Pannucci Christopher, Myckatyn Terence M, Mackinnon Susan E, Hayashi Ayato
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63110-1010, USA.
Restor Neurol Neurosci. 2007;25(1):45-63.
End-to-side (ETS) nerve repair, in which the distal stump of a transected nerve is coapted to the side of an uninjured donor nerve, offers a technique for repair of peripheral nerve injuries where the proximal nerve stump is unavailable or a significant nerve gap exists. Details of animal models are explored including motor and sensory regeneration to further clarify the mechanism of collateral sprouting while eliminating false positive results from contaminating axons. Some experimental studies support the conclusion that sensory or motor reinnervation may be derived from collateral sprouting while others suggest that reinnervation requires an injury to the donor nerve. Clinical experience with ETS neurorrhaphy includes management of upper extremity nerve injury, facial reanimation, reconstruction following tumor ablation, and the prevention of neuroma formation. Our interpretation of the ETS literature suggests that sensory axons may sprout without deliberately attempting to injure them, while motor axons regenerate only in response to a deliberate injury. Experimental and clinical experience with ETS neurorrhaphy has rendered mixed results. Our interpretation of the literature suggests that the success of this technique is dependent upon axonal injury of motor and possibly sensory nerves. While continued clinical and laboratory experimentation with ETS nerve repair is warranted, it should not yet replace more established techniques of nerve repair.
端侧（ETS）神经修复是将横断神经的远侧残端与未损伤的供体神经的侧面进行吻合，为近端神经残端无法获得或存在明显神经间隙的周围神经损伤修复提供了一种技术。探索了动物模型的细节，包括运动和感觉再生，以进一步阐明侧支发芽的机制，同时消除污染轴突产生的假阳性结果。一些实验研究支持感觉或运动再支配可能源于侧支发芽的结论，而另一些研究则表明再支配需要供体神经受到损伤。ETS神经缝合术的临床经验包括上肢神经损伤的处理、面部重建、肿瘤切除后的重建以及神经瘤形成的预防。我们对ETS文献的解读表明，感觉轴突可能在未刻意损伤的情况下发芽，而运动轴突仅在受到刻意损伤时才会再生。ETS神经缝合术的实验和临床经验结果不一。我们对文献的解读表明，该技术的成功取决于运动神经以及可能的感觉神经的轴突损伤。虽然有必要继续对ETS神经修复进行临床和实验室实验，但它目前还不应取代更成熟的神经修复技术。
