Muscle Flap Mass Preservation with End-to-Side Neurorrhaphy: An Experimental Study

The authors examined the preservation of rat gracilis muscle flap mass after motor and sensory end-to-side neurorrhaphy. The rat gracilis muscle flap model was designed based on a previous study. Twenty-four Sprague-Dawley rats were divided into three groups. In Group 1 (n = 8), the flap was denervated by transecting the obturator nerve. In Group 2 (n = 8), the flap was reinnervated by coapting the proximal saphenous nerve to the distal obturator nerve. In Group 3 (n = 8), the flap was reinnervated by coapting the motor branch of the femoral nerve to the distal stump of the obturator nerve. At 6 months postoperatively, the gracilis muscle flaps were examined, harvested, and weighed individually. Results showed that the flaps with motor nerve reinnervation retained good bulk, with a weight of 634.0 ± 65.1 gm, which was statistically significantly higher than the denervated group (457.5 ± 125.3 gm, p < 0.01). However, muscle mass preservation in the sensory reinnervated group (606.9 ± 209.1 gm) was not significantly different, compared to the denervated group. Histology revealed atrophic changes in the denervated group, compared to the sensory and motor-reinnervated groups. The authors concluded that muscle mass can be preserved by end-to-side nerve repair. Motor nerve reinnervation is able to better arrest atrophic changes of the muscle flaps.

KEYWORDS

End-to-side neurorrhaphy - muscle reinnervation

REFERENCES

• 1 Nahabedian M Y, Momen B, Galdino G, Manson P N. Breast reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome.  Plast Reconstr Surg. 2002;  110 446-475
• 2 Khouri R K, Cooley B C, Kunselman A R et al.. A prospective study of microvascular free-flap surgery and outcome.  Plast Reconstr Surg. 1998;  102 711-721
• 3 Hui K C, Zhang F, Greenberg L, Lineaweaver W C. Calf augmentation using free TRAM flap.  Microsurgery. 1999;  19 227-231
• 4 Harii K, Ohmori K, Torii S. Free gracilis muscle transplantation, with microneurovascular anastomoses for the treatment of facial paralysis. A preliminary report.  Plast Reconstr Surg. 1976;  57 133-143
• 5 Terzis J K, Sweet R C, Dykes R W, Williams H B. Recovery of function in free muscle transplants using microneurovascular anastomoses.  J Hand Surg. 1992;  3A 37-59
• 6 Guelinckx P J, Carlson B M, Faulkner J A. Morphologic characteristics of muscles grafted in rabbits with neurovascular repair.  J Reconstr Microsurg. 1992;  8 481-489
• 7 Doi K, Sakai K, Ihara K, Abe Y, Kawai S, Kurafuji Y. Reinnervated free muscle transplantation for extremity reconstruction.  Plast Reconstr Surg. 1993;  91 872-883
• 8 Hynes N M, Bain J R, Thomas A, Veltri K, Maguire J A. Preservation of denervated muscle by sensory protection in rats.  J Reconstr Microsurg. 1997;  13 337-343
• 9 Papakonstantinou K C, Kamin E, Terzis J K. Muscle preservation by prolonged sensory protection.  J Reconstr Microsurg. 2002;  18 173-182
• 10 Dautel G, Lineaweaver W C, Campagna-Pinto D et al.. Preservation of transplanted muscle mass by motor and sensory reinnervation. In: Freilinger G, Deutinger M Transactions of the Third Vienna Muscle Symposium Vienna; Blackwell MZV 1992: 96
• 11 Zhang F, Lineaweaver W C, Ustuner T et al.. Comparison of muscle mass preservation in denervated muscle and transplanted muscle flaps after motor and sensory reinnervation and neurotization.  Plast Reconstr Surg. 1997;  99 803-814
• 12 Chang K N, Buncke H J. Sensory reinnervation in reconstruction of the foot.  Foot Ankle. 1986;  7 124-132
• 13 Chang K N, DeArmond S J, Buncke Jr H J. Sensory reinnervation in microsurgical reconstruction of the heel.  Plast Reconstr Surg. 1986;  78 652-664
• 14 Balance C A, Balance H A, Stewart P. Remarks on the operative treatment of chronic facial palsy of peripheral origin.  Br Med J. 1903;  1 1009-1013
• 15 Harris W, Low V W. On the importance of accurate muscular analysis in lesions of the brachial plexus, and the treatment of Erb's palsy and infantile paralysis of the upper extremity by cross-union of the nerve roots.  Br Med J. 1903;  24 1035-1038
• 16 Viterbo F, Trindade J C, Hoshino K, Mazzoni Neto A. Lateroterminal neurorrhaphy without removal of the epineural sheath: experimental study in rats.  Sao Paulo Medical Journal (Rev Paul Med). 1992;  110 267-275
• 17 Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns J M. Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis?.  J Hand Surg. 1994;  19B 277-282
• 18 Zhang F, Cheng C, Chin B T et al.. Results of termino-lateral neurorrhaphy to original and adjacent nerves.  Microsurgery. 1998;  18 276-281
• 19 Tarasidis G, Watanabe O, Mackinnon S E, Strasberg S R, Haughey B H, Hunter D A. End-to-side neurorrhaphy: a long-term study of neural regeneration in a rat model.  Otolaryngol Head Neck Surg. 1998;  119 337-341
• 20 Kalliainen L K, Cederna P S, Kuzon W M. Mechanical function of muscle reinnervated by end-to-side neurorrhaphy.  Plast Reconstr Surg. 1999;  103 1919-1927
• 21 Liu K, Chen L E, Seaber A V, Goldner R V, Urbaniak J R. Motor functional and morphological findings following end-to-side neurorrhaphy in the rat model.  J Orthop Res. 1999;  17 293-300
• 22 Rowan P R, Chen L E, Urbaniak J R. End-to-side nerve repair. A review.  Hand Clin. 2000;  16 151-159
• 23 Zhang Z, Soucacos P N, Beris A E, Bo J, Ioachim E, Johnson E O. Long-term evaluation of rat peripheral nerve repair with end-to-side neurorrhaphy.  J Reconstr Microsurg. 2000;  16 303-311
• 24 Al-Qattan M M. Terminolateral neurorrhaphy: review of experimental and clinical studies.  J Reconstr Microsurg. 2001;  17 99-108
• 25 Ulkur E, Yuksel F, Acikel C, Okar I, Celikoz B. Comparison of functional results of nerve graft, vein graft, and vein filled with muscle graft in end-to-side neurorrhaphy.  Microsurgery. 2003;  23 40-48
• 26 Dautel G, Braga da Silva J, Merle M. Pedicled or free flap transfer of the gracilis muscle in rats.  J Reconstr Microsurg. 1991;  7 23-25
• 27 Viterbo F, Trindade J C, Hoshino K, Mazzoni A. Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats.  Br J Plast Surg. 1994;  47 75-80
• 28 Viterbo F, Trindade J C, Hoshino K, Mazzoni Neto A. End-to-side neurorrhaphy with removal of the epineural sheath: an experimental study in rats.  Plast Reconstr Surg. 1994;  94 1038-1047
• 29 Tham S KY, Morrison W A. Motor collateral sprouting through an end-to-side nerve repair.  J Hand Surg. 1998;  23A 844-851
• 30 Noah E M, Williams A, Jorgenson C, Skoulis T G, Terzis J K. End-to-side neurorrhaphy: a histologic and morphometric study of axonal sprouting into an end-to-side nerve graft.  J Reconstr Microsurg. 1997;  13 99-106
• 31 Chen Y G, Brushart T M. The effect of denervated muscle and Schwann cells on axon collateral sprouting.  J Hand Surg. 1998;  23A 1025-1033
• 32 Bertelli J A, dos Santos A R, Calixto J B. Is axonal sprouting able to traverse the conjunctival layers of the peripheral nerve? A behavioral, motor, and sensory study of end-to-side nerve anastomosis.  J Reconstr Microsurg. 1996;  12 559-563
• 33 Zuker R. End-to-side nerve coaptation for muscle reinnervation. Presented at the Fifth Annual Meeting, American Society for the Peripheral Nerve Oct 5-7, 1995 Montreal, Canada;
• 34 Ross D, Zuker R, Matsuda A. End-to-side nerve coaptation for muscle reinnervation.  J Reconstr Microsurg. 1995;  11 373
• 35 Kalliainen L K, Kuzon W M. Reinnervating skeletal muscle using termino-lateral neurorrhaphy.  J Reconstr Microsurg. 1997;  13 136
• 36 Shah M H, Kasabian A K, Karp N S et al.. Axonal regeneration through an autogenous nerve bypass: an experimental study in the rat.  Ann Plast Surg. 1997;  38 408-414
• 37 Zhang Z, Soucacos P N, Bo J, Beris A E. Evaluation of collateral sprouting after end-to-side nerve coaptation using a fluorescent double-labeling technique.  Microsurgery. 1999;  19 281-286
• 38 Tarasidis G, Watanabe O, Mackinnon S E, Strasberg S R, Haughey B H, Hunter D A. End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model.  Ann Otol Rhinol Laryngol. 1997;  106 506-512
• 39 Boyd I A, Smith R S. The muscle spindle. In: Dyck PJ, Thomas PK, Lambert EH Peripheral Neuropathy, 2d ed. Philadelphia; WB Saunders 1984: 171
• 40 Schaafsma A, Otten E, Van Willigen J D. A muscle spindle model for primary afferent firing based on a simulation of intrafusal mechanical events.  J Neurophysiol. 1991;  65 1297-312