Conventional Versus Epineural Sleeve Neurorrhaphy Technique: Functional and Histomorphometric Analysis

Abstract

Three methods of nerve repair involving the epineural sleeve technique were compared with conventional nerve repair using the rat sciatic nerve transection model in four groups. In group 1, the sciatic nerve was repaired using the conventional epineural technique by placing four sutures. In groups 2, 3, and 4, the epineural sleeve technique was combined with two sutures, fibrin glue, and two sutures with fibrin glue, respectively. Functional recovery was evaluated using walking track analysis, limb circumference, and the severity of toe contracture. Diameter of the sciatic nerve fibers, total number of myelinated fibers, diameter of the myelin sheath, and the axon-to-fiber diameter ratio were measured at 12 weeks. The results showed better functional recovery as well as a higher number of myelinated fibers in groups using the epineural sleeve technique compared with conventional technique ( < 0.05). The addition of fibrin glue, however, did not make any significant difference. The epineural sleeve technique was found to be superior when compared with conventional nerve repair, providing faster functional recovery and improved nerve regeneration.

Nerve growth factor combined with an epineural conduit for bridging a short nerve gap (10 mm). A study in rabbits

“…Although the results of our study are in agreement with those of Siemionow et al 8 and Tetik et al, 9 there are distinct differences between the two animal models: 1) Our study was performed in rabbits. In contrast, the epineural sleeve technique studies 8,9 used the rat sciatic transection model.…”

“…Tetik et al 9 compared the epineural sleeve technique with conventional nerve repair using the rat sciatic nerve transection model. They suggested that the epineural sleeve technique was provided faster functional recovery and improved nerve regeneration.…”

“…8,9,24 In our experiment, a 10-mm defect was created, and the epineurium from the proximal stump was mobilized preserving only 2 mm, and it was reversed to facilitate gap bridging. In contrast to the above-mentioned studies, 8,9,23,24 our laboratory has selected the rabbit sciatic nerve transection model, because it has a well-developed epineurium, which can be harvested without significantly injuring the nerve. 21 Moreover, the complications of automutilation and autotomy seen with the rat sciatic nerve injury model are completely avoided.…”

Regeneración de las lesiones críticas del nervio periférico con factores de crecimiento. Estudio experimental

“…Para evitar estos inconvenientes, resulta útil efectuar un contra apoyo con una pinza de microcirugía en el momento de pasar el hilo. El número de puntos de sutura por grupo fascicular debe ser limitado (Mackinnon SE, 1989;Sunderland S, 1990;Harris & Tindall, 1991;Tetik et al, 2002;Maggi et al, 2003;Dvali & Mackinnon, 2003). Si se logra un buen afrontamiento, puede bastar un solo punto, gracias a la contención adicional suministrada por los puntos interfasciculares o epineurales.…”

Effect of subepineurial dehydroepiandrosterone treatment on healing of transected nerves repaired with the epineurial sleeve technique

“…Using our own modification of the sleeve technique, we confirmed that the sleeve technique provides better stump coaptation, prevents axoplasmic fluid leakage, reduces the amount of foreign material at the coaptation site, and directs the fasciculi to a functioning end-organ rather than letting them escape into ectopic fibrous tissue. 4,5 The epineural sleeve can be used for delivery of nerve regeneration-promoting factors. One of these, dehydroepiandrosterone, may actually improve nerve regeneration in a rat sciatic nerve crush injury model.…”