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Pérez et al. End-to-side neurorrhaphy for early reinnervation

INTRODUCTION The current study was conducted to evaluate the
provision of early muscular reinnervation to avoid
End-to-end neurorrhaphy (EEN) is the conventional muscle atrophy and function loss.
reconstructive method for patients with peripheral
nerve injuries. In some cases, as in patients with METHODS
complex upper extremity trauma and/or extensive
oncologic resections, an end-to-side neurorrhaphy From January 2008 to November 2008, fifty male adult
(ESN) is considered to be a good alternative for neural Wistar rats were used for study. Their weight ranged
reconstruction. [1-3] However, this technique (ESN) has from 350 to 400 g and they were divided into 5 groups
been abandoned by some surgeons secondary to of 10 rats each. Before and after surgery, the animals
discouraging functional outcomes. [4-6] Viterbo et al. [7,8] were housed in plastic boxes, with a 12-h light/dark
has stated that ESN from a “healthy” nerve can “bridge” cycle, and were given free access to food and water.
a neurological deficit, and indeed the outcomes from
this type of surgery are better than those obtained from The measured criteria included anatomic changes of
end-to-end coaptation. End-to-side nerve coaptation the leg, difficulty with ambulation, and microscopic
has also been used for patients with unilateral facial neural and muscle morphology of the implied nerves
paralysis with good results. [9,10] There are experimental and muscles. All the study rats were analyzed 90 days
models in which the orbicularis occuli muscle has been after the procedure.
re-innervated with this technique. [11]
The rats were anesthetized with an intraperitoneal
Patients with upper extremity proximal nerve injection of a 1:10 pentobarbital solution (60 mg/mL) at
injuries may require more than one year to achieve a conventional dosage. During the procedure, a dose
reinnervation in the distal extremity (during this time, of 0.1-0.2 mL of the same solution was administered
axonal growth takes place). However, full reinnervation as needed. The procedure was performed on the
does not imply full recovery given the risk of often peroneal and tibial nerves of the right lower extremity.
irreversible and uncorrectable muscle contracture and In group 0, nerves were dissected and exposed without
joint stiffness. In clinical studies, ESN has proven its sectioning. In the remaining groups, a neurotomy of
usefulness by improving sensation alone. [6] the peroneal nerve was made 20 mm proximal to its

Figure 1: Surgical procedures. G1: Group 1PN neurotomy and repair with EEN; G2: group 2, ESN without end-to-end repair; G3: group
3, both EEN and ESN using a nerve graft; G4: group 4, no repair done. EEN: end-to-end neurorrhaphy; ESN: end-to-side neurorrhaphy;
PN: peroneal nerve; TN: tibial nerve. Optical lenses original magnification ×400
Plastic and Aesthetic Research ¦ Volume 4 ¦ February 22, 2017 19