barbieri CH, Barreira AA: The end-to-side peripheral nerve repair. Functional and morphometric study using the peroneal nerve of rats. J Neurosci Methods 2004; 136(1): 45-53.
Fraher J, Dockery P: A strong myelin thickness-axon size correlation emerges in developing nerves despite independent growth of both parameters. J Anat 1998; 193 (Pt 2): 195-201.