Results of End-to-Side Nerve Coaptation in Severe Obstetric Brachial Plexus Lesions

Pondaag, Willem; Gilbert, Alain

doi:10.1227/01.neu.0000317314.54450.79

Cited by 23 publications

(12 citation statements)

References 57 publications

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“…Neurotomy of the donor nerve may enhance regeneration of repaired nerve through ETS neurorrhaphy. 10,26 Brenner et al and Kalantarian et al found that the efficacy of reinnervation and functional restoration of function of the compromised nerves was proportional to the degree of the donor nerve axotomy. 3,14 Lesions in the donor nerve are likely important to provide a larger area of contact between the nerves as well as creating a suitable microenvironment for growth and neurotrophic factors which are related to the development, maintenance, and regeneration of the axonal sprouts.…”

Section: Discussionmentioning

confidence: 99%

Changes of the donor nerve in end‐to‐side neurorrhaphies with epineurial window and partial neurectomy: A long‐term evaluation in the rat model

et al. 2013

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End-to-side (ETS) neurorrhaphy has been applied in the repair of peripheral nerve injuries and in babysitter procedures. However, the long-term changes of donor nerve and muscle after ETS remain unknown. This study was designed to investigate long-term changes in donor nerve and muscle in a rat model. Sixty Lewis rats were equally allocated into three groups of 20 rats. The peroneal nerve was divided. In Group A, end-to-end (ETE) neurorrhaphy was performed. In Group B, ETS was performed to an epineurial window on the tibial nerve. In Group C, ETS was performed to the tibial nerve with 40% partial neurectomy. The following data were obtained at 6, 12, 18, and 24 weeks postoperatively: latency delaying rate (LDR), amplitude recovery rate (ARR), myelinated fiber counts, muscle force and weight, and cross-sectional area of gastrocnemius muscle fibers. The results showed no significant changes of the donor nerve and muscle in Group B. Nerve regeneration was found in the peroneal nerve, and myelinated fiber number was significantly decreased when compared to the nerve with ETE. In Group C, the myelinated axon number in the peroneal nerve was equivalent to the level in ETE repair. However, function and structure of the donor nerve and muscle were significantly impaired in the early postoperative period. Nonetheless, full recovery was observed 24 weeks after surgery. Both ETS with epineurial window and 40% donor nerve neurectomy showed reinnervation of the recipient nerve without structural and functional changes of the donor system in a long-term follow-up. Partial neurectomy may promote recipient nerve regeneration, but at the cost of donor neuromuscular compromises in the early postoperative period. This study provides long-term evidence for further investigation of ETS in peripheral nerve repair and in babysitter procedures.

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Section: Discussionmentioning

confidence: 99%

Changes of the donor nerve in end‐to‐side neurorrhaphies with epineurial window and partial neurectomy: A long‐term evaluation in the rat model

et al. 2013

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“…In addition, due to the long outgrowth trajectory, severe atrophy can occur. The use of the end-to-side technique has been abandoned by most surgeons because of the poor results [24]. We present two cases with surprisingly good results, which can be attributed exclusively to the ETSN technique.…”

Section: Discussionmentioning

confidence: 87%

Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries

2015

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“…However there are some authors who still believe that the ETS with sutures could harm the donating nerve, especially small dimension nerves 8,9 .…”

Section: Many Authors Have Recently Enhanced the Results Of End-mentioning

confidence: 99%

Nerve growth factor with fibrin glue in end-to-side nerve repair in rats

Silva

Aydos

et al. 2012

Acta Cir. Bras.

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PURPOSE:To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS:Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS:All the analyzed variables did not show any differences among the four operated groups (p>0.05), which were statistically superior to group B (p<0.05), but inferior to group A (p>0.05). CONCLUSION:The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.Key words: Suture Techniques. Fibrin Tissue Adhesive. Microsurgery. Rats. RESUMO OBJETIVO:Determinar os efeitos do reparo nervoso término-lateral realizado apenas com cola de fibrina contendo fator de crescimento nervoso em ratos. MÉTODOS:Setenta e dois ratos Wistar foram distribuídos em seis grupos: A -não submetido à secção nervosa; B -secção do nervo fibular (sem reparo); Os outros grupos tiveram o nervo fibular seccionado e então reparado na superfície lateral do nervo tibial

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Results of End-to-Side Nerve Coaptation in Severe Obstetric Brachial Plexus Lesions

Abstract: This study does not convincingly show that the end-to-side nerve repair in infants with an obstetric brachial plexus lesion is effective. Its use cannot be recommended as standard therapy.

Cited by 23 publications

References 57 publications

Changes of the donor nerve in end‐to‐side neurorrhaphies with epineurial window and partial neurectomy: A long‐term evaluation in the rat model

Changes of the donor nerve in end‐to‐side neurorrhaphies with epineurial window and partial neurectomy: A long‐term evaluation in the rat model

Results of nerve reconstructions in treatment of obstetrical brachial plexus injuries

Nerve growth factor with fibrin glue in end-to-side nerve repair in rats

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