Repair of Motor Nerve Defects: Comparison of Suture and Fibrin Adhesive Techniques

1989 ◽  
Vol 100 (1) ◽  
pp. 17-21 ◽  
Author(s):  
Shigeki Nishihira ◽  
Thomas V. McCaffrey
Keyword(s):  
Sciatic Nerve ◽  
Motor Nerve ◽  
Nerve Repair ◽  
Suture Technique ◽  
Nerve Graft ◽  
Tissue Adhesive ◽  
Muscle Twitch ◽  
Fibrin Adhesive ◽  
Fibrin Tissue Adhesive ◽  
Nerve Muscle

Two groups of rats were used to evaluate the results of nerve repair using fibrin tissue adhesive. In one group of 10 rats, a simple neurotomy of the sciatic nerve was performed. In the second group of 10 rats, a 1-cm segment of sciatic nerve was excised bilaterally and used as an autogenous nerve graft. The neurotomy and the nerve graft were repaired on one side by microsurgical suture technique using 10-0 nylon suture. The opposite side was repaired using fibrin adhesive. The results of the repair were assessed at 12 weeks. Functional assessment of nerve regeneration was performed in those rats with intact repair sites. Nerve-muscle twitch strengths were not significantly different ( p > 0.05) between nerves repaired using suture and fibrin adhesive; however, compound active potential parameters were significantly better in nerve grafts repaired using suture technique ( p < 0.05).

scholarly journals First human experience with autologous Schwann cells to supplement sciatic nerve repair: report of 2 cases with long-term follow-up

2017 ◽  
Vol 42 (3) ◽  
pp. E2 ◽  
Author(s):  
Zachary C. Gersey ◽  
S. Shelby Burks ◽  
Kim D. Anderson ◽  
Marine Dididze ◽  
Aisha Khan ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Peripheral Nerve ◽  
Sural Nerve ◽  
Gunshot Wound ◽  
Nerve Repair ◽  
Nerve Graft ◽  
Sensory Function ◽  
Long Term Follow Up

OBJECTIVE Long-segment injuries to large peripheral nerves present a challenge to surgeons because insufficient donor tissue limits repair. Multiple supplemental approaches have been investigated, including the use of Schwann cells (SCs). The authors present the first 2 cases using autologous SCs to supplement a peripheral nerve graft repair in humans with long-term follow-up data. METHODS Two patients were enrolled in an FDA-approved trial to assess the safety of using expanded populations of autologous SCs to supplement the repair of long-segment injuries to the sciatic nerve. The mechanism of injury included a boat propeller and a gunshot wound. The SCs were obtained from both the sural nerve and damaged sciatic nerve stump. The SCs were expanded and purified in culture by using heregulin β1 and forskolin. Repair was performed with sural nerve grafts, SCs in suspension, and a Duragen graft to house the construct. Follow-up was 36 and 12 months for the patients in Cases 1 and 2, respectively. RESULTS The patient in Case 1 had a boat propeller injury with complete transection of both sciatic divisions at midthigh. The graft length was approximately 7.5 cm. In the postoperative period the patient regained motor function (Medical Research Council [MRC] Grade 5/5) in the tibial distribution, with partial function in peroneal distribution (MRC Grade 2/5 on dorsiflexion). Partial return of sensory function was also achieved, and neuropathic pain was completely resolved. The patient in Case 2 sustained a gunshot wound to the leg, with partial disruption of the tibial division of the sciatic nerve at the midthigh. The graft length was 5 cm. Postoperatively the patient regained complete motor function of the tibial nerve, with partial return of sensation. Long-term follow-up with both MRI and ultrasound demonstrated nerve graft continuity and the absence of tumor formation at the repair site. CONCLUSIONS Presented here are the first 2 cases in which autologous SCs were used to supplement human peripheral nerve repair in long-segment injury. Both patients had significant improvement in both motor and sensory function with correlative imaging. This study demonstrates preliminary safety and efficacy of SC transplantation for peripheral nerve repair.

Specificity of Muscle Reinnervation following Repair of the Transected Sciatic Nerve

1992 ◽  
Vol 17 (3) ◽  
pp. 257-261 ◽  
Author(s):  
Q. ZHAO ◽  
L. B. DAHLIN ◽  
M. KANJE ◽  
G. LUNDBORG
Keyword(s):  
Skeletal Muscle ◽  
Sciatic Nerve ◽  
Statistical Significance ◽  
Nerve Repair ◽  
Nerve Graft ◽  
The Other ◽  
Muscle Contractility ◽  
Tetanic Force ◽  
Rat Sciatic Nerve ◽  
Muscle Reinnervation

Specificity of muscle reinnervation and the recovery of muscle contractility were studied after repair of the transected rat sciatic nerve. Six different techniques were compared: epineurial suture, perineural suture, whole nerve graft, interfascicular grafts, skeletal muscle bridge and tubulization. Muscle tetanic force and specificity of reinnervation were evaluated 12 weeks after nerve repair. Recovery of tetanic force was superior after repair with epineurial sutures. There was no statistical significance between the other methods in respect of tetanic force. The specificity of muscle reinnervation was best after tubulization, repair with interfascicular grafts and perineurial suture.

The Effect of Systemic Triamcinolone Acetonide on Nerve Repair

1987 ◽  
Vol 96 (2) ◽  
pp. 158-164 ◽  
Author(s):  
Stephen F. Bansberg ◽  
Thomas V. Mccaffrey
Keyword(s):  
Action Potential ◽  
Nerve Regeneration ◽  
Triamcinolone Acetonide ◽  
Motor Nerve ◽  
Nerve Repair ◽  
Compound Action Potential ◽  
Contralateral Side ◽  
Muscle Twitch ◽  
Index Ratio ◽  
Compound Action

The effects of timed-release pellets of triamcinolone acetonide on sciatic nerve regeneration were studied. Bilateral nerve defects were created in 18 rats. One defect was sutured primarily, while the contralateral side was grafted with a 1 cm autogenous graft. Nerve regeneration was assessed at 20 weeks by muscle-twitch strength and compound action potential parameters measured proximal and distal to the repair site. Conduction velocity and regenerative index (ratio of distal to proximal compound action potential area) were calculated. Significant improvement of the regenerative index and twitch strength occurred in animals treated with a 0.5 mg 21-day-release pellet. Improvement occurred in animals treated with 0.5 mg 60-day pellets, but the difference was not significant. The findings suggest that regeneration was enhanced as a result of increased numbers of axons that made distal connections in the animals that received 21-day-release triamcinolone systemically. Corticosteroid therapy may benefit motor nerve repair.

scholarly journals Effect of auto-transplantation of bone marrow on the nerve autography in the dogs

2011 ◽  
Vol 11 (2) ◽  
pp. 128
Author(s):  
O.H. Al-Hyani
Keyword(s):  
Bone Marrow ◽  
Sciatic Nerve ◽  
Median Nerve ◽  
Clinical Observation ◽  
Nerve Repair ◽  
Nerve Graft ◽  
Absorbable Suture ◽  
Histological Changes ◽  
Nerve Segment ◽  
Normal Physiological Function

The research was conducted to study the repair of transected sciatic nerve through by grafting sciatic nerve with nerve segment and addition of bone marrow in dogs. Twelve adult dogs from both sexes was used. They was divided into two groups, six animals in each group. The left sciatic nerve was used as a model in this research for monitoring the process of nerve repair. In group one, the sciatic nerve was transected and a piece of nerve about 1cm in length was removed, and the resultant gap was repaired by autotransplantation with a segment of nerve harvested from the median nerve of the forelimb with the consideration that the harvested median nerve segment was slightly longer than the resected sciatic nerve segment. The implanted nerve segment was sutured with sciatic nerve using non absorbable suture (nylon 5\0). In group two, the same surgical procedure was performed as in group one, but a bone marrow that aspirated from the same animal was applied on the nerve transplantation. The assessment of sciatic nerve repair was accomplished by studying the clinical observation of normal physiological function of the operated limb, additionally studying the histological changes on the nerve graft transplantation at 30 and 45 postoperative days. The study was revealed, the application of bone marrow on the nerve graft segment was enhanced the degree of healing of transected sciatic nerve that indicated by improvement the functional use of affect hind limb clinically, with improvement the vasculrization of nerve graft segment and increase proliferation of nerve cells (Schwann and microglial cells) with extension of collagen fibers that aid to bridge the sciatic nerve with grafted nerve segment histologicaly rather than in group one.In conclusion the addition of bone marrow on the nerve graft segment accelerate the degree of healing of transected sciatic nerve with improve the functional use of operated limb.

scholarly journals Adesivo tecidual de fibrina versus suturas para o enxerto autólogo de conjuntiva em cirurgias primária de pterígio: uma revisão integrativa / Fibrin tissue adhesive versus sutures for autologous conjunctiva graft in primary pterygium surgery: an integrative review

2020 ◽  
Vol 65 (1) ◽  
pp. 1
Author(s):  
Gabriel Veiga Mansur ◽  
Ana Beatriz Sperto Silva ◽  
José Calil Mansur ◽  
Angélica Augusta Grigoli Dominato
Keyword(s):  
Integrative Review ◽  
Tissue Adhesive ◽  
Cochrane Library ◽  
National Library ◽  
Conjunctival Hyperemia ◽  
Fibrin Adhesive ◽  
Conjunctival Autograft ◽  
Increased Risk ◽  
Painful Sensation ◽  
Fibrin Tissue Adhesive

Introdução: Pterígio caracteriza-se pelo crescimento benigno fibrovascular, que surge da conjuntiva e se estende para a córnea. Atualmente a excisão cirúrgica, com enxerto autólogo de conjuntiva, constitui-se o tratamento padrão-ouro. No entanto, a sutura do enxerto é uma etapa demorada podendo induzir ao processo inflamatório local. Objetivo: Comparar os estudos sobre tratamento cirúrgico de pterígio confrontando a efetividade do adesivo tecidual de fibrina com as suturas no enxerto autólogo de conjuntiva. Método: Tratou-se de revisão integrativa utilizando-se da estrutura PICO para elaboração da pergunta norteadora. Os estudos foram levantados nas bases de dados: Cochrane Library, Medline via portal PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Eletronic Library Online) e Science direct. A ferramenta utilizada para indexação e recuperação de assuntos na literatura foi Descritor de Ciências da Saúde. Os critérios de inclusão foram: ensaios clínicos, randomizados, publicados entre 2015 a 2020 e disponíveis na íntegra. Resultados:  Identificou-se duzentos e oitenta e um estudos, no entanto após a aplicação dos critérios de inclusão e exclusão restaram apenas cinco artigos. O tempo cirúrgico variou entre os tipos, sendo de 3,6 minutos a 20,17 ± 3,23 minutos para adesivo de fibrina e de 13,3 minutos a 32,42 ± 4,47 minutos para as suturas. Dentre os desconfortos oculares estavam sensação dolorosa e de corpo estranho, hiperemia conjuntival, hemorragia, edema e secreção. A recorrência foi observada em 19,9% dos voluntários dos estudos sendo 19,8% após o uso do adesivo de fibrina. Conclusão: Adesivo de fibrina mostrou-se seguro e eficaz para fixar enxerto autólogo de conjuntiva nas cirurgias de remoção de pterígio, mostrando-se capaz de reduzir o tempo operatório e as principais queixas dos pacientes no pós operatório imediato. No entanto, não oferece redução na taxa de recorrência, por isso deve-se atentar para risco aumentado de hemorragia conjuntival.Palavras chave: Pterígio, Adesivo tecidual de fibrina, Suturas  ABSTRACT Introduction: Pterygium characterized by benign fibrovascular growth that arises from the conjunctiva and extends to a cornea. Currently, surgical excision with autologous conjunctival autograft is the gold standard treatment. However, suturing the graft takes a long time and induces a local inflammatory process. Objective: To compare studies on the surgical treatment of pterygium confronting the effectiveness of fibrin tissue adhesive with sutures in conjunctival autograft. Methodology: It was an integrative review using the PICO structure to elaborate the guiding question. The studies were surveyed in the databases: Cochrane Library, Medline via PubMed (US National Library of Medicine Nation all Institutes of Health), Lilacs, Scielo (Scientific Electronic Library Online) and Science direct. The tool used for indexing and retrieving subjects in the literature was a Health Sciences Descriptor. The inclusion criteria were: clinical trials, randomized, published between 2015 and 2020 and available in full. Results: Two hundred and eighty-one studies were identified, however, after applying the inclusion and exclusion criteria, only five articles remained. The surgical time varied between types, ranging from 3.6 minutes to 20.17 ± 3.23 minutes for fibrin adhesive and 13.3 minutes to 32.42 ± 4.47 minutes for sutures. Among the eye discomforts were a painful sensation and a foreign body, conjunctival hyperemia, hemorrhage, edema and secretion. Recurrence was observed in 19.9% of the study volunteers, with 19.8% after the use of fibrin adhesive.Conclusion: The use of fibrin glue is safe and effective for fixing the autograft in pterygium removal surgeries, proving capable of reducing the operative time and the main complaints of patients in the immediate postoperative period. However, it does not offer a reduction in the recurrence rate and attention should be paid to the increased risk of conjunctival hemorrhage.Keywords: Pterygium, Fibrin tissue adhesive, Sutures

EFFECTS OF SYSTEMICALLY APPLIED IGF-1 ON MOTOR NERVE RECOVERY AFTER PERIPHERAL NERVE TRANSECTION AND REPAIR IN THE RAT — A FUNCTIONAL STUDY

Hand Surgery ◽  
1999 ◽  
Vol 04 (02) ◽  
pp. 131-136 ◽  
Author(s):  
B. S. Lutz ◽  
S.-F. Ma ◽  
D. C. C. Chuang ◽  
F.-C. Wei
Keyword(s):  
Median Nerve ◽  
Muscle Power ◽  
Motor Nerve ◽  
Neck Region ◽  
Motor Recovery ◽  
Functional Study ◽  
Nerve Transection ◽  
Muscle Twitch ◽  
Muscle Weight ◽  
Nerve Muscle

The trophic effects of systemically applied Rh insulin-like growth factor-1 (rhIGF-1) on peripheral motor nerve regeneration following transection and epineural repair in rats median nerve have been examined. RhIGF-1 (0.5 mg/kg/rat) was administered subcutaneously to the neck region of the repaired side for 14 days post-operation. Motor recovery was tested with the grasping test that is an objective quantitative behavioural assessment of regeneration of the rats median nerve. Muscle twitch tension and muscle weight were measured in the flexor digitorum sublimus muscle. No significant differences between experimental and control animals regarding onset of muscle function, recovery of muscle power, and muscle weight were found. These results demonstrate that subcutaneously applied rhIGF-1 cannot improve functional motor recovery after nerve transection and repair in the rat as has been demonstrated after nerve crushing injury. This is regarded as a consequence of specificity failure during reinnervation, which occurs after nerve transection and repair, whereas after crushing injury specific reinnervation is a common feature.

scholarly journals Median Nerve Repair with Autologous Sciatic Nerve Graft: A Case Report

ISRN Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-2 ◽  
Author(s):  
Brian T. Ragel ◽  
Gregory C. Park ◽  
Sid Brevard
Keyword(s):  
Sciatic Nerve ◽  
Lower Extremity ◽  
Median Nerve ◽  
Nerve Repair ◽  
Treatment Options ◽  
Donor Site ◽  
Nerve Graft ◽  
Military Hospital ◽  
Nerve Grafting ◽  
Lower Extremity Injuries

Background. Peripheral nerve injury treatment options are limited to primary nerve repair, nerve grafting, and tendon transfers. In this case, a large suitable donor site was easily accessible and delayed grafting was indicative of poor prognosis. Case Description. A 25-year-old soldier presented to a military hospital in Afghanistan following a roadside bomb attack. The patient had a medial shrapnel wound in the bicipital groove with a cool pulseless hand and catastrophic lower extremity injuries. Bilateral above-the-knee amputations (AKAs) and exploration of the medial shrapnel wound were undertaken. A 7 cm traumatic defect in the median nerve was repaired with interpositional sciatic nerve graft harvested from the AKA. Conclusion. Recovery of motor function after nerve grafting is dependent on motor axons reinnervating target muscles, making proximal nerve injuries problematic. We identify a potential nerve harvest site in patients with lower extremity amputations in need of long segment nerve repairs.

scholarly journals Effect of electrical stimulation on motor nerve regeneration in sciatic nerve ligated-mice

2017 ◽  
Vol 27 (3) ◽  
Author(s):  
Farzaneh Samiee ◽  
Mohammad-Reza Zarrindast
Keyword(s):  
Electrical Stimulation ◽  
Sciatic Nerve ◽  
Nerve Regeneration ◽  
Muscle Force ◽  
Motor Nerve ◽  
Nerve Repair ◽  
Gluteus Maximus ◽  
Biceps Femoris ◽  
Surface Emg ◽  
Significant Difference

The purpose of this study was to investigate the effect of electrical stimulation on sciatic nerve regeneration and functional recovery of target muscles. Mice were randomly divided into 3 groups: ligated without electrical stimulation, ligated with electrical stimulation and control (non-ligated). The unilateral peripheral mononeuropathy was produced on the right hind limb. Sciatic nerve was then electrically stimulated daily for a period of 2 weeks (duration: 0.2 msec, frequency: 100Hz, amplitude: 15mA). Evoked surface EMG was recorded from biceps femoris (BF) and gluteus maximus (GM) muscles on the 3rd, 7th, 10th and 14th day after sciatic nerve ligation. Muscle force and sensitivity was determined by processing of the recorded EMG signals in time and frequency domains respectively. The results showed electrical stimulation (ES) produced a significant increase in the EMG response of BF, and muscle force significantly increased on the 14th day (p&lt;0.001), however no significant difference was found in GM muscle force between experimental groups. This may be due to possible innervation by inferior gluteal nerve. Frequency analysis of BF signals indicates that hyperalgesia remained after 14 days in both ligated groups. On the 14th day no difference in GM muscle sensitivity was found between groups. In conclusion, the results of this study have shown that the electrical stimulation of sciatic nerve accelerates nerve repair and indirectly improves BF muscle force to a comparable level with control without effect on muscle sensitivity. However, ES had no effect on GM muscle force and sensitivity.

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