Plastic Surgery Research Council
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Presenter: Jill Shea, PhD
Co-Authors: Doner LJ; Garlick JW; Mendenhall SD; Agarwal JP
University of Utah

Introduction: There is an enormous clinical need for better outcomes after peripheral nerve repair. We hypothesize that repairing a proximally severed nerve in the traditional end-to-end fashion in combination with a distal side-to-side bridge, between the damaged nerve and a nearby healthy nerve, will result in preserved muscle function and an overall superior outcome when compared to end-to-end repair alone.

Methods: Rats were divided into four groups (n=7/group). Group 1 Transected: a 10mm gap was created in the proximal tibial nerve, Group 2 Transected + Repaired: the transected tibial nerve was repaired, Group 3 Transected + Repaired + Nerve Bridge: same as in Group 2 with the addition of a distal nerve bridge between the tibial and peroneal nerves via epineurial windows. Group 4 Transected + Nerve Bridge: 10 mm nerve gap and a nerve bridge placed as in Group 3. At 90 days the following outcome measures were determined: gastrocnemius mass, muscle and nerve nuclear density, and axonal infiltration into the nerve bridge.

Results: Group 3 had less gastrocnemius atrophy than Group 1 (p<0.01; Fig 1). Group 1 and 2 also had greater muscle nuclear density (p<0.05; Fig 2), as well as other histological characteristics of denervated muscle, such as smaller muscle fibers than Group 3. There were no differences between Group 4 and the other groups in terms of muscle atrophy and nuclear density. The proximal and distal segments of the tibial nerve of Group 3 had nearly equivalent nuclear densities, whereas in Group 2 the distal segment had a much greater nuclear density compared with the proximal segments (p<0.05). Finally, there was neuronal sprouting via the epineural windows in Group 3 (5/7) and Group 4 (4/7)(Fig 3).

Discussion: Poor outcomes after repair of peripheral nerve injuries are a major clinical obstacle. The present study demonstrates that a distal side-to-side nerve bridge in conjunction with repair of a transected nerve in a rat model results in greater prevention of muscle atrophy. This new surgical approach could greatly improve patient outcome following peripheral nerve injury.

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