J Korean Neurosurg Soc.  2017 Jul;60(4):417-423. 10.3340/jkns.2016.1010.010.

Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve: An Experimental Research

• Civi S
• Durdag E
• Aytar MH
• Kardes O
• Kaymaz F
• Aykol S

• KMID: 2387879
• DOI: http://doi.org/10.3340/jkns.2016.1010.010

Abstract

OBJECTIVE
Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM).
METHODS
We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups: group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals.
RESULTS
Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D.
CONCLUSION
Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.

Keyword

Nerve bridging; Sensory nerve defect; End-to-side coaptation; Neural cell adhesion molecules

MeSH Terms

Animals
Methods
Muscles
Neural Cell Adhesion Molecules
Peripheral Nerves
Rats
Rats, Sprague-Dawley
Skin
Sural Nerve*
Tibial Nerve*
Neural Cell Adhesion Molecules

Figure

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  Fig. 1 A: The divisions of sciatic nevre under operation microscope. B: Peroneal division is spared below with metric paper, sural nerve is sectioned. Proximal and distal endings of sectioned sural nerve is demostrated by arrows. C: Sural stumps are coapted to tibial nerve by ETS fashion. Proximal and distal coaptation of sural nerve is demostrated by arrows. ETS: end-to-side.

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  Fig. 2 A typical compound picture of nociceptive innervation fields of the examined peripheral nerves. Saphenous nerve (a), peroneal nerve (b), sural nerve (c), tibial nerve (d), and compound innervation of nociceptive dermatomes (e). T: tibial nerve, S: sural nerve, P: peroneal nerve.

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  Fig. 3 The number of pinch test positive rats in different time intervals.

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  Fig. 4 A box plot summarizing the mean values of positively stained nerve endings in each group.

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  Fig. 5 A: On the micrograph of group A the arrows point anti-NCAM positive free nerve endings (original magnification, ×20, indirect immunohistochemistry). B: On the micrograph of group B the arrow points ant -NCAM positive free nerve ending (original magnification, ×20, indirect immunohistochemistry). More stained free nerve endings are seen on group A than in group B. NCAM: neural cell adhesion molecule.

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  Fig. 6 A: On the micrograph of group C the arrows point anti-NCAM positive free nerve endings (original magnification, ×20, indirect immunohistochemistry). B: On the micrograph of group D the arrows point anti-NCAM positive nerve endings (original magnification, ×20, indirect immunohistochemistry). More stained free nerve ending are seen on group C than in group D. NCAM: neural cell adhesion molecule.

Reference

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