Anatomy Department, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.
Plastic and Reconstructive Surgery Department and Burn Unit, Centro Hospitalar de Lisboa Central-Hospital de São José, Lisbon, Portugal.
PLoS One. 2018 Apr 16;13(4):e0195692. doi: 10.1371/journal.pone.0195692. eCollection 2018.
The aim of this study was to evaluate in the Wistar rat the efficacy of various autologous nerve conduits with various forms of blood supply in reconstructing a 10-mm-long gap in the median nerve (MN) under conditions of local ischemia. A 10-mm-long median nerve defect was created in the right arm. A loose silicone tube was placed around the nerve gap zone, in order to simulate a local ischemic environment. Rats were divided in the following experimental groups (each with 20 rats): the nerve Graft (NG) group, in which the excised MN segment was reattached; the conventional nerve flap (CNF) and the arterialized neurovenous flap (ANVF) groups in which the gap was bridged with homonymous median nerve flaps; the prefabricated nerve flap (PNF) group in which the gap was reconstructed with a fabricated flap created by leaving an arteriovenous fistula in contact with the sciatic nerve for 5 weeks; and the two control groups, Sham and Excision groups. In the latter group, the proximal stump of the MN nerve was ligated and no repair was performed. The rats were followed for 100 days. During this time, they did physiotherapy. Functional, electroneuromyographic and histological studies were performed. The CNF and ANVF groups presented better results than the NG group in the following assessments: grasping test, nociception, motor stimulation threshold, muscle weight, and histomorphometric evaluation. Radial deviation of the operated forepaw was more common in rats that presented worse results in the other outcome variables. Overall, CNFs and ANVFs produced a faster and more complete recovery than NGs in the reconstruction of a 10-mm-long median nerve gap in an ischemic environment in the Wistar rat. Although, results obtained with CNFs were in most cases were better than ANVFs, these differences were not statistically significant for most of the outcome variables.
本研究旨在评估在 Wistar 大鼠中，在局部缺血条件下，各种具有不同血液供应形式的自体神经导管在重建 10mm 长正中神经（MN）缺损中的疗效。在右上肢创建 10mm 长的正中神经缺损。在神经间隙区域周围放置一个宽松的硅胶管，以模拟局部缺血环境。将大鼠分为以下实验组（每组 20 只大鼠）：神经移植（NG）组，其中切除的 MN 段重新连接；常规神经皮瓣（CNF）和动脉化动静脉皮瓣（ANVF）组，其中用同源正中神经皮瓣桥接间隙；预制神经皮瓣（PNF）组，其中用通过在与坐骨神经接触 5 周后留下动静脉瘘来创建的预制皮瓣重建间隙；以及两个对照组，假手术组和切除组。在后一组中，MN 神经的近端残端被结扎，没有进行修复。大鼠随访 100 天。在此期间，它们进行了物理治疗。进行了功能、电神经肌电图和组织学研究。在以下评估中，CNF 和 ANVF 组的结果优于 NG 组：抓握试验、痛觉、运动刺激阈值、肌肉重量和组织形态计量评估。在其他结果变量表现较差的大鼠中，操作前爪的桡偏更为常见。总体而言，在缺血环境下，CNF 和 ANVF 在重建 10mm 长正中神经缺损方面比 NG 产生更快、更完全的恢复。尽管 CNF 的结果在大多数情况下优于 ANVF，但在大多数结果变量中，这些差异并不具有统计学意义。
