Nerve Repair Using a Composite Graft of Vein and Denatured Skeletal Muscle: Morphologic Analysis

ABSTRACT

Five groups of six rats each underwent sciatic resection, bridged with a 20-mm-long graft. Five different types of graft were used: (1) vein; (2) fresh muscle; (3) denatured muscle; (4) vein and fresh muscle; and (5) vein and denatured muscle. Denaturation was obtained by dry thermal shock in a microwave oven. Morphologic analysis took place at 6 months. The macroscopic appearance of the graft was continuous in all type 4 and 5 animals. Morphometric analysis within the graft revealed a significantly greater number of fibers in type 3 animals. Average fiber diameter and g ratio were higher, although not significantly, in type 5 animals. Distal to the graft, average fiber diameter and g ratio were significantly higher in type 5 rats.

Denaturation by exposure to thermal shock significantly improves axonal regeneration, both quantitatively and qualitatively. The regeneration rate seems to be more rapid within denatured muscle. Denaturing muscle by exposure to thermal shock provides an excellent guide for axonal regrowth, but axonal leaks may occur. This problem is solved by a muscle-in-vein graft technique.

KEYWORD

Nerve substitute - nerve graft - vein and muscle

REFERENCES

• 1 Alnot J Y, Benfrech E. Les autogreffes nerveuses. Problèmes techniques actuels.  Ann Chir Main . 1989;  8 291-295
• 2 Archibald S J, Shefner J, Krarup C, Madison R D. Monkey median nerve repaired by nerve graft or collagen nerve guide tube.  J Neurosci . 1995;  15 4109-4123
• 3 Bour C, Merle M. Les allogreffes nerveuses et les problèmes immunologiques.  Ann Chir Main . 1989;  8 334-335
• 4 Giardino R, Aldini N N, Perege G. Biological and synthetic conduits in peripheral nerve repair: a comparative experimental study.  Int J Artif Organs . 1995;  18 225-230
• 5 Glasby M A, Gchmeissner S E, Huang C, De Souza A B. Degenerated muscle grafts used for peripheral nerve repair in primates.  J Hand Surg . 1986;  11B 347-351
• 6 Glasby M A, Carrick M J, Hems T EJ. Freeze-thawed skeletal muscle autografts used for brachial plexus repair in the non-human primate.  J Hand Surg . 1992;  17B 526-535
• 7 Katz D, Alnot J Y, Henin D. Allogreffes nerveuses congelées, étude expérimentale chez le rat.  Ann Chir Main . 1989;  8 329-333
• 8 Lundborg G, Dahlin L B, Danielsen N. Nerve regeneration in silicone chambers: influence of gap length and of distal stump components.  Exp Neurol . 1982;  76 361-375
• 9 Whitworth I H, Dore C, Hall S. Different muscle graft denaturing methods and their use for nerve repair.  Br J Plast Surg . 1995;  48 492-499
• 10 Chiu D T, Strauch B. A prospective clinical evaluation of autogenous vein grafts used as a nerve conduit for distal sensory nerve defects of 3 cm or less.  Plast Reconstr Surg . 1990;  86 928-234
• 11 Battiston B, Tos P, Cushway T, Geuna S. Nerve repair by means of vein filled with muscle grafts I. Clinical results.  Microsurgery . 2000;  20 32-36
• 12 Battiston B, Tos P, Geuna S. Nerve repair by means of vein filled with muscle grafts II. Morphological analysis of regeneration.  Microsurgery . 2000;  20 37-41
• 13 Brunelli G A, Battiston B, Vigasio A. Bridging nerve defects with combined skeletal muscle and vein conduits.  Microsurgery . 1993;  14 247-251
• 14 Greene E C. Anatomy of the Rat (facsimile edition of transactions of the American Philosophical Society, new series, vol. 27, 1935). New York: Hafner.
• 15 Ratinahirana H, Hauw J J. Morphométrie. In: Bouche P, Vallat JM, (eds) Neuropathies Périphériques: Polyneuropathie et Mononeuropathies Multiples, Paris:Doin; 1992: 98-114
• 16 Colonna M, Anastasi G, Cavallaro G. Nerve regeneration through autogenous vein grafts: an SEM evaluation.  J Reconstr Microsurg . 1996;  14 205-210
• 17 Strauch B, Ferder M, Lovelle-Allen S. Determining the maximal length of a vein conduit used as an interposition graft for nerve regeneration.  J Reconstr Microsurg . 1996;  12 521-527
• 18 Strauch B, Rodriguez D, Diaz J. Autologous Schwann cells drive regeneration through a 6-cm autogenous venous nerve conduit.  J Reconstr Microsurg . 2001;  17 589-597
• 19 Froidart-Dessale M, Dubuisson A, Lejeune A. Sciatic nerve regeneration through venous or nervous grafts in the rat.  Exp Neurol . 1997;  148 236-246
• 20 Lolley R D, Bose W J, Bastian F. Vein, Silastic and polyglycolic acid fine mesh: a comparative study in peripheral nerve repair.  Ann Plastic Surg . 1995;  35 266-271
• 21 Bailey S B, Eichler M E, Villadiego A, Rich K M. The influence of fibronectin and laminin during Schwann cell migration and peripheral nerve regeneration through silicon chambers.  J Neurocytol . 1993;  22 176-184
• 22 Baldwin S P, Krewson C E, Saltzman W M. PC12 cell aggregation and neurite growth in gels of collagen, laminin and fibronectin.  Int J Dev Neurosci . 1996;  14 351-364
• 23 Baron-Van Evercooren A, Kleinmann H K, Ohno S. Nerve growth factor, laminin and fibronectin promote neurite growth in human fetal sensory ganglia cultures.  J Neurosci Res . 1982;  8 179-193.
• 24 Baron-Van Evercooren A, Kleinmann H K, Seppa H EJ. Fibronectin promotes rat Schwann cell growth and motility.  J Cell Biol . 1982;  93 211-216
• 25 Moutain R E, Glasby M A, Sharp J F, Murray J AM. A morphological comparison of interposed freeze-thawed skeletal muscle autografts and interposed nerve autografts in the repair of the rat facial nerve.  Clin Otolaryngol . 1993;  18 171-177
• 26 Jaffe E A, Mosher D F. Synthesis of fibronectin by cultured human endothelial cell.  J Exp Med . 1978;  14 1779-1791