Experimental nerve reconnection: importance of initial repair.
We believe that the randomness of sprout regrowth is the cause of most poor experimental and clinical functional results after nerve repair. We have elaborated a technique of repair, called "nerve reconnection," aiming to minimize randomness of regrowth. This technique enhances the precision of repair by minimizing physical and chemical damage to the stumps and by ensuring stress-free stump abutment. In this study, the reconnection technique was compared to the conventional microsuture method. First, both techniques were tested as the primary method of repair. A method of behavioral evaluation, the sciatic functional index, was used to assess the results. The reconnection groups consistently showed satisfactory functional results, even after two successive procedures. In contrast, only one-third of the animals in the suture groups reached satisfactory functional levels. In the second part of the study, animals with unsatisfactory results after primary suture were reoperated in an attempt to improve the poor results of initial surgery. The secondary procedures used were either the reconnection technique or conventional microsuture. All secondary procedures failed to improve poor preexisting functional conditions. These findings stress the importance of the original "blueprint" of the nerve and the necessity of maintaining this unique pattern during initial repair.
de Medinaceli
L
L
Cell Surgery Laboratory, Eastern Virginia Medical School, Norfolk.
Seaber
A V
AV
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D005684:Gait; D008297:Male; D009416:Nerve Regeneration; D010525:Peripheral Nerves / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D019736:Prostheses and Implants; D051381:Rats; D011919:Rats, Inbred Strains; D012086:Reoperation; D012584:Sciatic Nerve / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery; D013314:Stress, Mechanical; D013537:Sutures; D013997:Time Factors