Side-to-side nerve grafts sustain chronically denervated peripheral nerve pathways during axon regeneration and result in improved functional reinnervation

Adil Ladak, Paul Schembri, Jaret Olson, Esther Udina, Neil Tyreman, Tessa Gordon

Research output: Contribution to journalArticleResearchpeer-review

25 Citations (Scopus)

Abstract

Background: Progressive atrophy of Schwann cells in denervated nerve stumps is a major reason for progressive failure of functional recovery after peripheral nerve injury and surgical repair. Objective: To examine whether side-to-side nerve bridges between an intact donor nerve and a recipient denervated distal nerve stump promote nerve growth and in turn, protect distal nerve stumps to improve axon regeneration after delayed surgical repair. Methods: In Sprague-Dawley rats, 1 or 3 side-to-side common peroneal (CP) nerve bridges were used to bridge between the donor intact tibial (TIB) nerve and a recipient denervated CP distal nerve stump in the contralateral hind limb. No bridges were placed in control animals. After 4 months, either a fluorescent retrograde dye was applied to back-label TIB motoneurons with axons that had grown into the CP nerve stump or the proximal and distal CP nerve stumps were resutured in experimental and control animals to encourage CP nerve regeneration for 5 months. Retrograde dyes were again applied to count CP motoneurons that regenerated their axons through protected and unprotected nerve stumps. Results: Significantly more donor TIB motoneurons regenerated axons into the recipient denervated CP nerve stump through 3 side-to-side CP nerve bridges compared with 1 bridge. This TIB nerve protection significantly increased the number of CP motoneurons regenerating axons through the denervated CP nerve stumps, the number of regenerated axons, and the weight of the reinnervated muscles. Conclusion: Multiple side-to-side nerve bridges protect chronically denervated nerve stumps to improve axon regeneration and target reinnervation after delayed nerve repair. Copyright © 2011 by the Congress of Neurological Surgeons.
Original languageEnglish
Pages (from-to)1654-1665
JournalNeurosurgery
Volume68
Issue number6
DOIs
Publication statusPublished - 1 Jun 2011

Keywords

  • Delayed nerve repair
  • Denervated nerve pathways
  • End-to-side nerve grafting
  • Improving nerve regeneration
  • Nerve autografts
  • Peripheral nerve regeneration
  • Proximal nerve injuries

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