Nerve Bypass Grafting for the Treatment of Neuroma-in-Continuity: An Experimental Study on the Rat

ABSTRACT

The treatment of neuroma-in-continuity is controversial. To bypass neuroma-in-continuity with a nerve graft using end-to-side neurorrhaphy is considered to be theoretically a good option. To test this therapeutic modality, we performed a nerve bypass graft in a neuroma-in-continuity rat model. An obstructive neuroma-in-continuity was created in a transected peroneal nerve by interposition using the aponeurosis of the spinal muscles. In the experimental animals, (1) immediate, (2) 3-week delayed, or (3) no ulnar nerve bypass graft was performed. The peroneal functional index (PFI), conduction velocity, tibialis anterior muscle weight, and histomorphometric analyses were performed and compared with control (simply cut and repair) animals. On postoperative day 70, the recoveries of the PFI values, conduction velocity, and tibialis anterior muscle weight in the bypassed animals showed no significant differences as compared with the control animals, and the extent of these recoveries in the bypassed animals were significantly superior to those in the no-graft animals. In the histomorphometric analysis, the mean percent nerve in the bypassed animals was significantly larger than that in the no-graft animals. In conclusion, this technique may be a good alternative to the current therapeutic techniques for neuroma-in-continuity when there is a significant retained function.

KEYWORDS

Nerve bypass graft - neuroma-in-continuity - end-to-side neurorrhaphy

REFERENCES

• 1 Kline D G, Nulsen F E. The neuroma in continuity. Its preoperative and operative management.  Surg Clin North Am. 1972;  52 1189-1209
• 2 Mackinnon S E, Glickman L T, Dagum A. A technique for the treatment of neuroma in-continuity.  J Reconstr Microsurg. 1992;  8 379-383
• 3 Shah M H, Kasabian A K, Karp N S et al.. Axonal regeneration through an autogenous nerve bypass: an experimental study in the rat.  Ann Plast Surg. 1997;  38 408-414 discussion 414-405
• 4 Kasabian A, Karp N, Margiotta M. Treatment of a neuroma-in-continuity of the peroneal nerve with nerve bypass grafts-a case report.  Ann Plast Surg. 1999;  42 449-451
• 5 Adelson P D, Bonaroti E A, Thompson T P, Tran M, Nystrom N A. End-to-side neurorrhaphies in a rodent model of peripheral nerve injury: a preliminary report of a novel technique.  J Neurosurg. 2004;  101 78-84
• 6 Kerns J M, Malushte T S, Nagel T, Shott S, Safanda J, Gonzalez M. Repair of partial lesions with nerve grafting methods in the rat tibial nerve.  J Reconstr Microsurg. 2005;  21 257-266
• 7 Kerns J M, Sladek E H, Malushte T S et al.. End-to-side nerve grafting of the tibial nerve to bridge a neuroma-in-continuity.  Microsurgery. 2005;  25 155-164 discussion 164-156
• 8 Bain J R, Mackinnon S E, Hunter D A. Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat.  Plast Reconstr Surg. 1989;  83 129-138
• 9 Sagot Y, Rosse T, Vejsada R, Perrelet D, Kato A C. Differential effects of neurotrophic factors on motoneuron retrograde labeling in a murine model of motoneuron disease.  J Neurosci. 1998;  18 1132-1141
• 10 Ballance C, Ballance H, Stewart P. Remarks on the operative treatment of chronic facial palsy of peripheral origin.  Br Med J. 1903;  1 1009-1013
• 11 Viterbo F, Trindade J C, Hoshino K, Mazzoni Neto A. Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats.  Rev Paul Med. 1992;  110 267-275
• 12 Viterbo F, Trindade J C, Hoshino K, Mazzoni Neto A. End-to-side neurorrhaphy with removal of the epineurial sheath: an experimental study in rats.  Plast Reconstr Surg. 1994;  94 1038-1047
• 13 Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns J M. Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis?.  J Hand Surg [Br]. 1994;  19 277-282
• 14 Bertelli J A, dos Santos A R, Calixto J B. Is axonal sprouting able to traverse the conjunctival layers of the peripheral nerve? A behavioral, motor, and sensory study of end-to-side nerve anastomosis.  J Reconstr Microsurg. 1996;  12 559-563
• 15 Noah E M, Williams A, Jorgenson C, Skoulis T G, Terzis J K. End-to-side neurorrhaphy: a histologic and morphometric study of axonal sprouting into an end-to-side nerve graft.  J Reconstr Microsurg. 1997;  13 99-106
• 16 al-Qattan M M, al-Thunyan A. Variables affecting axonal regeneration following end-to-side neurorrhaphy.  Br J Plast Surg. 1998;  51 238-242
• 17 Rovak J M, Cederna P S, Macionis V, Urbanchek M S, Van Der Meulen J H, Kuzon Jr W M. Termino-lateral neurorrhaphy: the functional axonal anatomy.  Microsurgery. 2000;  20 6-14
• 18 Giovanoli P, Koller R, Meuli-Simmen C et al.. Functional and morphometric evaluation of end-to-side neurorrhaphy for muscle reinnervation.  Plast Reconstr Surg. 2000;  106 383-392
• 19 De Sa J M, Mazzer N, Barbieri C H, Barreira A A. The end-to-side peripheral nerve repair. Functional and morphometric study using the peroneal nerve of rats.  J Neurosci Methods. 2004;  136 45-53
• 20 Edds Jr M V. Collateral nerve regeneration.  Q Rev Biol. 1953;  28 260-276
• 21 Slack J R, Hopkins W G, Williams M N. Nerve sheaths and motoneurone collateral sprouting.  Nature. 1979;  282 506-507
• 22 Buehler M J, Seaber A V, Urbaniak J R. The relationship of functional return to varying methods of nerve repair.  J Reconstr Microsurg. 1990;  6 61-69
• 23 Isaacs J, Allen D, Chen L E, Nunley II J. Reverse end-to-side neurotization.  J Reconstr Microsurg. 2005;  21 43-48 discussion 49-50
• 24 Kryger G S, Kryger Z, Zhang F, Shelton D L, Lineaweaver W C, Buncke H J. Nerve growth factor inhibition prevents traumatic neuroma formation in the rat.  J Hand Surg Am. 2001;  26 635-644
• 25 Tower S S. Atrophy and degeneration in skeletal muscle.  Am J Anat. 1935;  56 1-43
• 26 Schmalbruch H, al-Amood W S, Lewis D M. Morphology of long-term denervated rat soleus muscle and the effect of chronic electrical stimulation.  J Physiol. 1991;  441 233-241
• 27 You S, Petrov T, Chung P H, Gordon T. The expression of the low affinity nerve growth factor receptor in long-term denervated Schwann cells.  Glia. 1997;  20 87-100
• 28 Bennett G J. An animal model of neuropathic pain: a review.  Muscle Nerve. 1993;  16 1040-1048
• 29 Zimmermann M. Pathobiology of neuropathic pain.  Eur J Pharmacol. 2001;  429 23-37