Thursday, February 1, 2007
11912

Reverse End to Side Neurotization in a Regenerating Nerve

Elliott Gagnon, MD, Jonathan Isaacs, Seth Cheatham, and Charles McDowell.

Purpose: “By-pass grafting” around a neuroma in-continuity entails co-apting a nerve graft above and below the injured segment using two sequential end-to-side repairs. The proximal repair is analogous to what has been classically described as an end-to-side repair; the axons from the intact nerve sprout into the end of a recipient nerve and travel distally. At the distal connection, however, axons in the graft must enter the side of the intact nerve and find their way to appropriate end organs. This process has not been well investigated. Methods and Materials: To examine this, we performed a “reverse” end-to-side repair suturing the distal end of the peroneal nerve to the side of a transected/repaired tibial nerve in twenty rats. Primary end-to-end repairs of the tibial nerve were performed in ten additional rats. Twelve weeks later, contraction forces of the gastrocnemius muscle were measured following proximal stimulation. Measurements were repeated following elimination of potential pathways to identify which axons (peroneal or tibial) had achieved greater re-innervation. Results: Both groups of axons had achieved significant re-innervation. Conclusions: This study supports the idea that a reverse end-to-side repair can result in axonal invasion of the intact nerve and functional regeneration.