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Abstract
Purpose
We wanted to compare the nerve regeneration of inside-out vein grafts, muscle-filled inside-out vein grafts and fat-interposed inside-out vein grafts to repair the 10 mm sciatic nerve defects in rats.
Materials and Methods
We performed inside-out vein grafts, muscle-filled inside-out vein grafts and fat-interposed inside-out vein grafts to repair the 10 mm sciatic nerve defects in 45 rats. Histological examinations (the numbers and diameters of myelinated nerve fibers), electrophysiologic testing (Compound Muscle Action Potential (CMAP) and Nerve Conduction Velocity (NCV)) examinations were performed 3 months after surgery.
Results
Quantitative analysis of myelinated nerve fibers showed that total number of nerve fibers was significantly greater in group 1 or 3 than that in group 2. There were statistical differences in the three groups for the fiber diameters of the myelinated fibers. Electrophysiologic examination showed that both CMAP and NCV were significantly greater in group 3 than that in group 2 and there was no statistical difference between in groups 1 and 3.
Conclusion
This study shows that fat-interposed inside-out vein grafts have excellent axonal regeneration as compared to that of inside-out vein grafts or muscle-filled inside-out vein grafts to repair 10 mm sciatic nerve defects in rat. Therefore fat-interposed inside-out vein grafts are an effective method to accelerate the early axonal regeneration for repairing nerve defects.
Figures and Tables
Figure 1
Rat sciatic nerve repaired by means of inside out vein graft alone, group 1 (Masson's Trichrome stain, (A) ×400, (B) ×1000). Photomicrograph of a semithin cross-section shows a high number and small size of axon.
Figure 2
Rat sciatic nerve repaired by means of muscle-filled inside-out vein graft, group 2 (Masson's Trichrome stain, (A) ×400, (B) ×1000). Photomicrograph of a semithin cross-section shows increased fibrosis between the regenerated axon and small number of axon.
Figure 3
Rat sciatic nerve repaired by means of fat-interposed inside-out vein graft, group 3 (Masson's Trichrome stain, (A) ×400, (B) ×1000). This group shows more regular shape of axon and more parallel and organized regeneration.
Figure 4
EMG records at 3 months postoperatively. (A) Inside-out vein graft alone. (B) Muscle-filled inside out vein graft. (C) Fat-interposed inside-out vein graft.
References
1. Lassner F, Becker M, Fansa H, Walter GF, Berger A. Preservation of peripheral nerve grafts: a comparison of normal saline, HTK organ preservation solution, and DMEM Schwann cell culture medium. J Reconstr Microsurg. 1995. 11:447–453.
2. Lundborg G, Dahlin L, Danielsen N, Zhao Q. Trophism, tropism, and specificity in nerve regeneration. J Reconstr Microsurg. 1994. 10:345–354.
3. Terzis JK, Sun DD, Thanos PK. Historical and basic science review: past, present, and future of nerve repair. J Recosntr Microsurg. 1997. 13:215–225.
4. Yin Q, Kemp GJ, Frostick SP. Neurotrophins, neurones, and peripheral nerve regeneration. J Hand Surg Br. 1998. 23:433–437.
5. Chiu DT, Janecka I, Krizek TJ, Wolff M, Lovelace RE. Autogenous vein graft as a conduit for nerve regeneration. Surgery. 1982. 91:226–233.
6. Fansa H, Keilhoff G, Wolf G, Schneider W. Tissue engineering of peripheral nerves: a comparison of venous and acellular muscle grafts with cultured Schwann cells. Plast Reconstr Surg. 2001. 107:485–494.
7. Rigoni G, Smahel J, Chiu DT, Meyer VE. Vein interposition as a pathway for peripheral nerve regeneration. Handchir Mikrochir Plast Chir. 1983. 15:227–231.
8. Stahl S, Rosenberg N. Digital nerve repair by autogenous vein graft in high-velocity gunshot wounds. Mil Med. 1999. 164:603–604.
9. Strauch B, Ferder M, Lovelle-Allen S, Moore K, Kim DJ, Llena J. Determining the maximum length of a vein conduit used as an interposition graft for nerve regeneration. J Reconstr Microsurg. 1996. 12:521–527.
10. Walton RL, Brown RE, Matory WE Jr, Borah GL, Dolph JL. Autogenous vein graft repair of digital nerve defects in the finger: a retrospective clinical study. Plast Reconstr Surg. 1989. 84:944–949.
11. Feneley MR, Fawcett JW, Keynes RJ. The role of Schwann cells in the regeneration of peripheral nerve axons through muscle basal lamina grafts. Exp Neurol. 1991. 114:275–285.
12. Smahel J, Jentsch B. Stimulation of peripheral nerve regeneration by an isolated nerve segment. Ann Plast Surg. 1986. 16:494–501.
13. Zhang F, Blain B, Beck J, et al. Autogenous venous graft with one-stage prepared Schwann cells as a conduit for repair of long segmental nerve defects. J Reconstr Microsurg. 2002. 18:295–300.
14. Battiston B, Tos P, Cushway TR, Geuna S. Nerve repair by means of vein filled with muscle grafts I. Clinical results. Microsurgery. 2000. 20:32–36.
15. Battiston B, Tos P, Geuna S, Giacobini-Robecchi MG, Guglielmone R. Nerve repair by means of vein filled with muscle grafts II. Morphological analysis of regeneration. Microsurgery. 2000. 20:37–41.
16. Choi BH, Zhu SJ, Kim SH, et al. Nerve repair using a vein graft filled with collegen gel. J Reconstr Microsurg. 2005. 21:267–272.
17. Brunelli GA, Battiston B, Vigasio A, Brunelli G, Marocolo D. Bridging nerve defects with combined skeletal muscle and vein conduits. Microsurgery. 1993. 14:247–251.
18. Lee KS, Park JW, Koh YS, Oh KJ, Lee KH. Experimental study of nerve regeneration by inside-in and inside-out vein graft in the nerve defect of rat. J Korean Orthop Assoc. 1999. 34:1009–1017.
19. Lee KS, Shim JH, Kim TH, Ju SD. The study of nerve regeneration with infiltration of normal saline and nerve growth factor after vein graft to the resected sciatic nerve. J Korean Orthop Assoc. 2001. 36:17–24.
20. Pereira JH, Bowden RE, Gattuso JM, Norris RW. Comparison of results of repair of digital nerves by denatured muscle grafts and end-to-end sutures. J Hand Surg Br. 1991. 16:519–523.
21. Tang J, Wang XM, Hu J, Luo E, Qi MC. Autogenous standard versus inside-out vein graft to repair fascial nerve in rabbits. Chin J Traumatol. 2008. 11:104–109.
22. Tang JB, Gu YQ, Song YS. Repair of digital nerve defect with autogenous vein graft during flexor tendon surgery in zone 2. J Hand Surg Br. 1993. 18:449–453.
23. Lundborg G. Nerve regeneration and repair. A review. Acta Orthop Scand. 1987. 58:145–169.
24. Mackinnon SE, Dellon AL. Two point discrimination tester. J Hand Surg Am. 1985. 10:906–907.
25. Taras JS, Nanavati V, Steelman P. Nerve conduits. J Hand Ther. 2005. 18:191–197.
26. Longo FM, Hayman EG, Davis GE, et al. Neurite-promoting factors and extracellular matrix components accumulating in vivo within nerve regeneration chambers. Brain Res. 1984. 309:105–117.
27. Rodriguez FJ, Gómez N, Labrador RO, et al. Improvement of regeneration with predegenerated nerve transplants in silicone chambers. Restor Neurol Neurosci. 1999. 14:65–79.
28. Stanec S, Stanec Z. Ulnar nerve reconstruction with an expanded polytetrafluoroethylene conduit. Br J Plast Surg. 1998. 51:637–639.
29. Mackinnon SE, Dellon AL. Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube. Plast Reconstr surg. 1990. 85:419–424.
30. Ceballos D, Navarro X, Dubey N, Wendelschafer-crabb G, Kennedy WR, Tranquillo RT. Magnetically aligned collagen gel filling a collagen nerve guide improves peripheral nerve regeneration. Exp Neurol. 1999. 158:290–300.
31. Fawcett JW, Keynes RJ. Muscle basal lamina: a new graft material for peripheral nerve repair. J Neurosurg. 1986. 65:354–363.
32. Ide C. Nerve regeneration through the basal lamina scaffold of the skeletal muscle. Neurosci Res. 1984. 1:379–380.
33. Risitano G, Cavallaro G, Merrino T, Coppolino S, Ruggeri F. Clinical results and thoughts on sensory nerve repair by autologous vein graft in emergency hand reconstruction. Chir Main. 2002. 21:194–197.
34. Guena S, Tos P, Battiston B, Giacobini-Robecchi MG. Bridging peripheral nerve defects with muscle-vein combined guides. Neurol Res. 2004. 26:139–144.
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