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2013 | 85 | 7 | 387-394
Article title

Repair of the peripheral nerve gap with epineural sheath conduit to prevent muscle denervation atrophy in the diabetic rat model

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Muscle denervation atrophy is a result of lower motor neuron injury, thus an early restitution of muscle stimulation is essential in prevention of atrophic changes.The aim of the study was to evaluate the new application of naturally occurring epineural sheath conduit in repair of the peripheral nerve gap to prevent development of muscle denervation atrophy.Material and methods. We used the model of 20 mm sciatic nerve gap, resulting in denervation atrophy of the gastrocnemius muscle in the diabetic rats (DM type 2, n=42, Zucker Diabetic Fatty strain). We applied the epineural sheath conduit created from the autologous sciatic nerve for gap repair. Muscle atrophy was assessed with the Gastrocnemius Muscle Index (GMI) and microscopic muscle morphometry (mean fiber area) at 6 and 12 postoperative week. Muscle regeneration in the experimental group was compared to the gold-standard technique of autologous nerve grafting for the repair of created nerve gap.Results. The GMI evaluation revealed comparable muscle mass restoration in groups with nerve repair using both epineural sheath and standard autologous nerve grafting (reaching 28 and 35% of contralateral muscle mass at 12 postoperative week, respectively, p=0.1), and significantly better restoration when compared to the negative control group (no repair, 20%, p<0.01). Micromorphometry confirmed significantly larger area of the regenerated muscle fibers in groups with both nerve grafting and epineural sheath conduit repair (reaching for both ca. 42% of the non-operated side), when compared to severe atrophic outcome when no nerve repair was performed (14% of the control fiber area, p<0.0001). The effectiveness of epineural conduit technique in muscle mass restoration was observed between 6 and 12 weeks after nerve repair - when gastrocnemius muscle mass increased by 12%.Conclusions. Peripheral nerve gap repair with naturally occurring epineural sheath conduit is effective in prevention of muscle denervation atrophy. This method is applicable in diabetic model conditions, showing results of regeneration which are comparable to the autologous nerve graft repair
Physical description
1 - 07 - 2013
13 - 08 - 2013
  • Department of General Surgery, Oncological Gastroenterology, and Plastic Surgery, Medical University in Poznan, Kierownik: prof. dr hab. M. Drews
  • Department of Plastic Surgery, Cleveland Clinic, Cleveland OH
  • 60-355 Poznań, ul. Przybyszewskiego 49
  • Department of Plastic Surgery, Cleveland Clinic, Cleveland OH
  • Department of Plastic Surgery, Cleveland Clinic, Cleveland OH
  • Department of Plastic Surgery, Cleveland Clinic, Cleveland OH
  • Department of General Surgery, Oncological Gastroenterology, and Plastic Surgery, Medical University in Poznan, Kierownik: prof. dr hab. M. Drews
  • Department of Plastic Surgery, Cleveland Clinic, Cleveland OH
  • 1. Wu JX, Chen L, Ding F et al.: A rat model study of atrophy of denervated musculature of the hand being faster than that of denervated muscles of the arm. J Muscle Res Cell Motil 2013; 34(1): 15-22. doi: 10.1007/s10974-012-9328-3. Epub 2012 Oct 12.[WoS][Crossref]
  • 2. Guth L, Kemerer VF, Samaras TA et al.: The roles of disuse and loss of neurotrophic function in denervation atrophy of skeletal muscle. Exp Neurol 1981; 73(1): 20-36.[PubMed][Crossref]
  • 3. Heck CS, Davis HL: Effect of denervation and nerve extract on ultrastructure of muscle. ExpNeurol 1988; 100(1): 139-53.
  • 4. Siu PM: Muscle apoptotic response to denervation, disuse, and aging. Med Sci Sports Exerc 2009; 41(10): 1876-86. doi: 10.1249/MSS.0b013e3181- a6470b[Crossref][PubMed]
  • 5. Adhihetty PJ, O’Leary MF, Chabi B et al.: Effect of denervation on mitochondrially mediated apoptosis in skeletal muscle. J Appl Physiol 2007; 102(3): 1143-51. Epub 2006 Nov 22.
  • 6. Jin H, Wu Z, Tian T et al.: Apoptosis in atrophic skeletal muscle induced by brachial plexus injury in rats. J Trauma 2001; 50(1): 31-35.[PubMed][Crossref]
  • 7. Zhang P, Chen X, Fan M: Signaling mechanisms involved in disuse muscle atrophy. Med Hypotheses 2007; 69(2): 310-21. Epub 2007 Mar 21.[WoS][Crossref]
  • 8. Favier FB, Benoit H, Freyssenet D: Cellular and molecular events controlling skeletal muscle mass in response to altered use. Pflugers Arch 2008; 456(3): 587-600. doi: 10.1007/s00424-007-0423-z. Epub 2008 Jan 12.[Crossref][PubMed][WoS]
  • 9. Noble J, Munro CA, Prasad VS et al.: Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries. J Trauma 1998; 45: 116-22.[Crossref]
  • 10. S elecki BR, Ring IT , Simpson DA et al.: Trauma to the central and peripheral nervous systems: Part II: A statistical profile of surgical treatment New South Wales 1977. Aust N Z J Surg 1982; 52: 111-16.
  • 12. W ee AS , Truitt NR , Smith LD : Type and frequency of peripheral nerve injuries encountered in a clinical neurophysiology laboratory. J Miss StateMed Assoc 2006; 47(3): 67-71. Brunelli GA, Vigasio A, Brunelli GR. Different conduits in peripheral nerve surgery. Microsurgery 1994; 15(3): 176-78.
  • 13. Hagerty R, Bostwick J 3rd, Nahai F: Denervated muscle flaps: mass and thickness changes following denervation. Ann Plast Surg 1984; 12(2): 171-76.[Crossref]
  • 14. Y oshimura K, Harii K: A regenerative change during muscle adaptation to denervation in rats. JSurg Res 1999; 81(2): 139-46.
  • 15. Gilbert A, Pivato G, Kheiralla T: Long-term results of primary repair of brachial plexus lesions in children. Microsurgery 2006; 26(4): 334-42.[Crossref][PubMed]
  • 16. Borisov AB, Carlson BM: Cell death in denervated skeletal muscle is distinct from classical apoptosis. Anat Rec 2000 1; 258(3): 305-18.
  • 17. W ang Z, Yang Y, Xiang X et al.: Estimation of the normal range of blood glucose in rats. Wei ShengYan Jiu 2010; 39(2): 133-37.
  • 18. Gordon T, Tyreman N, Raji MA: The basis for diminished functional recovery after delayed peripheral nerve repair. J Neurosci 2011 6; 31(14): 5325-34. doi: 10.1523/JNEUROSCI.6156-10.2011.[WoS][Crossref]
  • 19. Jaeger MR, Braga-Silva J, Gehlen D et al.: End-to-end versus end-to-side motor and sensory neurorrhaphy in the repair of the acute muscle denervation. Ann Plast Surg 2011; 67(4): 391-6. doi: 10.1097/SAP.0b013e3182126816.[Crossref][WoS][PubMed]
  • 20. S chmidhammer R, Nógrádi A, Szabó A et al.: Synergistic motor nerve fiber transfer between different nerves through the use of end-to-side coaptation. Exp Neurol 2009; 217(2): 388-94. doi: 10.1016/j.expneurol.2009.03.027. Epub 2009 Apr 2.[Crossref][WoS]
  • 21. S iemionow M, Duggan W, Brzezicki G et al.: Peripheral nerve defect repair with epineural tubes supported with bone marrow stromal cells: a preliminary report. Ann Plast Surg 2011 Jul; 67(1): 73-84. doi: 10.1097/SAP.0b013e318223c2db.[WoS][Crossref]
  • 22. Choi BH, Zhu SJ, Kim BY et al.: Transplantation of cultured bone marrow stromal cells to improve peripheral nerve regeneration. Int J OralMaxillofac Surg 2005; 34(5): 537-42. Epub 2005 Jan 26. PubMed PMID: 16053875.
  • 23. Pereira Lopes FR, Camargo de Moura CamposL, Dias Corrêa J Jr et al.: Bone marrow stromal cells and resorbable collagen guidance tubes enhance sciatic nerve regeneration in mice. ExpNeurol 2006; 198(2): 457-68. Epub 2006 Feb 20. PubMed PMID: 16487971.
  • 24. Hou SY , Zhang HY, Quan DP et al.: Tissue-engineered peripheral nerve grafting by differentiated bone marrow stromal cells. Neuroscience 2006 19; 140(1): 101-10. Epub 2006 Apr 25. PubMed PMID: 16635551.
  • 25. A lluin O, Wittmann C, Marqueste T et al.: Functional recovery after peripheral nerve injury and implantation of a collagen guide. Biomaterials 2009; 30(3): 363-73. doi: 10.1016/j.biomaterials. 2008.09.043. Epub 2008 Oct 16.[Crossref][PubMed][WoS]
  • 26. Campos C: Chronic hyperglycemia and glucose toxicity: pathology and clinical sequelae. PostgradM e d 2 0 1 2 ; 1 2 4 ( 6 ) : 9 0 - 7 . d o i : 1 0 . 3 8 1 0 / pgm.2012.11.2615.
  • 27. K ennedy JM, Zochodne DW : The regenerative deficit of peripheral nerves in experimental diabetes: its extent, timing and possible mechanisms. Brain 2000; 123 (Pt 10): 2118-29.
  • 28. R ecknor JB, Mallapragada SK : Nerve Regeneration: Tissue Engineering Strategies. W: Bronzino JD (red.): The Biomedical Engineering Handbook: Tissue Engineering and Artificial Organs. 2006, Taylor & Francis: New York.
  • 29. W illiams HB: The value of continuous electrical muscle stimulation using a completely implantable system in the preservation of muscle function following motor nerve injury and repair: an experimental study. Microsurgery 1996; 17(11): 589-96.[PubMed]
  • 30. Mödlin M, Forstner C, Hofer C et al.: Electrical stimulation of denervated muscles: first results of a clinical study. Artif Organs 2005; 29(3): 203-06. [Crossref]
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