Vascularized versus Non-Vascularized Nerve Transfers: Histologic Study in Rats

ABSTRACT

From the clinical point of view, the state of vascularized nerve transfers is clearly demonstrated in the literature. This study was carried out to elicit the basic histologic differences between vascularized and non-vascularized nerve transfers in an animal experiment. In 46 rats, the lateral femoral cutaneous nerve was resected, and an interposition with a free (n=23) ischiatic nerve transfer on one side and a vascularized (n=23) ischiatic nerve transfer on the other side was carried out. Three months postoperatively, the rats were sacrificed and 45 nerve transfers and 46 contralateral reference specimen probes were histologically evaluated. A lower degree of nerve fibrosis and vesicular degeneration of the myelin sheath were found in the vascularized nerve transfers, compared to the free non-vascularized transfers. The thickness of the myelin sheaths was less in the free transfers. From a histologic point of view, a lower degree of degenerative changes was seen in the vascularized nerves after transfer.

KEYWORD

Vascularized vs. non-vascularized nerve transfers - histology - degenerative changes

REFERENCES

• 1 Millesi H, Meissl G, Berger A. The interfascicular nerve grafting of the ulnar and median nerve.  J Bone Joint Surg . 1972;  54A 727-734
• 2 Millesi H. Fascicular nerve repair and interfascicular nerve grafting. In: Daniel RK, Terzis JK (eds) Reconstructive Microsurgery Boston: Little Brown 1979
• 3 Alpar E K, Brooks D M. Long term results of ulnar to median nerve pedicle grafts.  Hand . 1978;  10 61-67
• 4 Edgerton M T. Cross arm nerve pedicle flap for reconstruction of major defects of the median nerve.  Surgery . 1968;  64 248-256
• 5 Seddon H J. Nerve grafting.  J Bone Joint Surg . 1963;  45B 447-453
• 6 Seddon H J. The use of autologous grafts for the repair of large gaps in peripheral nerves.  Br J Surg . 1947;  35 131-139
• 7 Lewis H P, McLaurin R L. Application of tissue transplant technique to experimental nerve grafting.  J Trauma . 1996;  9 227-234
• 8 Ozcan G, Shenaq S, Mirabi B, Spira M. Nerve regeneration in a bony bed: vascularized versus nonvascularized nerve grafts.  Plast Reconstr Surg . 1993;  91 1322-1331
• 9 Brooks D. The place of nerve grafting in orthopedic surgery.  J Bone Joint Surg . 1955;  37B 299-305
• 10 Tarlov I M, Epstein J A. Nerve grafts: the importance of an adequate blood supply.  J Neurosurg . 1945;  2 49-56
• 11 Taylor G I, Ham F J. The free vascularized nerve graft: a further experimental and clinical application of microvascular technique.  Plast Reconstr Surg . 1976;  57 413-419
• 12 Kärcher H, Kleinert R. Regeneration in vascularized and free nerve grafts: a comparative morphological study in rats.  J Maxillofac Surg . 1986;  14 341-343
• 13 Terzis J K, Breidenbach W. The anatomy of free vascularized nerve grafts. In Terzis JK (ed): Microreconstruction of Nerve Injuries. WJ Saunders Company 1987: 101-111
• 14 Kärcher H. Der gafäβgestielte Nervus saphenus. Anatomie und chirurgischer Zugang.  Dtsch Z Mund-, Kiefern-, Gesichtschir . 1988;  6 432-438
• 15 Schultes G, Gaggl A, Kärcher H. Reconstruction of accessory nerve defects with the vascularized long thoracic nerve versus the nonvascularized thoracodorsal nerve.  J Reconstr Microsurg . 1999;  15 265-271
• 16 Okinaga S, Nagano A. Can vascularisation improve the surgical outcome of the intercostal nerve transfer for traumatic brachial plexus palsy?.  <~>A clinical comparison of vascularized and non vascularized methods. J Microsurg . 1999;  19 176-180
• 17 Mackinnon S E, Kelly L, Hunter D A. Comparison of regeneration across a vascularized versus conventional nerve graft: case report.  Microsurgery . 1988;  9 226-233
• 18 Luchetti R, De Santis G, Soragni O. Vascularized nerve graft: a clinical contribution.  Chir Organi Mov . 1990;  75 153-161
• 19 Schultes G, Gaggl A, Kärcher H. Vascularized transplantation of the long thoracic nerve for sensory reinnervation of the lower lip.  Br J Maxillofac Surg. 2000; 
• 20 Shibata M, Tsai T M, Firelli J, Breidenbach W C. Experimental comparison of vascularized and nonvascularized nerve grafting.  J Hand Surg . 1988;  13A 358-365
• 21 Koshima J, Harii K. Experimental study of vascularized nerve grafts: a morphometric study of axonal regeneration of nerves transplanted into silicone tubes.  Ann Plast Surg . 1985;  14 235-243
• 22 Koshima J, Harii K. Experimental study of vascularized nerve grafts: a multifactorial analyses of axonal regeneration of nerves transplanted into an acute burn wound.  J Hand Surg . 1985;  10A 64-72
• 23 Koller R, Happak W, Frey M. Experimental surgery in the peripheral nerve-the correlation of morphometric and functional parameters.  Handchir Microchir Plast Chir . 1997;  29 330-334
• 24 Eberhard D, Millesi H. Split nerve grafting.  J Reconstr Microsurg . 1996;  12 71-76
• 25 Amillo S, Yanez R, Barrios R H. Nerve regeneration in different types of grafts: experimental study in rabbits.  J Microsurg . 1995;  16 621-630
• 26 O'Sullivan K, Pap S, Megerian C. Improved axon diameter and myelin sheath thickness in fascial nerve cable grafts wrapped in temporoparietal fascial flaps.  Ann Plast Surg . 1998;  40 478-485