Fascicular Turnover Flap Repair in Peripheral Nerve Defects; An Experimental Study

The main problems of treatment of peripheral nerve injuries are donor morbidity, long healing time and functional results as a quality of healing. Since the peripheral nervous system is divided into two as the somatic and autonomous nervous system. In case of any defect, the motor, sensational or autonomous functions of the relevant nerve are partially or completely lost. The aim of microsurgical reconstruction is proper coaptation with tensionless primary end-to-end nerve repair. The gold standard in the presence of nerve defect is autogenous nerve graft. Athough current fine techniques are used, lack of functional motor and sensory healing achievement remains unsolved. The rate of returning to work after the common ulnar and median nerve injuries is presented as approximately as a ratios of 60%. To eliminate the donor morbidity, nerve conduits and nerve allografts have been used as an alternative to the autogenous nerve graft. Further, nerve transfers have been offered and used in the treatment of the diseases caused by nerve defects. 

In this research, fascicular turnover flap repair conducted with the fascicular dissection from the healthy part of the defected nerve together with the intra-fascicular bindings in the peripheral nervous system and the contribution of this method to motor healing were evaluated in an experimental study. 

Twenty-eight male Sprague-Dawley adult rats were used. The animals were grouped under 4 categories with 7 animals in each. A critical defect of 1 cm was formed on the right sciatic nerve of the animals. The defect was not treated in Group A, treated with autologous nerve graft in Group B, and fascicular turnover flap reconstruction from distal stump was performed in Group C and bilateral in Group D.  According to the behavioristic, electro-physiologic and histopathologic evaluations; Groups C and D were found to be superior to Group A, whereas they showed no difference from Group B.

According to our study the fascicular turnover flap method was observed as successful.

Key Words: nerve, peripherial nerve, defect, flap, fascicular flap, turnover, reconstruction, microsurgery, electrophisiologic, rotade test, beam test, walking test,