scholarly journals Limb Muscle Reinnervation with the Nerve-Muscle-Endplate Grafting Technique: An Anatomical Feasibility Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Liancai Mu ◽  
Jingming Chen ◽  
Jing Li ◽  
Stanislaw Sobotka ◽  
Themba Nyirenda
Keyword(s):  
Functional Recovery ◽  
Peroneal Nerve ◽  
Muscle Force ◽  
Recovery Period ◽  
Foot Drop ◽  
Nerve Supply ◽  
Nerve Injuries ◽  
Adult Rats ◽  
Nerve Branch ◽  
Nerve Muscle

Background. Peroneal nerve injuries results in tibialis anterior (TA) muscle paralysis. TA paralysis could cause “foot drop,” a disabling condition that can make walking difficult. As current treatment methods result in poor functional recovery, novel treatment approaches need to be studied. The aim of this study was to explore anatomical feasibility of limb reinnervation with our recently developed nerve-muscle-endplate grafting (NMEG) in the native motor zone (NMZ). Methods. As the NMEG-NMZ technique involves in nerves and motor endplates (MEPs), the nerve supply patterns and locations of the MEP bands within the gastrocnemius (GM) and TA muscles of rats were investigated using Sihler’s stain and whole-mount acetylcholinesterase (AChE) staining, respectively. Five adult rats underwent TA nerve transaction. The denervated TA was reinnervated by transferring an NMEG pedicle from the ipsilateral lateral GM. At the end of a 3-month recovery period, maximal muscle force was measured to document functional recovery. Results. The results showed that the TA was innervated by the deep peroneal nerve. A single MEP band was located obliquely in the middle of the TA. The GM was composed of two neuromuscular compartments, lateral (GM-l) and medial (GM-m), each of which was innervated by a separate nerve branch derived from the tibial nerve and had a vertically positioned MEP band. The locations of MEP bands in the GM and TA muscles and nerve supply patterns demonstrated that an NMEG pedicle can be harvested from the GM-l and implanted into the NMZ within the TA muscle. The NMEG-NMZ pilot study showed that this technique resulted in optimal muscle force recovery. Conclusion. NMEG-NMZ surgery is feasible for limb reinnervation. Specifically, the denervated TA caused by peroneal nerve injuries can be reinnervated with a NMEG from the GM-l.

scholarly journals Nerve-Muscle-Endplate Band Grafting: A New Technique for Muscle Reinnervation

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. ons208-ons224 ◽  
Author(s):  
Liancai Mu ◽  
Stanislaw Sobotka ◽  
Hungxi Su
Keyword(s):  
Functional Recovery ◽  
Axonal Regeneration ◽  
Neuromuscular Junctions ◽  
Force Measurement ◽  
Recovery Period ◽  
Motor Endplate ◽  
Adult Rats ◽  
Nerve Branch ◽  
Muscle Reinnervation ◽  
Nerve Muscle

Abstract BACKGROUND Because currently existing reinnervation methods result in poor functional recovery, there is a great need to develop new treatment strategies. OBJECTIVE To investigate the efficacy of our recently developed nerve-muscle-endplate band grafting (NMEG) technique for muscle reinnervation. METHODS Twenty-five adult rats were used. Sternohyoid (SH) and sternomastoid (SM) muscles served as donor and recipient muscle, respectively. Neural organization of the SH and SM muscles and surgical feasibility of the NMEG technique were determined. An NMEG contained a muscle block, a nerve branch with nerve terminals, and a motor endplate band with numerous neuromuscular junctions. After a 3-month recovery period, the degree of functional recovery was evaluated with a maximal tetanic force measurement. Retrograde horseradish peroxidase tracing was used to track the origin of the motor innervation of the reinnervated muscles. The reinnervated muscles were examined morphohistologically and immunohistochemically to assess the extent of axonal regeneration. RESULTS Nerve supply patterns and locations of the motor endplate bands in the SH and SM muscles were documented. The results demonstrated that the reinnervated SM muscles gained motor control from the SH motoneurons. The NMEG technique yielded extensive axonal regeneration and significant recovery of SM muscle force-generating capacity (67% of control). The mean wet weight of the NMEG-reinnervated muscles (87% of control) was greater than that of the denervated SM muscles (36% of control). CONCLUSION The NMEG technique resulted in successful muscle reinnervation and functional recovery. This technique holds promise in the treatment of muscle paralysis.

Intraoperative 1-Hour Electrical Nerve Stimulation Enhances Outcomes of Nerve–Muscle-Endplate Band Grafting Technique for Muscle Reinnervation

2017 ◽  
Vol 33 (08) ◽  
pp. 533-543 ◽  
Author(s):  
Jingming Chen ◽  
Themba Nyirenda ◽  
Liancai Mu ◽  
Stanislaw Sobotka
Keyword(s):  
Nerve Regeneration ◽  
Functional Recovery ◽  
Nerve Stimulation ◽  
Muscle Force ◽  
Force Measurement ◽  
Nerve Branch ◽  
Electrical Nerve Stimulation ◽  
Muscle Reinnervation ◽  
The Mean ◽  
Nerve Muscle

Background Increasing evidence suggests that 1-hour electrical nerve stimulation during surgery improves nerve regeneration and functional recovery. However, it remains unknown if this approach has beneficial effects on the outcomes of our recently developed nerve–muscle-endplate band grafting-native motor zone (NMEG-NMZ) technique for muscle reinnervation. Methods In this study, NMEG-NMZ transplantation was performed in a rat model. The right sternomastoid muscle was experimentally denervated and immediately reinnervated by implanting a NMEG harvested from the ipsilateral sternohyoid (SH) muscle into the NMZ of the target muscle. Before implantation of the NMEG, the SH nerve branch innervating the NMEG was subjected to intraoperative 1-hour continuous electrical stimulation (20 Hz). Three months after surgery, the degree of functional recovery was evaluated with muscle force measurement and the extent of nerve regeneration and endplate reinnervation was examined using histological and immunohistochemical methods. Results A combination of NMEG-NMZ with electrical nerve stimulation resulted in a greater degree of functional recovery than the NMEG-NMZ alone. The mean muscle force of the treated muscles was 90% of the contralateral control. The muscle mass was recovered up to 90% of the control. The mean number and percentage of area of the regenerated axons in the treated muscles was computed to be 81 and 84% of the control muscles, respectively. On average, 83% of the denervated endplates in the treated muscles were reinnervated by regenerated axons. Conclusion Intraoperative brief nerve stimulation promotes nerve regeneration, endplate reinnervation, and functional recovery of the muscles reinnervated with NMEG-NMZ technique.

Surgical outcome of foot drop caused by common peroneal nerve injuries; is the glass half full or half empty?

2016 ◽  
Vol 158 (6) ◽  
pp. 1133-1138 ◽  
Author(s):  
Mohammadreza Emamhadi ◽  
Babak Bakhshayesh ◽  
Sasan Andalib
Keyword(s):  
Surgical Outcome ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Nerve Injuries

scholarly journals A CADAVERIC STUDY OF COMMON PERONEAL NERVE IN RELATION TO FIBULAR TUNNEL

2021 ◽  
pp. 1-4
Author(s):  
Jaskaran Singh ◽  
Bhawani Shankar Modi ◽  
Kavita Pahuja ◽  
Tejendra Singh
Keyword(s):  
Peroneal Nerve ◽  
Close Contact ◽  
Average Distance ◽  
Common Peroneal Nerve ◽  
Lower Limbs ◽  
Foot Drop ◽  
Sensory Loss ◽  
Nerve Injuries ◽  
Muscle Nerve ◽  
The Common

INTRODUCTION: The common peroneal nerve is major lateral division of the sciatic nerve supplies lateral and anterior compartment of leg, when injured may leads to debilitating conditions such as foot drop and sensory loss or numbness in its supplied area. Common peroneal nerve's position subjects it to nerve injuries at two places one behind the knee joint where the nerve is superficial and other being the course of nerve through the fibular tunnel where its being tugged between musculo-aponeurotic fibers of peroneus longus muscle. Nerve injuries to common peroneal nerve has been attributed to several factors depending upon its anatomical position such as this may be due to sudden weight loss, prolonged sitting in squatting position, meniscus injuries in athletes or whether it is any surgical procedures involving the upper part of tibia and fibula. MATERIAL & METHODS: In present study we examine 70 lower limbs equally of right and left sides, the course, branching pattern and other reference point distances were measured with the help of metallic scale and dissections were photograph. RESULT: In 60% cases nerve separate from sciatic at the apex of popliteal fossa and in 80% cases it passes through the groove and then in about 70% specimen it passes through fibular tunnel, where it remains on an average 1.33 cm below the fibular head. The average distance of the nerve division was found 2.73 cm and just below that at a distance of 4.29 cm the nerve is in close contact with the bone. CONCLUSION: In present study we have observed average 7 muscular branches with variable origin from the common peroneal nerve in fibular tunnel which are likely to be damaged during surgical incision at this site.

Surgical Outcome of Peripheral Nerve Injury

2020 ◽  
Vol 02 ◽  
Author(s):  
Rahul K. Nath ◽  
Chandra Somasundaram
Keyword(s):  
Peripheral Nerve ◽  
Brachial Plexus ◽  
Sural Nerve ◽  
Peroneal Nerve ◽  
Foot Drop ◽  
Nerve Grafting ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries ◽  
Long Thoracic Nerve ◽  
Thoracic Nerve

: Our article focuses on various surgical treatments and outcomes in patients who had upper and or lower extremity musculoskeletal disorders due to peripheral nerve injuries. Here, we mainly discuss the benefits of the Nath method of surgical management in infants, children (preteen and teen), and adult patients in the following four categories of peripheral nerve damage. Brachial Plexus Injury and Upper Extremity Musculoskeletal Dysfunctions: Improvements in detail are discussed in obstetric brachial plexus palsy patients, who had the soft tissue surgical procedure, modified Quad, and the novel osseous operative technique, triangle tilt at our clinic. Upper Trunk of Brachial Plexus and Long Thoracic Nerve Damage and Winging Scapula: There are at least 18 categories of causation/etiology of upper plexus and long thoracic nerve lesions in 575 patients who visited our clinic with winging scapula, limited shoulder movements, and or pain. Further, we discuss the results of the excellent recovery of hundreds of these patients, who had decompression and neurolysis of the upper trunk of brachial plexus and long thoracic nerve. Peroneal Nerve Lesion and Foot Drop:: Our management of foot drop by nerve transfers to the deep peroneal nerve is discussed. Sural Nerve Grafting to Cavernous Nerve Impairment after Prostatectomy or Genital Surgery: We also discuss briefly our experience and results of the sural nerve grafting, which restores the function of cavernous nerves resected during radical prostatectomy. Conclusion: The lead author (RKN) has developed and implemented several innovative new surgical approaches as a reconstructive microsurgeon. These surgical techniques have proven clinical and functional improvements in patients with upper and lower extremity musculoskeletal disorders due to peripheral nerve injuries.

scholarly journals Drop Foot Secondary to a Peroneal Intraneural Ganglion Connected to the Superior Tibiofibular Joint: A Case Report

2020 ◽  
Author(s):  
Kenan Kıbıcı ◽  
Berrin Erok ◽  
Akın Onat
Keyword(s):  
Peroneal Nerve ◽  
Imaging Modality ◽  
Axonal Neuropathy ◽  
Common Peroneal Nerve ◽  
Foot Drop ◽  
Intraneural Ganglion ◽  
Articular Branch ◽  
Ankle Eversion ◽  
Adjacent Structures ◽  
Tibiofibular Joint

AbstractPeroneal neuropathy is the most frequent mononeuropathy of the lower extremity. Intraneural ganglion cysts (INGCs) are among rare causes of peroneal nerve palsy. According to the articular (synovial) theory, the articular branch plays the key role in the pathogenesis. Patients present with pain around the fibular head and neck, motor weakness resulting in foot drop and paresthesia in the anterolateral calf and foot. Ultrasonography (US) and MRI are both useful in the diagnosis, but MRI is the best imaging modality in the demonstration of the articular connection and the relation of the cyst with adjacent structures, even without special neurography sequences. We present a 32-year-old male patient referred to our neurosurgery clinic with suspicion of lumbar radiculopathy. He presented with right foot drop which began 3 weeks prior. On examination, there was 90% loss in the ankle dorsiflexion and finger extension. Ankle eversion was also weakened. There was no low back or posterolateral thigh pain to suggest L5 radiculopathy and sciatic neuropathy. Following negative lumbar spine MRI, peripheral neuropathy was concerned. Electrodiagnostic evaluations findings were consistent with acute/subacute common peroneal nerve (CPN) axonal neuropathy. Subsequent MRI of knee showed a homogeneous, thin-walled tubular cystic lesion, extending along the course of the CPN and its articular branch. Full recovery of the neuropathy was achieved with early diagnosis and decompression via microsurgical epineurotomy. The diagnosis of INGC was confirmed by histopathologic examination. INGCs, although rare, should also be considered in the differential diagnosis of peripheral mononeuropathies.

scholarly journals Establishment of a Sheep Model for Hind Limb Peripheral Nerve Injury: Common Peroneal Nerve

2021 ◽  
Vol 22 (3) ◽  
pp. 1401
Author(s):  
Rui D. Alvites ◽  
Mariana V. Branquinho ◽  
Ana C. Sousa ◽  
Federica Zen ◽  
Monica Maurina ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Injury ◽  
Peripheral Nerve Injury ◽  
Peroneal Nerve ◽  
Common Peroneal Nerve ◽  
Small Sample ◽  
Therapeutic Options ◽  
Nerve Injuries ◽  
Sheep Model ◽  
The Common

Thousands of people worldwide suffer from peripheral nerve injuries and must deal daily with the resulting physiological and functional deficits. Recent advances in this field are still insufficient to guarantee adequate outcomes, and the development of new and compelling therapeutic options require the use of valid preclinical models that effectively replicate the characteristics and challenges associated with these injuries in humans. In this study, we established a sheep model for common peroneal nerve injuries that can be applied in preclinical research with the advantages associated with the use of large animal models. The anatomy of the common peroneal nerve and topographically related nerves, the functional consequences of its injury and a neurological examination directed at this nerve have been described. Furthermore, the surgical protocol for accessing the common peroneal nerve, the induction of different types of nerve damage and the application of possible therapeutic options were described. Finally, a preliminary morphological and stereological study was carried out to establish control values for the healthy common peroneal nerves regarding this animal model and to identify preliminary differences between therapeutic methods. This study allowed to define the described lateral incision as the best to access the common peroneal nerve, besides establishing 12 and 24 weeks as the minimum periods to study lesions of axonotmesis and neurotmesis, respectively, in this specie. The post-mortem evaluation of the harvested nerves allowed to register stereological values for healthy common peroneal nerves to be used as controls in future studies, and to establish preliminary values associated with the therapeutic performance of the different applied options, although limited by a small sample size, thus requiring further validation studies. Finally, this study demonstrated that the sheep is a valid model of peripheral nerve injury to be used in pre-clinical and translational works and to evaluate the efficacy and safety of nerve injury therapeutic options before its clinical application in humans and veterinary patients.

scholarly journals Use of superficial peroneal nerve graft for treating peripheral nerve injuries

2016 ◽  
Vol 51 (1) ◽  
pp. 63-69
Author(s):  
Samuel Ribak ◽  
Paulo Roberto Ferreira da Silva Filho ◽  
Alexandre Tietzmann ◽  
Helton Hiroshi Hirata ◽  
Carlos Augusto de Mattos ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Peroneal Nerve ◽  
Nerve Graft ◽  
Superficial Peroneal Nerve ◽  
Peripheral Nerve Injuries ◽  
Nerve Injuries

Predictors of functional recovery following surgery for foot drop due to degenerative lumbar disease

2021 ◽  
pp. 1-6
Author(s):  
Assaf Berger ◽  
Laurence Mangel ◽  
Sharif Basal ◽  
Zvi Lidar ◽  
Gilad J Regev ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Postoperative Period ◽  
Univariate Analysis ◽  
Degenerative Disease ◽  
Foot Drop ◽  
Functional Improvement ◽  
Lumbar Degenerative Disease ◽  
Motor Weakness ◽  
Short And Long Term

OBJECTIVE Surgery for foot drop secondary to lumbar degenerative disease is not always associated with postoperative functional improvement. It is still unclear whether early decompression results in better functional recovery and how soon surgery should be performed. This study aimed to evaluate predicting factors that affect short- and long-term recovery outcomes and to explore the relationship between timing of lumbar decompression and recovery from foot drop in an attempt to identify a cutoff time from symptom onset until decompression for optimal functional improvement. METHODS The authors collected demographic, clinical, and radiographic data on patients who underwent surgery for foot drop due to lumbar degenerative disease. Clinical data included tibialis anterior muscle (TAM) strength before and after surgery, duration of preoperative motor weakness, and duration of radicular pain until surgery. TAM strength was recorded at the immediate postoperative period and 1 month after surgery while long-term follow-up on functional outcomes were obtained at ≥ 2 years postsurgery by telephone interview. Data including degree and duration of preoperative motor weakness as well as the occurrence of pain and its duration were collected to analyze their impact on short- and long-term outcomes. RESULTS The majority of patients (70%) showed functional improvement within 1 month postsurgery and 40% recovered to normal or near-normal strength. Univariate analysis revealed a trend toward lower improvement rates in patients with preoperative weakness of more than 3 weeks (33%) compared with patients who were operated on earlier (76.5%, p = 0.034). In a multivariate analysis, the only significant predictor for maximal strength recovery was TAM strength before surgery (OR 6.80, 95% CI 1.38–33.42, p = 0.018). Maximal recovery by 1 month after surgery was significantly associated with sustained long-term functional improvement (p = 0.006). CONCLUSIONS Early surgery may improve the recovery rate in patients with foot drop caused by lumbar degenerative disease, yet the strongest predictor for the extent of recovery is the severity of preoperative TAM weakness. Maximal recovery in the short-term postoperative period is associated with sustained long-term functional improvement and independence.

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