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Pérez et al. Plast Aesthet Res 2017;4:18-23 Plastic and
DOI: 10.20517/2347-9264.2016.95
Aesthetic Research

www.parjournal.net
Original Article Open Access

Early muscle reinnervation by means

of end-to-side neurorrhaphy in an

experimental model

Araceli Pérez , Rafael Reynoso , Rosa M. Romero , Angélica González , Jorge Ochoa , Dulce H. Gutiérrez ,
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2
2
2
1
3
Damián Palafox 1
1 Department of Plastic Surgery, General Hospital “Dr. Manuel Gea Gonzalez”, Mexico City 14080, Mexico.
2 Department of Morphology of Cell and Tissue, National Pediatric Institute, Mexico City 14080, Mexico.
3 Department of Plastic Surgery, Hospital Angeles, Mexico City 14080, Mexico.
4 Department of Health Sciences, Technological University of Mexico, Mexico City 14080, Mexico.
Correspondence to: Dr. Araceli Pérez, Department of Plastic Surgery, General Hospital “Dr. Manuel Gea Gonzalez”, Mexico City 14080, Mexico.
E-mail: dra.araceliperez@hotmail.com
How to cite this article: Pérez A, Reynoso R, Romero RM, González A, Ochoa J, Gutiérrez DH, Palafox D. Early muscle reinnervation by means of
end-to-side neurorrhaphy in an experimental model. Plast Aesthet Res 2017;4:18-23.

ABSTRACT
Article history: Aim: The aim of the study was to provide early muscular reinnervation to avoid muscle
Received: 01-11-2016 atrophy and functional loss in an experimental model. Methods: Fifty rats were divided
Accepted: 05-11-2016 into five groups. In group 0 (control group) only nerve dissection was performed. Total
Published: 22-02-2017 peroneal nerve section was performed in the remaining groups. Immediate end-to-end
neurorrhaphy (EEN) was made in group 1. In group 2, an end-to-side neurorrhaphy (ESN)
was performed from the tibial nerve to the peroneal nerve. In group 3, a direct EEN, plus
Key words: an ESN, were used as a nerve graft as a bridge from the donor nerve (tibial); all nerve
Nerve transfer, coaptations were performed through an epineural window. In group 4, only a neurotomy
neurorrhaphy, was made without any type of reconstruction. Results: Neural diameters were similar
muscle reinnervation, in groups 0, 1, and 3 (38 ± 1 mm, 31 ± 6 mm, 32 ± 3 mm). Neural fibers in group 3 had
nerve repair an 18% increase in the number of axons (P < 0.001) when compared to group 0. Group
2 (28 ± 1 mm) and group 4 (19 ± 3 mm) had diminished diameters with a lower index of
muscle regeneration. Animals in group 4 presented with “clawed” lower extremities and
had difficulty with ambulation. Neural graft diameters was similar in groups 2 and 3 (33
± 4 mm, 31 ± 3 mm), but axon density was significantly higher in group 3 (53 ± 6 mm, 39
± 8 mm) (P < 0.001). Axon density was 36% higher when the combination of EEN and
ESN with a neural graft through an epineural window was performed. Conclusion: This
study revealed that the combination of EEN and ESN repairs with the addition of a neural
graft provides a lower index of muscle fiber destruction, and can be a reliable method for
reconstruction in high neural injuries.

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