Frozen Vein Wrapping for Chronic Nerve Constriction Injury Reduces Sciatic Nerve Allodynia in a Rat Model

Abstract BackgroundAutologous vein wrapping (VW) is used in the treatment of recurrent chronic constriction neuropathy and traumatic peripheral nerve injury. However, use of autologous veins is limited by the inability to obtain longer veins of sufficient length for larger sites. Frozen allograft tissue has several advantages, including its availability for large grafts, avoidance of donor-site morbidity, and shorter operation time. Here, we investigated the effect of frozen vein wrapping (FVW) in Wistar rats as a model of sciatic nerve injury. MethodsThe rats were grouped by treatment as (i) untreated after chronic constriction injury surgery (CCI; control group), (ii) treated with vein wrapping using freshly isolated vein (VW), and (iii) treated with vein wrapping using frozen vein (FVW). Mechanical allodynia was assessed with von Frey filaments on postoperative days (PODs) 1, 3, 5, 7, and 14. ResultsThe response of heme oxygenase-1 gene, Hmox-1, expression to VW and FVW was assessed by RT-PCR. Both VW and FVW significantly increased withdrawal threshold levels compared to the untreated control group on POD 1, 3, and 5. Both VW and FVW also showed increased HO-1 expression compared to the CCI group. ConclusionsOur results suggest that FVW may be a suitable therapeutic optionas a source of large grafts.

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VULNERABILITY OF THE GRADUALLY ELONGATED NERVE TO COMPRESSION INJURY

Hand Surgery ◽

10.1142/s0218810401000400 ◽

2001 ◽

Vol 06 (01) ◽

pp. 29-35 ◽

Cited By ~ 8

Author(s):

Kazuo Ikeda ◽

Mitsuteru Yokoyama ◽

Katsuro Tomita ◽

Shigenori Tanaka

Keyword(s):

Sciatic Nerve ◽

Peripheral Nerve ◽

Nerve Injury ◽

Control Group ◽

Severe Damage ◽

Compression Injury ◽

Sciatic Nerves

The purpose of this study is to clarify the vulnerability of the gradually elongated peripheral nerve. Rabbit's sciatic nerves were gradually elongated to 30 mm at the rate of 2.0 mm/day and 4.0 mm/day. Immediately after elongation, the sciatic nerve was exposed and compressed for 30 minutes at various forces, 15, 30 and 60 g/0.1 cm2. Immediately after elongation and compression, 2, 4 and 8 weeks after compression, each group was electrophysiologically and histologically estimated — 15 g/0.1 cm2 caused no damage to the control group, neurapraxia to the 2.0 mm/day group, and axonotmesis to the 4.0 mm/day group; 30 g/0.1 cm2 caused neurapraxia to the control group and axonotmesis to the 2.0 mm/day group; 60 g/0.1 cm2 caused axonotmesis to the control group and slowly recovered axonotmesis to the 2.0 mm/day group. This study shows that though mild compression, does not cause nerve injury to the intact nerve, it can sometimes cause severe damage to the gradual elongated nerve.

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Age-dependent Responses to Nerve Injury– induced Mechanical Allodynia

Anesthesiology ◽

10.1097/00000542-200602000-00021 ◽

2006 ◽

Vol 104 (2) ◽

pp. 344-350 ◽

Cited By ~ 30

Author(s):

Douglas G. Ririe ◽

James C. Eisenach

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Nerve Root ◽

Spinal Nerve ◽

Developmental Differences ◽

Mechanical Stimuli ◽

Spinal Nerve Root ◽

Withdrawal Threshold ◽

Partial Sciatic Nerve Ligation ◽

Sensitizing Effect

Background Developmental differences in responses to acute and chronic nerve injury have received minimal attention. This study examines developmental differences in behavioral responses to a proximal (closer to the spinal cord) (L5 and L6 spinal nerve root ligation) or to a more distal (closer to peripheral innervation) (partial sciatic nerve ligation) nerve injury in rats paralleling the infant to young adult human. Methods Withdrawal thresholds to von Frey filament testing in the hind paw were determined before and various times after either spinal nerve root ligation or partial sciatic nerve ligation in rats aged 2, 4, and 16 weeks. Control rats of these ages were observed serially without surgery. Times for withdrawal thresholds to mechanical stimuli to return to 80% of that of the hind paw in the control animals were compared among the different ages in the two models. Results Baseline withdrawal thresholds in younger rats were lower (P < 0.05). In the 2-week-old animals, distal injury partial sciatic nerve ligation did not cause a reduction in withdrawal threshold from baseline. This was different from the spinal nerve root ligation group and the older animals in the partial sciatic nerve ligation group. However, when compared with age-matched control animals, both nerve injuries resulted in reduced withdrawal thresholds (P < 0.05). The resolution of hypersensitivity to mechanical stimulation, as measured by return of threshold to 80% of controls, occurred more quickly in 2-week-old than in 4- and 16-week-old animals in both injury models (P < 0.05). Conclusion These data suggest that resolution of sensitization to A-fiber input occurs more rapidly in young animals. In addition, distal injury has less of a sensitizing effect on A-fiber input than proximal injury in the younger animals. The authors speculate that neuroimmune responses, especially at the site of injury, are developmentally regulated and less likely to produce chronic pain when injury occurs at a young age.

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Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study

10.21203/rs.3.rs-39680/v3 ◽

2020 ◽

Author(s):

Quanzhe Liu ◽

Wenlai Guo ◽

Wenrui Qu ◽

Xiaolan Ou ◽

Rui Li ◽

...

Keyword(s):

Postoperative Complications ◽

Nerve Injury ◽

Donor Site ◽

Graft Loss ◽

Operation Time ◽

Plantar Artery ◽

Significant Difference ◽

Medial Plantar Artery ◽

Volar Surface

Abstract Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.

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Effects of 7,8-dihydroxycoumarin on the Myelin Morphological Changes and PSD-95 Protein Expression in Balb/c Mice after Sciatic Nerve Injury

10.1101/529917 ◽

2019 ◽

Author(s):

Jian Cao ◽

Limin Zhang ◽

Jinlong Li ◽

Hui Leng

Keyword(s):

Sciatic Nerve ◽

Protein Expression ◽

Nerve Injury ◽

Morphological Changes ◽

Sciatic Nerve Injury ◽

Dose Effect ◽

Control Group ◽

Male Adult ◽

Effect Relationship ◽

Injured Nerve

AbstractTo investigate the effects of 7,8-dihydroxycoumarin on the myelin morphological changes and PSD-95 protein expression in mice with sciatic nerve injury, and to explore the relationship between PSD-95 protein and myelin regeneration after nerve myelin injury. 127 male adult Balb/c mice were selected and randomly divided into high, medium and low 7,8-dihydroxycoumarin dose groups and blank control group. Anastomosis was then carried out for the amputated right sciatic nerve, and intraperitoneal injection of 7,8-dihydroxycoumarin was applied postoperatively. At weeks 1, 2, 4 and 8 after surgery, nervous tissues from the injury side were taken for immunohistochemical Luxol Fast Blue (LFB) staining, so as to observe the morphological changes of the locally injured nerve myelin. Meanwhile, PSD-95 mRNA and protein expression were determined using real-time PCR and western blotting. The nerve myelin recovery in injury side of mice at all time points showed a definite dose-effect relationship with the dose of 7,8-dihydroxycoumarin. Moreover, 7,8-dihydroxycoumarin could inhibit the PSD-95 mRNA level and protein expression. At the same time, there was a dose-effect of the inhibition. 7,8-dihydroxycoumarin can affect nerve recovery in mice with sciatic nerve injury, which shows a definite dose-effect relationship with its dose. Besides, PSD-95 protein expression can suppress the regeneration of the injured nerve myelin.

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The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

International Journal of Health Sciences and Research ◽

10.52403/ijhsr.20220112 ◽

2022 ◽

Vol 12 (1) ◽

pp. 87-91

Author(s):

Lucretya Yeniwati Tanuwijaya ◽

Agus Roy Rusly Hariantana Hamid ◽

I Gusti Putu Hendra Sanjaya

Keyword(s):

Case Report ◽

Skin Graft ◽

Skin Flap ◽

Donor Site ◽

Surgical Techniques ◽

Operation Time ◽

Donor Site Morbidity ◽

Reconstruction Procedure ◽

Local Skin ◽

And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

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Distraction subtalar arthrodesis for calcaneal malunion

The Bone & Joint Journal ◽

10.1302/0301-620x.101b5.bjj-2018-1306.r1 ◽

2019 ◽

Vol 101-B (5) ◽

pp. 596-602 ◽

Cited By ~ 3

Author(s):

A. El-Hawary ◽

Y. R. Kandil ◽

M. Ahmed ◽

A. Elgeidi ◽

H. El-Mowafi

Keyword(s):

Bone Graft ◽

Donor Site ◽

Donor Site Morbidity ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Local Bone ◽

Iliac Bone Graft ◽

Calcaneal Malunion ◽

The Mean

Aims We hypothesized that there is no difference in the clinical and radiological outcomes using local bone graft versus iliac graft for subtalar distraction arthrodesis in patients with calcaneal malunion. In addition, using local bone graft negates the donor site morbidity. Patients and Methods We prospectively studied 28 calcaneal malunion patients (the study group) who were managed by subtalar distraction arthrodesis using local calcaneal bone graft. The study group included 16 male and 12 female patients. The median age was 37.5 years (interquartile range (IQR) 29 to 43). The outcome of the study group was compared with a control group of ten patients previously managed by subtalar distraction arthrodesis using iliac bone graft. The control group included six male and four female patients. The median age was 41.5 years (IQR 36 to 44). Results The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly in the study and the control groups (p < 0.001). Fusion was achieved in 27 patients in the study group at a median time of 13 weeks (IQR 12 to 14), while all the patients in the control group achieved fusion at a mean time of 13.2 weeks (11 to 15). The mean talocalcaneal height and talar declination angle improved significantly in both the study and the control groups (p < 0.001). There was no significant difference between both groups concerning the preoperative or the postoperative clinical and radiological measurements. Donor site morbidity was reported in four out of ten patients in the control group. Conclusion Local calcaneal bone graft can successfully be used to achieve subtalar distraction arthrodesis with appropriate correction of alignment and calcaneal malunion. We recommend using local instead of iliac bone graft as it gave comparable results and avoids the possibility of donor site morbidity. Cite this article: Bone Joint J 2019;101-B:596–602.

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Onlay Fascial Grafts to Silicone-Polytetrafluorethylene Composite Implants in Augmentation Rhinoplasty: A Retrospective Study of 241 Cases

Aesthetic Surgery Journal ◽

10.1093/asj/sjz121 ◽

2019 ◽

Vol 39 (11) ◽

pp. 1182-1190

Author(s):

Lee Seng Khoo ◽

Cheng-I Yen ◽

Chun-Shin Chang ◽

Hung-Chang Chen ◽

Chih-Jung Huang ◽

...

Keyword(s):

Patient Group ◽

Donor Site ◽

Donor Site Morbidity ◽

Control Group ◽

Complication Rates ◽

Augmentation Rhinoplasty ◽

Level Of Evidence ◽

No Donor ◽

Asian Ethnicity

Abstract Background Silicone-polytetrafluoroethylene composite implants are fast gaining popularity in Asian rhinoplasty. Nonetheless, implant displacement, erythematous reactions, and infections still occur in the authors’ patient group during long-term follow-up. Objectives The authors reported successful experience of combining the utilization of silicone-polytetrafluoroethylene composite implants with onlay temporal fascial grafts to circumvent these complications. Methods Sixty-four patients of Asian ethnicity underwent augmentation rhinoplasty utilizing an I-shaped composite implant with an onlay fascial graft from January 2015 to June 2018, with a mean follow-up period of 13.5 months. This patient group was compared with a control group of 177 Asian patients who underwent augmentation rhinoplasty utilizing the same composite implant but without the addition of a fascial graft; the control group was treated from February 2012 to June 2015, with a mean follow-up of 42.0 months. Complications were compared between these 2 patient groups, specifically focusing on malposition/deviations, erythema, and infections. Results There was a marked decrease in complication rates with the addition of an onlay temporal fascial graft to cover the composite implant in augmentation rhinoplasty (7.8% vs 14.7%) as well as the rate of erythematous reactions (0% vs 6.2%, P = 0.04), infection (1.6% vs 1.1%), and implant malposition/deviation (0% vs 4.5%). Harvesting the temporal fascia and fashioning the onlay graft added an additional 33 minutes on average per procedure. No donor site morbidity was encountered. Conclusions Although the operative time increased, the benefits of adding onlay fascial grafts to silicone-polytetrafluoroethylene implants in alloplastic augmentation rhinoplasty outweigh the drawbacks, as evidenced by the decrease in erythematous reactions. Level of Evidence: 4

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The effects of optimizing blood inflow in the pedicle on perforator flap survival: A pilot study in a rat model

Archives of Plastic Surgery ◽

10.5999/aps.2019.00871 ◽

2020 ◽

Vol 47 (3) ◽

pp. 209-216

Author(s):

Radu Olariu ◽

Helen Laura Moser ◽

Ioana Lese ◽

Dan Sabau ◽

Alexandru Valentin Georgescu ◽

...

Keyword(s):

Donor Site ◽

Perforator Flap ◽

Donor Site Morbidity ◽

Laser Doppler ◽

Control Group ◽

Doppler Flowmetry ◽

Flap Survival ◽

Group Iii ◽

Group I ◽

Group Ii

Background Perforator flaps have led to a revolution in reconstructive surgery by reducing donor site morbidity. However, many surgeons have witnessed partial flap necrosis. Experimental methods to increase inflow have relied on adding a separate pedicle to the flap. The aim of our study was to experimentally determine whether increasing blood flow in the perforator pedicle itself could benefit flap survival.Methods In 30 male Lewis rats, an extended posterior thigh perforator flap was elevated and the pedicle was dissected to its origin from the femoral vessels. The rats were assigned to three groups: control (group I), acute inflow (group II) and arterial preconditioning (group III) depending on the timing of ligation of the femoral artery distal to the site of pedicle emergence. Digital planimetry was performed on postoperative day (POD) 7 and all flaps were monitored using laser Doppler flowmetry perioperatively and postoperatively in three regions (P1-proximal flap, P2-middle of the flap, P3-distal flap).Results Digital planimetry showed the highest area of survival in group II (78.12%±8.38%), followed by groups III and I. The laser Doppler results showed statistically significant higher values in group II on POD 7 for P2 and P3. At P3, only group II recorded an increase in the flow on POD 7 in comparison to POD 1.Conclusions Optimization of arterial inflow, regardless if performed acutely or as preconditioning, led to increased flap survival in a rat perforator flap model.

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Transcriptomic Analysis Reveals PTBP1 as a Key Molecular Signature of Sciatic Nerve Injury Recovery

10.21203/rs.3.rs-166941/v1 ◽

2021 ◽

Author(s):

Zijia Chai ◽

Jinjin Fu ◽

Zhe Yang ◽

Yi E. Sun

Keyword(s):

Sciatic Nerve ◽

Nerve Injury ◽

Early Stage ◽

Sciatic Nerve Injury ◽

Sensory Function ◽

Molecular Signature ◽

Control Group ◽

P Value ◽

Immunofluorescence Test ◽

Hub Genes

Abstract Background: Peripheral nerves control motor, sensory, and autonomic functions, so injury can seriously affect a patient's quality of life. There have been studies that have shown that the repair factors are different at different ages, and we have identified a repair hub gene that plays a key role throughout the entire age group. Methods: From Gene Expression Omnibus database GSE4090, mice of 2 and 24 months of age after sciatic nerve injury were selected from mice transcriptome data of differentially expressed genes in common, and the hub genes were then determined using protein-protein network and MCODE analysis, DAVID biological process, molecular function, and cell component analysis, and the miRWalk analysis of hub genes was performed to verify the key molecule. In mice aged eight weeks of sciatic 2 nerve clamps damage building, on days 0, 1, 4, and 7, sciatic nerve motor and sensory function were evaluated, and sciatic nerve immunofluorescence test was performed to verify PTBP1 expression. The continuous data were expressed as the mean ±SD. An independent t-test was used to compare two groups. A p-value of less than 0.05 was considered statistically significant. Results: Bioinformatics analysis showed that PTBP1 is one of the key molecules in mouse sciatic nerve repair after injury. The immunofluorescence test verified that the number of positive cells reached a maximum value of 30.6 ±6.4/ROI on day 7 after injury and a minimum value of 17.4 ±7.0/ROI in the control group (p<0.001). However, the percentage of PTBP1 positive cells reached a peak of 90.8 ±16.9% at the early stage of injury, i.e., the first day, and then dropped to a minimum of 75.7 ±8.9% on the seventh day in the animal experiment as the repair time gradually increased (p<0.05). Conclusions: PTBP1 plays a key role in the repair of sciatic nerve injury, providing a new strategy for clinical treatment of patients of all ages.

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