There are several reasons why end-to-side nerve coaptation has not been widely adopted clinically. Among these are the putative damage inflicted on the donor nerve and the variable quality of the regeneration in the recipient nerve.
So far experiments on end-to-side nerve repair have been short term and mostly carried out on rats. This long-term study of end-to-side nerve repair of ulnar to median and median to ulnar nerve was performed using adult nonhuman primates. Eleven nerve repairs were studied at different time points. Eighteen, 22, 33 and 57 months after surgery a qualitative and quantitative analysis of the donor nerve and regenerating nerve revealed variable levels of percentage axonal regeneration compared with matched controls (1.4%–136%). Morphological evidence of donor nerve damage was identified distal to the coaptation site in four of the 11 cases, and in these cases the best axonal regeneration in the corresponding recipient nerves was observed. This donor nerve damage could neither be demonstrated in terms of a decrease in axon counts distal to the coaptation nor as donor target organ denervation. Recipient target organ regeneration like the axonal regeneration varied, with evidence of motor regeneration in eight out of 11 cases and sensory regeneration, as measured by percentage innervation density compared with matched controls, varied from 12.5% to 49%.
Results from the present study demonstrate that the end-to-side coaptation technique in the nonhuman primate does not give predictable results. In general the motor recovery appeared better than the sensory and in those cases where donor nerve damage was observed there was better motor and sensory regeneration overall than in the remaining cases.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- End-to-side neurorrhaphy with removal of the epineural sheath: an experimental study in rats.Plast Reconstr Surg. 1994; 94: 1038-1047
- Operative treatment of chronic facial palsy of peripheral origin.Br Med J. 1903; May; : 1009-1013
- End-to-side nerve suture—a technique to repair peripheral nerve injury.S Afr Med J. 1999; 89: 1188-1194
- End-to-side nerve suture in clinical practice.Hand Surg. 2003 Jul; 8: 33-42
- Re-innervation of M. biceps by end-to-side nerve suture.Hand Surg. 2003 Jul; 8: 25-31
- Les anastomoses nerveuses terminolaterales. Rapport clinique preliminaire a propos de dix cas.Ann Chir Plast Esthet. 2001; 46: 129-133
- End-to-side neurorrhaphies of the ulnar and median nerves at the wrist: report of two cases without sensory or motor improvement.Ann Plast Surg. 2000; 45: 641-643
- Can sensory and motor collateral sprouting be induced from intact peripheral nerve by end-to-side anastomosis?.J Hand Surg [Br]. 1994; 19: 277-282
- “Donor” muscle structure and function after end-to-side neurorrhaphy.Plast Reconstr Surg. 2001; 107: 789-796
- End-to-side neurorrhaphy: a histologic and morphometric study of axonal sprouting into an end-to-side nerve graft.J Reconstr Microsurg. 1997; 13: 99-106
- Functional and morphometric evaluation of end-to-side neurorrhaphy for muscle reinnervation.Plast Reconstr Surg. 2000; 106: 383-392
- Histologic assessment of nerve regeneration in the rat.Plast Reconstr Surg. 1985; 75: 384-388
- End-to-side nerve suture in the primate (chacma baboon).Hand Surg. 1998; 3: 1-6
Committee on Care and Use of Laboratory Animals Resources Commission on Life Sciences, National Research Council. Guide for the care and use of laboratory animals. NIH Publication, 86–93. Bethesda: Public Health Service, National Institutes of Health; 1985. p. 86–93.
- Atlas of peripheral nerve pathology.Arnold Publishers, London1999
- The cytoskeletal architecture of the presynaptic terminal and molecular structure of synapsin 1.J Cell Biol. 1989; 108: 111-126
- A new animal model to investigate axonal sprouting after end-to-side neurorrhaphy.J Reconstr Microsurg. 1999; 13: 317-325
- Results of termino-lateral neurorrhaphy to original and adjacent nerves.Microsurgery. 1998; 18: 276-281
- End-to-side neurorrhaphy resulting in limited sensory axonal regeneration in a rat model.Ann Otol Rhinol Laryngol. 1997; 106: 506-512
- Evaluation of collateral sprouting after end-to-side nerve coaptation using a fluorescent double labelling technique.Microsurgery. 1999; 19: 281-286
- End-to-side neurorrhaphy and lateral axonal sprouting in a long graft rat model.Laryngoscope. 2002; 112: 899-905
- Ultrastructure of early axonal regeneration in an end-to-side neurorrhaphy model.J Reconstr Microsurg. 2000; 16: 313-323
- Peripheral nerve regeneration and neurotrophic factors.J Anat. 1999; 194: 1-14
- IGF-I and end-to-side nerve repair: a dose–response study.J Reconstr Microsurg. 2001; 117: 247-256
- Axonal regeneration stimulated by the combination of nerve growth factor and ciliary neurotrophic factor in an end-to-side model.J Hand Surg [Am]. 2001; 26: 478-488
- Immunohistochemical study of skin reinnervation by regenerative axons.J Comp Neurol. 1997; 380: 164-174
- Lateral terminal neurorrhaphy with removal of the epineural sheath: an experimental study in rats.Sao Paulo Med J. 1992; 110: 267-275
- Primary sensory neurons and satellite cells after peripheral axotomy in the adult rat.Exp Brain Res. 2002; 142: 308-318
- Scand J Plast Reconstr Surg Hand Surg. 1996; 30: 1-6
- Sensory recovery after hand reimplantation: a clinical, morphological, and neurophysiological study in humans.Scand J Plast Reconstr Surg Hand Surg. 2003; 37: 163-173
Published online: July 11, 2006
Accepted: December 9, 2005
Received: July 13, 2004
© 2006 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.