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J Reconstr Microsurg
DOI: 10.1055/a-2508-6439
Original Article

Utilizing Lateral Sprouting Axons to Reinnervate a Transferred Free Muscle to Enhance Distal Muscle Recovery When Performing High-Level Nerve Repair: Experimental Rat Study

Chung-Kan Tsao 
1   Department of Plastic Surgery, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
Shih-Ming Jung
2   Department of Pathology, Chang Gung University Taoyuan, Chang Gung Memorial Hospital, Taoyuan, Taiwan
,
David Chwei-Chin Chuang 
1   Department of Plastic Surgery, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan, Taiwan
3   Department of Plastic Surgery, Taipei Medical University, Wan Fang Hospital, Taipei, Taiwan
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Abstract

Background High-level median or ulnar nerve injuries and repairs typically result in suboptimal reinnervation of distal muscles. Functioning free muscle transplantation (FFMT) is increasingly recognized as an effective method to restore function in chronic muscle denervation cases. This study investigates the efficacy of using an additional FFMT, neurotized by lateral sprouting axons from a repaired high-level mixed nerve in the upper limb, to enhance distal hand function.

Methods Thirty-five Sprague–Dawley rats were divided into four groups to evaluate the proposed FFMT technique. The infraclavicular median nerve (MN) was transected and repaired in each animal. The nearby musculocutaneous nerve (MCN) was transected, and the terminal nerve after the biceps muscle was divided and embedded into the biceps muscle, creating an FFMT model. The distal stump of the MCN was anchored to the MN, 1.5 mm distal to the MN repair site. Assessments of nerve and muscle function were conducted 4 months postoperatively.

Results Behavioral analysis, along with measurements of biceps muscle weight and tetanic contraction force, indicated significant recovery in the biceps muscle. Histological staining confirmed reinnervation of the MCN from the repaired MN. Additionally, functional examination of the flexor digitorum superficialis muscle revealed no deterioration associated with the repaired MN.

Conclusion The study demonstrates the potentiality of utilizing lateral sprouting axons from a repaired high-level MN to reinnervate an additional FFMT to enhance flexor digitorum superficialis function. The surgical strategy promises recovery of distal muscle function and implies for diverse clinical applications.

Keywords

high-level nerve injury - functioning free muscle transplantation


Publication History

Received: 27 February 2024

Accepted: 23 December 2024

Accepted Manuscript online:
30 December 2024

Article published online:
31 January 2025

© 2025. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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