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J Reconstr Microsurg 2023; 39(06): 435-443
DOI: 10.1055/s-0042-1758186
Original Article

Supercharge End-to-Side Sensory Transfer to A Long Nerve Graft to Enhance Motor Regeneration in A Brachial Plexus Model—An Experimental Rat Study

Bassem W. Daniel 
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taipei, Taiwan
3   Freiburg University Medical Center, Freiburg, Germany
,
Teun Giesen
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
4   Faculty of Health, Medicine and Life Sciences, University of Maastricht, Maastricht, The Netherlands
,
Johnny Chuieng-Yi Lu
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
,
Tommy Nai-Jen Chang
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
,
Abraham Zavala
2   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taipei, Taiwan
,
David Chwei-Chin Chuang 
1   Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
› Author Affiliations Funding The study was supported by a grant from the Ministry of Science and Technology Taiwan (MOST 107-2314-B-182A-093). None of the authors have a financial interest in any of the products, devices, or drugs mentioned in this article.
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Abstract

Background Long nerve grafts will affect muscle recovery. Aim of this study is to investigate if supercharged end-to-side (SETS) sensory nerve transfer to long nerve graft can enhance functional outcomes in brachial plexus animal model.

Methods A reversed long nerve graft (20–23-mm) was interposed between C6 and musculocutaneous nerve (MCN) in 48 SD rats. The sensory nerves adjacent to the proximal and distal coaptation sites of the nerve graft were used for SETS. There were four groups with 12 rats in each: (A) nerve graft alone, (B) proximal SETS sensory transfer, (C) distal SETS sensory transfer, and (D) combined proximal and distal SETS sensory transfers. Grooming test at 4, 8, 12 and 16 weeks, and compound muscle action potentials (CMAP), biceps tetanic muscle contraction force, muscle weight and MCN axon histomorphologic analysis at 16 weeks were assessed.

Results Grooming test was significantly better in group C and D at 8 weeks (p = 0.02 and p = 0.04) and still superior at 16 weeks. There was no significant difference in CMAP, tetanic muscle contraction force, or muscle weight. The axon counts showed all experimental arms were significantly higher than the unoperated arms. Although the axon count was lowest in group C and highest in group D (p = 0.02), the nerve morphology tended to be better in group C overall.

Conclusion Distal sensory SETS transfer to a long nerve graft showed benefits of functional muscle recovery and better target nerve morphology. Proximal sensory inputs do not benefit the outcomes at all.

Keywords

SETS - sensory nerve transfer - long nerve graft - muscle function outcomes - brachial

Note

This study was presented at the Meeting of the World Society of Reconstructive Microsurgery in Bologna, Italy (WSRM 2019).


Supplementary Material



Publication History

Received: 22 May 2022

Accepted: 17 September 2022

Article published online:
30 November 2022

© 2022. Thieme. All rights reserved.

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