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A Comparison of Collateral Sprouting of Sensory and Motor Axons after End-to-Side Neurorrhaphy with and without the Perineurial Window

Haninec, Pavel M.D., Ph.D.; Kaiser, Radek M.D., Ph.D.; Dubový, Petr Ph.D.

Plastic & Reconstructive Surgery: September 2012 - Volume 130 - Issue 3 - p 609–614
doi: 10.1097/PRS.0b013e31825dc20a
Hand/Peripheral Nerve: Original Article
Discussion

Background: Many experimental studies have confirmed collateral sprouting of axons after end-to-side neurorrhaphy and its possible clinical application. There is still controversy about how the surgical method should be carried out. The aim of the present study was to quantitatively evaluate collateral sprouting of motor and sensory axons after end-to-side neurorrhaphy with and without the perineurial window.

Methods: End-to-side neurorrhaphy of the distal stump of transected musculocutaneous nerve with intact ulnar nerve with or without a perineurial window was performed in a rat model. Collateral sprouts were quantitatively evaluated by counting of motor and sensory neurons following their retrograde labeling by Fluoro-Ruby and Fluoro-Emerald applied to the ulnar and musculocutaneous nerves, respectively.

Results: Our results show that significantly more motor and sensory axons sent their collateral branches into the recipient nerve in the group with a perineurial window. Some axons were injured during preparation of the perineurial window; the injured axons reinnervated directly into the recipient nerve to contribute to results of functional reinnervation.

Conclusion: The authors conclude that it is necessary to create a perineurial window when using end-to-side neurorrhaphy in clinical practice, especially in brachial plexus reconstruction.

Prague and Brno, Czech Republic

From the Department of Neurosurgery, 3rd Faculty of Medicine, Charles University, and the Department of Anatomy, Division of Neuroanatomy, Faculty of Medicine, and Central European Institute of Technology, Masaryk University.

Received for publication January 17, 2012; accepted March 5, 2012.

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this article.

Pavel Haninec, M.D., Ph.D.; 3rd Faculty of Medicine, Charles University, Department of Neurosurgery, Faculty Hospital Kralovske Vinohrady, Srobarova 50, 100 34 Prague, Czech Republic, pavel.haninec@fnkv.cz

©2012American Society of Plastic Surgeons