End-to-side neurorrhaphy with and without perineurium
Keywords:
End-to-side neurorrhaphy, Microsurgery, RatsAbstract
OBJECTIVE: We compared end-to-side neurorraphy with and without the perineural sheath. METHOD: Twenty rats were used. The peroneal nerve was sectioned and the distal end was sutured to the lateral face of the tibial nerve. We removed the perineural sheath only on the right side, but not on the left side. The proximal end of the peroneal nerve was curved back approximately at a 100° angle and implanted into the adductor muscle. Six months later, the 14 surviving animals were submitted to electrophysiological tests, sacrificed, and the nerves and muscles were taken for histological exams. RESULTS: On the right side, the muscles that had positive response needed an average of 258.89 mV (±92.31) of electric stimulus and on the left side 298.34 mV (±139.32). The average weight of the tibial cranial muscles of the right side was 0.47 g (0.18) and for the left side 0.45 g (0.15). The distal end of the peroneal nerve showed averages of 310.29 (±191.34) nerve fibers on the right side and 287.71 (±183.60) on the left side. The tibial nerve above the neurorraphy showed averages of 939.46 (±223.51) nerve fibers on the right side and 959.46 (±327.48) on the left side. The tibial nerve below the neurorraphy showed averages of 935.17 (±298.65) nerve fibers on the right side and 755.31 (±323.26) on the left side. The average areas of the right tibial cranial muscles were 0.0162 m2 (±0.008), after 230 magnification, and 0.0152 m2 (0.0064) for the left tibial cranial muscles. The histological features of the tibial cranial muscles, taking normal as 100%, were 78.21 (±20.75) on the right side and 82.14 (±15.89) on the left side. The statistical analysis (Student's t test) did not reveal any difference (p>0.05) among right and left sides for all variables. CONCLUSION: The authors concluded that the two neurorraphies (with and without perineurium) did not show any difference regarding morphological and electrophysiological features studied.
Downloads
References
Ballance CA, Ballance HA, Stewart P. Remarks on the operative treatment of chronic facial palsy of peripheral origin. Br Med J 1903;2:1009-13.
Sherren J. Some points in the surgery of the peripheral nerves. Edinburgh: Edinb Med J 1906;20:297-332.
Krivolutskaia EG, Tchumassov EI, Matina VN, Meltsova GM, Kirilov AL. Nijiacthka betbeh jihueboro hepba no thny koheu B bok. URSS: Stomachia; 1987.
Viterbo F. Neurorrafia látero-terminal, estudo experimental no rato. Botucatu: 1992 (PhD Thesis - Faculdade de Medicina, Universidade Estadual Paulista).
Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns JM. Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? J Hand Surgery 1994;19B:277-82.
Michalany J. In: Técnica histológica em anatomia patológica. Săo Paulo: Editora Pedagógica e Universitária 1980:128.
Box GEP, Hunter WG, Hunter JS. Statistics for experiments. New York: John Wiley & Sons; 1978:653.
Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A. Latero-terminal neurorraphy without removal of the epineural sheath: experimental study in rats. Rev Paul Med 1992;110(6):267-75.
Viterbo F. A new method for treatment of facial palsy: the cross-face nerve transplantation with end-to-side neurorraphy. Rev Soc Bras Cir Plástica Estética e Reconstrutiva 1993;8(1,2,3):29-38.
Viterbo F, Trindade JC, Hoshino K, Mazzoni-Neto A. Two end-to-side neurorraphies and nerve graft with removal of the epineural sheath: experimental study in rats. Brit J Plast Surg 1994;47:75-80.