Subscribe to RSS
DOI: 10.1055/s-2001-16360
Quantification of Nerve Tension After Nerve Repair: Correlations with Nerve Defects and Nerve Regeneration
Publication History
Publication Date:
31 December 2001 (online)
ABSTRACT
This study tested the validity of a quantitative in vitro nerve-tension-measuring technique, by correlating the tension measurements with functional and morphologic assessments of nerve regeneration. Initially, harvested nerves were used in vitro to determine a K value for lateral displacement in this tissue. Next, this value was used to calculate the tension of nerve repair, following 0-, 3-, 6-, and 9-mm resections of nerves in groups of rats. After quantifying the nerve tensions following excision and repair, the authors determined a sciatic function index to evaluate functional recovery and axon diameter in the animals. Functional recovery was significantly impaired in animals with elevated measurable tension (9.04 ± 0.74 g in a 6-mm defect, 27.76 ± 8.86 g in a 9-mm defect), compared to animals with no or 3-mm excision and measured tension of 3.3 ± 1.09 g or less. Increased tension was also associated with a significant decrease in axon diameter. This study succeeded, therefore, in quantitatively relating the elements of measured nerve tension, nerve gaps, functional nerve recovery, and morphologic regeneration. Quantification of nerve tension by lateral displacement in vivo offers a possible solution to clinical management of nerve gaps, when the choice between primary repair and nerve grafting is not a clear one.
KEYWORD
Nerve repair - nerve tension - nerve regeneration
REFERENCES
- 1 Millesi H. Fascicular nerve repair and interfascicular nerve grafting. In: Daniel R, Terzis J (eds): Reconstructive Microsurgery Boston: Little Brown 1977: 430-442
- 2 Millesi H. The current state of nerve microsurgery. In: Riediger D, Ehrenfeld M (eds): Microsurgical Tissue Transplantation Chicago: Quintessence Publishing Co. 1989: 159-175
- 3 Millesi H. Reconstruction of the peripheral nerve. In: Terzis J, Smith K (eds): The Peripheral Nerve New York: Raven Press 1990: 116-131
- 4 O'Brien B, Morrison W. Reconstructive Microsurgery. Edinburgh: Churchill Livingstone 1987: 143-148
- 5 Mackinnon S. Update on peripheral nerve microsurgery. Adv Plast Reconstr Surg . 1995; 2 75-79
- 6 Millesi H, Meissl G, Berger A. The interfascicular nerve grafting of the median and ulnar nerves. J Bone Joint Surg . 1972; 54A 727-50
- 7 Van Beek A, Pirela-Cruz M. Microsurgical nerve repairs. In: Omer G, Spinner M, Van Beek A (eds): Management of Peripheral Nerve Problems, 2nd ed. Philadelphia: WB Saunders Co 1998: 260-269
- 8 Terzis J, Faibisoff B, Williams B. The nerve gap: suture under tension versus graft. Plast Reconstr Surg . 1975; 56 166-70
- 9 Haas H G. Investigations on nerve sutures under tension. In: Riediger D, Ehrenfeld M (eds): Microsurgical Tissue Transplantation Chicago: Quintessence Publishing Co. 1989: 177-181
- 10 Kristal P, Tencer A F, Trumble T E. A method for measuring tension in small ligaments: an application to the ligaments of the wrist carpus. J Biomech Eng . 1993; 115 218-24
- 11 Zhang F, Lineaweaver W C, Buntic R, Walker R. Mechanical evaluation of anastomotic tension and patency in arteries. J Reconstr Microsurg . 1996; 12 121-6
- 12 De Medinaceli L, Freed W J, Wyatt R J. An index of the functional condition of rat sciatic nerve based on measurements made from walking tracks. Exp Neurol . 1982; 77 634-43
- 13 Bain J R, Mackinnon S E, Hunter D A. Functional evaluation of complete sciatic, peroneal, and posterior tibial nerve lesions in the rat. Plast Reconstr Surg . 1989; 83 129-38
- 14 Lundborg G, Rydevik B. Effects of stretching the tibial nerve of the rabbit. a preliminary study of the intraneural circulation and the barrier function of the perineurium. J Bone Joint Surg . 1973; 55 390-401
- 15 Rodkey W G, Cabaud H E, McCarroll H R. Neurorrhaphy after loss of a nerve segment: comparison of epineurial suture under tension versus multiple nerve grafts. J Hand Surg . 1980; 5A 366-71
- 16 Terzis J K, Strauch B. Microsurgery of the peripheral nerve: a physiological approach. Clin Orthop . 1978; 133 39-48
- 17 Bora F W, Richardson S, Black J. The biomechanical responses to tension in a peripheral nerve. J Hand Surg . 1980; 5A 21-25
- 18 Clark W L, Trumble T E, Swiontkowski M F, Tencer A F. Nerve tension and blood flow in a rat model of immediate and delayed repairs. J Hand Surg . 1992; 17A 677-87
- 19 Hentz V R, Rosen J M, Xiao S J. The nerve gap dilemma: a comparison of nerves repaired end to end under tension with nerve grafts in a primate model. J Hand Surg . 1993; 18A 417-425
- 20 Kenda J P, Stokes I A, O'Hara J P, Dickson R A. Tension and creep phenomena in peripheral nerve. Acta Orthop Scan . 1979; 50 721-5
- 21 Rydevik B L, Kwan M K, Myers R R. An in vitro mechanical and histological study of acute stretching on rabbit tibial nerve. J Orthop Res . 1990; 8 694-701
- 22 Sunderland S, Bradley K C. Stress-strain phenomena in human peripheral nerve trunks. Brain . 1961; 84 102-119
- 23 Kuypers P D, van Egeraat M J, Godschalk M, Hovius S E. Loss of viable neuronal units in the proximal stump as possible cause for poor function recovery following nerve reconstructions. Exp Neurol . 1995; 132 77-81