The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery

Lubiatowski, Przemysław; Ünsal, Faik Murat; Nair, Dileep; Özer, Kağan; Siemionow, Maria

doi:10.1002/micr.20472

Cited by 30 publications

(21 citation statements)

References 20 publications

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“…The histological analysis showed regeneration of small nerve fibers, and the inside-out slided epineural tube did not show degeneration or scarring. Histologically, a structure resembling epineurium was formed on the donor site, which corresponds with the findings of previous studies in which the epineurium was removed 18,31,37 ( Figure 3). The formation of small nerve bundles, microfascicular regeneration, is a known phenomenon after nerve transection or ischemic injury, as is the regrowing of these microfascicles outside the nerve trunk.…”

Section: Discussionsupporting

confidence: 89%

Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects

Luokkala

Ryhänen

Näpänkangas

et al. 2016

Hand (New York, N,Y.)

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Background: The repair of a segmental peripheral nerve injury is a clinical challenge. Several studies have been performed to determine superior methods for overcoming nerve gaps. The purpose of this study was to investigate if the inside-out slided epineurium of the distal segment of an injured nerve can serve as a conduit to bridge a short nerve defect (10 mm). Methods: Nineteen sciatic nerves in Sprague-Dawley rats were transected, and a 10-mm gap was left between the ends. A section of distal epineurium was pulled inside out to bridge the gap. Walking track analysis was performed, and the sciatic function index (SFI) was calculated. Wet muscle mass and withdrawal reflex were measured. The density of axon fibers at different levels of repaired nerves was determined, and histological analysis was performed at 16 weeks. Results: The mean SFI improved from −81.0 at 4 weeks to 36.3 at 16 weeks. The axon densities showed regeneration through the epineural tube, and 5 of the rats demonstrated a withdrawal reflex. The weight of the tibialis anterior muscle of the injured limb at 16 weeks was 59% that of the uninjured side. Conclusions: The distal epineural sheath tube provided a size-matched conduit between the nerve stumps, with no histological donor-site morbidity. Histologically, regeneration occurred through the epineural tube without neuroma formation, and functional recovery was comparable to that of previous studies of nerve repair techniques. Technique may be an addition to the armamentarium of tools used to treat segmental nerve defects.

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Section: Discussionsupporting

confidence: 89%

Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects

Luokkala

Ryhänen

Näpänkangas

et al. 2016

Hand (New York, N,Y.)

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“…Lubiatowski et al 24 compared the nerve recovery following epineural sleeve technique with graft reconstruction in rat sciatic nerve transection model. They reported that nerve defects repaired with the sleeve technique to anchor nerve grafts displayed improved functional recovery when compared with the conventional epineural repair.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Barmpitsioti¹,

Konofaos

Ignatiadis

et al. 2011

Microsurgery

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The purpose of this study was to evaluate the effect of direct administration of nerve growth factor (NGF) into an epineural conduit across a short nerve gap (10 mm) in a rabbit sciatic nerve model. The animals were divided into two groups. In group 1, n = 6, a 10-mm defect was created in the sciatic nerve and bridged with an epineural flap. A dose of 1 μg of NGF was locally administered daily for the first 21 days. NGF administration was made inside the epineural flap using a silicone reservoir connected to a silicone tube. In group 2, n = 6, the 10-mm defect was bridged with a nerve graft. This group did not receive any further treatment. At 13 weeks, all animals, before euthanasia, underwent electromyography (EMG) studies and then specimen sent for histology morphometric analysis. NGF administration ensured a significantly increased average number of myelinated axons per μm(2) (P = 0.028) and promoted fiber maturation (P = 0.031) and better EMG results (P = 0.046 for latency P = 0.048 for amplitude), compared with the control group. Although nerve grafts remain the gold standard for peripheral nerve repair, NGF-treated epineural conduits represent a good alternative, particularly when an unfavorable environment for nerve grafts is present.

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“…The graft was coaptated proximally to the sciatic nerve and distally to the posterior tibial nerve using six 10/0 nylon sutures (Bear Microsurgery, Arosurigcal instruments, Newport Beach) creating a “pull‐over sleeve,” which was first described by Siemionow and coworkers26, 27 The muscle was closed using 4 5/0 Vicryl sutures (Ethicon Inc, Johnson & Johnson Somerville), followed by closing the skin using 5/0 Vicryl sutures (Ethicon Inc, Johnson & Johnson Somerville).…”

Section: Methodsmentioning

confidence: 99%

Isogenic venous graft supported with bone marrow stromal cells as a natural conduit for bridging a 20 mm nerve gap

et al. 2010

Self Cite

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In this study, we introduce a technique for bridging large neural gaps, using an isogenic vein graft supported with isogenic bone marrow stromal cells (BMSC). In three groups a nerve defect of 20 mm was bridged with a vein graft. Our first experimental group comprized an empty venous graft, in group II the venous nerve graft was filled with saline where as in group III the venous nerve graft was filled with BMSC. The animals were tested for functional recovery up to 3 months post repair. Our results show that the BMSC filled venous graft resulted in significantly better regeneration of the nerve defect compared to controls, as confirmed by the functional recovery measured by somatosensory evoked potentials, toe spread, pin prick, and gastrocnemius muscle index. Conclusively, the results confirm that the vein graft supported with BMSC is associated with better functional nerve regeneration.

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The epineural sleeve technique for nerve graft reconstruction enhances nerve recovery

Cited by 30 publications

References 20 publications

Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects

Distal Inside-Out Epineural Sliding Technique to Repair Segmental Nerve Defects

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

Isogenic venous graft supported with bone marrow stromal cells as a natural conduit for bridging a 20 mm nerve gap

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