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
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
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
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
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
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
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
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
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
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
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;
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
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
