The repair of large peripheral nerve defects is not always possible, especially when the proximal stump is not available. In these cases, end-to-side nerve anastomosis has been proposed. In the present experiment, using the terminal branches of the rat brachial plexus, the authors studied behavioral responses after end-to-side nerve anastomoses using fibrin glue, 3 and 6 months after surgery. Rats were evaluated by results of a grasping test, a capsaicin test and a hot-plate test. The collected data demonstrated that there was no functional motor or sensory reinnervation after the end-to-side nerve anastomoses. The conjunctive layers of the peripheral nerve thus represented an effective barrier to reinnervation.

No abstract

In closed injuries, nerves may be damaged by compression, stretch, or friction; the lesion may be circumscribed or extensive. Indications for exploratory surgery are very difficult to establish. However, in a number of cases, no lesions are observed during surgery and only neurolysis is performed. Neurolysis, nevertheless, may devascularize the nerves, compromising the final outcome of nerve regeneration. The goal of this reported work was to study the effects of neurolysis during the process of regeneration. Experiments were performed in the rat median nerve, and assessment was made by behavioral and electrophysiologic studies 2, 3, 6 and 12 weeks after surgery. The experiments demonstrated that exploratory microneurolysis had no deleterious effect on nerve recovery when performed during the process of nerve regeneration. Indeed, microneurolysis accelerated the rate of nerve recovery. Early exploratory surgery thus had no deleterious effects on nerve regeneration, and not only offered a better prognosis in reparable lesions, but also a potential beneficial effect of neurolysis in accelerating recovery.

The surgical strategy proposed might be a useful alternative to selective sensory repair in the emerging field of brachial plexus reconstruction by direct spinal cord surgery.

Sensory reconstruction has recently been stressed in breast reconstruction. However, there are no reports concerning the reconstruction of a sensitive areola. The bilateral reconstruction of a sensitive areola using a neurocutaneous flap based on the medial antebrachial cutaneous nerve is reported. The flap was harvested from the distal third of the forearm as an island flap and tunneled to reach the apex of the new breast, which was previously reconstructed using a 135-cc, gel-filled, silicone prosthesis covered by a latissimus dorsi myocutaneous flap. Six months later, fine sensibility in the reconstructed areola was demonstrated. The patient could perceive light touch, pain, and 14 mm two-point discrimination. At 2 months after surgery, 50 percent of cutaneous faulty stimulus location was observed. However, at 4 and 6 months after surgery, faulty location disappeared. Six months after harvesting the medial antebrachial cutaneous nerve, the sensory deficit was minimal; it included a hypoesthesic zone of 4 to 7 cm and an anesthesic zone of 2.5 to 5 cm on the middle third of the forearm. Fifteen months after the procedure, no hypoesthesic zone was observed; only a 2 to 3 cm anesthesic zone on the proximal medial side of the forearm existed. This sensory deficit passed unnoticed by the patient. The technique developed here is a refinement in breast reconstruction, and we think it should be used in selected patients.