Treatment of Peripheral Nerve Injury with Tension Stitch Method: An Experimental Study

Year 2022, Volume: 12 Issue: 3, 437 - 443, 30.05.2022

Ali Sakinsel , Mert Sızmaz , Lütfü Baş

https://doi.org/10.16899/jcm.1039032

Abstract

Objective: The aim of our study is to examine the tension stitch method we use to prevent unwanted tissue deficiency between the cut nerve endings in rats that will be kept waiting for secondary neurorrhaphy.
Material and Method: 30 male Wistar Albino rats were randomly divided into three groups. The right sciatic nerve was released proximally from the sciatic nerve 1 \ 3 bifurcation area in the first and second groups and anastomosed with the tibial nerve in the third group. After 4 weeks, the region was reopened, unhealthy nerve endings were cut under the microscope, and secondary neurorrhaphy was performed end-to-end.
Results: In the third experimental group, it was observed that there was no change in the position of the tension stitches placed on the distal and proximal ends of the sciatic nerve, and the nerve endings adhered to the area where they were positioned by suture. At the eighth week, it was observed that the rats that could not use their right lower extremities in the preoperative and early postoperative periods used their extremities more actively. At the twelfth week, it was observed that the rats in all groups had complete recovery of trophic disturbances and the animals started to walk better visually.
Discussion: In our study, the electrophysiological and histopathological data obtained at the eighth week and obtained at the twelfth week were significantly better in the tension-stitched group compared to the other groups, indicating that the best early and late nerve healing was in this group.

Keywords

neurorrhaphy, tension stitch, nerve healing, end-to-end

Gergi Dikişi Yöntemi ile Periferik Sinir Yaralanmalarının Tedavisi: Deneysel Bir Çalışma

Abstract

Amaç: Çalışmamızın amacı sekonder nörorafi için bekletilecek ratlarda kesilen sinir uçları arasındaki istenmeyen doku eksikliğini önlemek için kullandığımız gergi dikiş yöntemini incelemektir.
Gereç ve Yöntem: 30 adet erkek Wistar Albino rat randomize olarak üç gruba ayrıldı. Sağ siyatik sinir, birinci ve ikinci grupta siyatik sinirin 1/3 bifurkasyon alanından proksimalde serbest bırakılırken, üçüncü grupta tibial sinir ile anastomoz yapıldı. Dört hafta sonra bölge yeniden açıldı, mikroskop altında sağlıksız sinir uçları kesildi ve uçtan uca sekonder nörorafi yapıldı.
Bulgular: Üçüncü deney grubunda siyatik sinirin distal ve proksimal uçlarına konulan gergi dikişlerinin pozisyonunda herhangi bir değişiklik olmadığı, sinir uçlarının sütür ile yerleştirildiği bölgeye yapıştığı gözlendi. Sekizinci haftada ameliyat öncesi ve ameliyat sonrası erken dönemde sağ alt ekstremitesini kullanamayan ratların ekstremitelerini daha aktif kullandıkları görüldü. On ikinci haftada tüm gruplardaki ratlarda trofik bozuklukların tamamen düzeldiği ve hayvanların görsel olarak daha iyi yürümeye başladıkları görüldü.
Tartışma: Çalışmamızda sekizinci ve on ikinci haftada elde edilen elektrofizyolojik ve histopatolojik veriler gergi dikişli grupta diğer gruplara göre anlamlı olarak daha iyiydi, bu da en iyi erken ve geç sinir iyileşmesinin bu grupta olduğunu göstermektedir.

Keywords

nörorafi, gergi dikişi, sinir iyileşmesi, uçtan uca

References

• 1. Viterbo F, Trindade JC, 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(2):75-80.
• 2. Lundborg G, Zhao Q, Kanje M, Danielsen N, Kerns JM. Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis? J Hand Surg Br 1994;19(3):277-82.
• 3. Lundborg G, Dahlin L, Danielsen N, Zhao Q. Trophism, tropism, and specificity in nerve regeneration. J Reconstr Microsurg 1994;10(5):345-54.
• 4. Zhang Z, Soucacos PN, Bo J, Beris AE. Evaluation of collateral sprouting after end-to-side nerve coaptation using a fluorescent double-labeling technique. Microsurgery 1999;19(6):281-6.
• 5. Lykissas MG. Current concepts in end-to-side neurorrhaphy. World J Orthop 2011;2(11):102-6.
• 6. Zhang Z, Soucacos PN, Bo J, et al. Reinnervation after end-to-side nerve coaptation in a rat model. Am J Orthop (Belle Mead NJ) 2001;30(5):400-6; discussion 7.
• 7. Battiston B, Papalia I, Tos P, Geuna S. Chapter 1: Peripheral nerve repair and regeneration research: a historical note. Int Rev Neurobiol 2009;87:1-7.
• 8. Belen D, Aciduman A, Er U. History of peripheral nerve repair: may the procedure have been practiced in Hippocratic School? Surg Neurol 2009;72(2):190-3; discussion 3-4.
• 9. Millesi H. Peripheral nerve surgery today: turning point or continuous development? J Hand Surg Br 1990;15(3):281-7.
• 10. Fox IK, Brenner MJ, Johnson PJ, Hunter DA, Mackinnon SE. Axonal regeneration and motor neuron survival after microsurgical nerve reconstruction. Microsurgery 2012;32(7):552-62.
• 11. Lutz BS, Chuang DC, Chuang SS, Hsu JC, Ma SF, Wei FC. Nerve transfer to the median nerve using parts of the ulnar and radial nerves in the rabbit--effects on motor recovery of the median nerve and donor nerve morbidity. J Hand Surg Br 2000;25(4):329-35.
• 12. Stamatoukou A, Papadogeorgou E, Zhang Z, Pavlakis K, Zoubos AB, Soucacos PN. Phrenic nerve neurotization of the musculocutaneous nerve with end-to-side neurorrhaphy: a short report in a rabbit model. Microsurgery 2006;26(4):268-72.
• 13. Geuna S, Papalia I, Ronchi G, et al. The reasons for end-to-side coaptation: how does lateral axon sprouting work? Neural Regen Res 2017;12(4):529-33.
• 14. Tos P, Colzani G, Ciclamini D, Titolo P, Pugliese P, Artiaco S. Clinical applications of end-to-side neurorrhaphy: an update. Biomed Res Int 2014;2014:646128.
• 15. Dvali LT, Myckatyn TM. End-to-side nerve repair: review of the literature and clinical indications. Hand Clin 2008;24(4):455-60, vii.
• 16. Lundborg G. Richard P. Bunge memorial lecture. Nerve injury and repair--a challenge to the plastic brain. J Peripher Nerv Syst 2003;8(4):209-26.
• 17. Félix SP, Pereira Lopes FR, Marques SA, Martinez AM. Comparison between suture and fibrin glue on repair by direct coaptation or tubulization of injured mouse sciatic nerve. Microsurgery 2013;33(6):468-77.
• 18. Grinsell D, Keating CP. Peripheral nerve reconstruction after injury: a review of clinical and experimental therapies. Biomed Res Int 2014;2014:698256.
• 19. Battiston B, Geuna S, Ferrero M, Tos P. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005;25(4):258-67.
• 20. Gonzalez-Perez F, Cobianchi S, Geuna S, et al. Tubulization with chitosan guides for the repair of long gap peripheral nerve injury in the rat. Microsurgery 2015;35(4):300-8.
• 21. Rodríguez FJ, Valero-Cabré A, Navarro X. Regeneration and functional recovery following peripheral nerve injury. Drug Discov Today Dis Models 2004;1(2):177-85.
• 22. Echaniz G, De Miguel M, Merritt G, et al. Bilateral suprazygomatic maxillary nerve blocks vs. infraorbital and palatine nerve blocks in cleft lip and palate repair: A double-blind, randomised study. Eur J Anaesthesiol 2019;36(1):40-7.
• 23. Beris A, Gkiatas I, Gelalis I, Papadopoulos D, Kostas-Agnantis I. Current concepts in peripheral nerve surgery. Eur J Orthop Surg Traumatol 2019;29(2):263-9.
• 24. Dellon AL, Ferreira MC, Williams EH, Rosson GD. Which end is up? Terminology for terminolateral (end-to-side) nerve repair: a review. J Reconstr Microsurg 2010;26(5):295-301.
• 25. Trehan SK, Model Z, Lee SK. Nerve Repair and Nerve Grafting. Hand Clin 2016;32(2):119-25.
• 26. Buena ITP, Fichman M. Sural Nerve Graft. StatPearls [Internet] 2021.
• 27. Griffin JW, Hogan MV, Chhabra AB, Deal DN. Peripheral nerve repair and reconstruction. J Bone Joint Surg Am 2013;95(23):2144-51.
• 28. Li R, Liu Z, Pan Y, Chen L, Zhang Z, Lu L. Peripheral nerve injuries treatment: a systematic review. Cell Biochem Biophys 2014;68(3):449-54.
• 29. Gordon T. Peripheral Nerve Regeneration and Muscle Reinnervation. Int J Mol Sci 2020;21(22).
• 30. Benfield C, Isaacs J, Mallu S, Kurtz C, Smith M. Comparison of Nylon Suture Versus 2 Fibrin Glue Products for Delayed Nerve Coaptation in an Animal Model. J Hand Surg Am 2021;46(2):119-25.
• 31. Wang X, Yuan C, Wo Y, et al. Will Repeated Ablative Er:YAG Laser Treatment Sessions Cause Facial Skin Sensitivity? Results of a 12-Month, Prospective, Randomized Split-Face Study. Rejuvenation Res 2020;23(2):122-9.