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J Reconstr Microsurg 2004; 20(5): 385-397
DOI: 10.1055/s-2004-830002
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Impact of Epineurial Excision of the Distal Recipient Nerve in Terminolateral Neurorrhaphy

Selahattin Ozmen1 , Osman Latifoglu1 , Suhan Ayhan1 , Reha Yavuzer1 , Gulay Nurlu2 , Cem Sezer3 , Kenan Atabay1
  • 1Department of Plastic and Reconstructive Surgery, Istanbul, Turkey
  • 2Department of Pathology, Gazi University Faculty of Medicine, Istanbul, Turkey
  • 3Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Publication History

Accepted: 20 February 2004

Publication Date:
06 July 2004 (online)

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Different surgical modifications were studied to improve success in terminolateral neurorrhaphy. The authors evaluated the efficacy of distal epineurial excision of the recipient nerve stump. Forty male Wistar rats were evaluated in four groups. The right hind limbs of the animals were used as experimental limbs and the left hind limbs as control limbs. The peroneal nerve was transected at a level 1 cm above the bifurcation of the tibial nerve. The proximal stump of the peroneal nerve was covered with gluteus maximus muscle fibers in all groups. In Group 1, the distal peroneal nerve was not processed and was left in the operative field. In Group 2, the distal peroneal nerve stump was sutured to an epineurial window on the tibial nerve by epineurial neurorrhaphy. In Group 3, the distal stump of the peroneal nerve was buried in the tibial nerve without epineurial resection, and in Group 4 with a 1-mm epineurial excision. Walking track analyses, electromyographic studies, and histomorphometric analyses were performed after a 3-month follow-up period. Statistical analysis was done with ANOVA and Tukey tests. No important donor-nerve injury was detected. Axonal regeneration and functional results were better in Group 4 compared to Groups 2 and 3. An increased donor and recipient nerve contact surface area with the excision of the epineurium from the distal peroneal nerve stump (Group 4) might provide superior results with longer follow-up periods.

KEYWORDS

Terminolateral - end-to-side - neurorrhaphy - epineurial excision

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Selahattin OzmenM.D. 

Department of Plastic and Reconstructive Surgery, Gazi University Faculty of Medicine

58. sk 18/2 Emek-Cankaya, Ankara 06510, Turkey