title: Use of small gap anastomosis for the repair of peripheral nerve injury by cutting and sleeve jointing the epineurium.
abstract: BACKGROUND
  Although epineurium neurorrhaphy is the most reliable and conventional method for the repair of peripheral nerve injury and is accepted as the gold standard, it is still far from ideal. Many attempts have been made to develop nerve anastomosis techniques. The aim of this study was to investigate the use of small gap anastomosis performed by cutting and sleeve jointing the epineurium for nerve repair.
  
  
  METHODS
  A 12-week study was performed using small gap anastomosis via cutting and sleeve jointing the epineurium, compared with epineurium neurorrhaphy in situ, to repair a rat sciatic nerve rupture. Three experimental groups were included: sham control (n = 8), small gap anastomosis (n = 16), and epineurium neurorrhaphy (n = 16). About 12 weeks after surgery, recovery was assessed with walking track analysis, electrophysiology, hematoxylin and eosin staining, immunohistochemistry, and electron microscopy.
  
  
  RESULTS
  The sciatic nerve functional index observed in the small gap anastomosis group was significantly higher than that in the epineurium neurorrhaphy group (p < 0.05). In vivo electrophysiological analysis confirmed that the small gap anastomosis group showed a significantly higher conduction velocity than the epineurium neurorrhaphy group (p < 0.05). Postoperative morphometric analysis revealed better results after small gap anastomosis compared with epineurium neurorrhaphy.
  
  
  CONCLUSIONS
  Small gap anastomosis via cutting and sleeve jointing the epineurium could be an alternative to epineurium neurorrhaphy for the repair of peripheral nerve injury, particularly, considering that the epineurium originates from native tissue that provides a suitable microenvironment for the selective regeneration of axons.
authors.affiliation: Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Peiji
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Jiaju
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Jiang
authors.affiliation: Department of Hand and Foot Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D008297:Male; D008866:Microsurgery / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D051381:Rats; D017207:Rats, Sprague-Dawley; D020127:Recovery of Function; D012584:Sciatic Nerve / Q000293:injuries / Q000601:surgery*