A new insight on peripheral nerve repair: the technique of internal nerve splinting

Abstract

OBJECTIVE Neuropathic pain produced by symptomatic neuromas is an important problem after peripheral nerve injury (PNI). End-to-end anastomosis of the nerve stump for PNI is well established but cannot efficiently prevent neuroma-in-continuity formation. METHODS Sciatic nerve injury was used in the experimental model. Seventy-two rats were randomly divided into four groups: rats with nerve anastomosis sites supported with silicone tubes represented the internal nerve splinting (INS) group (n = 18); rats with end-to-end nerve anastomosis represented control group 1 (CON1) (n = 18); rats with INS and the nerve anastomosis site represented control group 2 (CON2) (n = 18); and rats that underwent the same surgical procedures for skin and muscle operations but without sciatic nerve injury represented the normal group (n = 18). RESULTS Gross evaluations of the nerve anastomosis sites, gastrocnemius muscle atrophy, axonal regeneration and remyelination, neuropathic pain, and scar hyperplasia of the neuromas were performed, as well as motor function evaluations. Axonal regeneration, remyelination, and gastrocnemius muscle atrophy were similar between the INS group and CON1 (p > 0.05). However, neuropathic pain and scar hyperplasia—as evaluated according to the expression of anti–sigma-1 receptor antibody and anti–α-smooth muscle actin, respectively—and the weight ratios of the neuromas were reduced in the INS group compared with those of CON1 and CON2 (p < 0.05). CONCLUSIONS Application of INS in nerve repair effectively prevented traumatic neuroma-in-continuity formation and inhibited neuropathic pain without influencing nerve regeneration in rats.

Siyatik sinir yaralanması oluşturulan ratlarda Andız (Juniperus sp) kökü ekstraktının ve B12 vitamininin sinir iyileşmesi üzerine etkisinin karşılaştırılması

“…In nerve injuries, the end-to-end anastomosis technique is commonly applied to repair nerve damage (Horasanli et al, 2017;Zhang et al, 2023). Luo et al (2022) and Ozay et al (2023) observed the healing process by performing suturing after making an incision for sciatic nerve injury in their studies. The method of inducing nerve injury in the present study is similar to the nerve injury method employed by Luo et al (2022) and Ozay et al (2023).…”

Molecular Basis of Surgical Coaptation Techniques in Peripheral Nerve Injuries

“…It also generates a bust of action potentials at the proximal stump that is propagated to the soma via L-type voltage-gated calcium channels and the release of calcium from the endoplasmic reticulum. This results in the activation of the second messenger cAMP, which activates several important pro-regenerative transcription factors including dual leucine zipper-bearing kinase (DKL; also known as MAP3K12) and CREB1 (cAMP-responsive element-binding protein 1) [ 7 , 8 , 9 , 10 ]. The slower phase of injury is mediated via protein kinases, including calcium/calmodulin-dependent kinase 2(CMAK2); mitogen-activated protein kinases (MAPK) such as Erk1 and Erk2; phosphatidylinositol 3-kinase (PI3K); protein kinase A (PKA); protein kinase C (PKC); and c-jun N-terminal kinase (JNK).…”

“…There is a simultaneous downregulation of neurofilaments, neuropeptides and neurotransmitters gene expression, thus inhibiting the neurotransmitter function of the neuron. It also results in the ‘cell body response’ that is seen after PNI and includes swelling of the neuronal cell; chromatolysis (scattering of Nissl bodies or rough endoplasmic reticulum); migration of the nucleus to the peripheral of the neuron; and increased protein synthesis for regeneration [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ].…”

“…The current surgical gold standard is a direct end-to-end (ETE) repair; however, this approach is only viable if the resulting gap is small and amenable to a tension-free repair [ 1 , 2 , 5 ]. Historically, the most common direct repair technique is end-to-end coaptation, indicated when nerve segments can be approximated without tension in the presence of a viable proximal nerve stump [ 6 , 7 , 8 , 9 ]. In cases where direct repair is not feasible, autografts and/or cadaveric allografts are often employed to fill the gap.…”

Traumatic peripheral nerve injuries: diagnosis and management

“…Risk of neuroma formation can be minimized by avoiding iatrogenic nerve injury, early primary repair where possible and precise coaptation of the epineurium intraprocedurally [61 ▪▪ ,62,63]. Nonsurgical strategies for neuroma management include aggressive management with adjuvant analgesics, and neuromodulation using peripheral or spinal repetitive electrical stimulation or transcutaneous magnetic stimulation, techniques which may also stimulate axonal regeneration [64]. A number of surgical strategies have also been proposed.…”