Konofaos Petros, Bassilios Habre Samer, Wallace Robert D
Department of Plastic Surgery, University of Balamand, Beirut, Lebanon.
Ann Plast Surg. 2018 Dec;81(6):736-740. doi: 10.1097/SAP.0000000000001663.
Peripheral nerves injuries are extremely debilitating and have been a perennial challenge to the reconstructive surgeon. End-to-side (ETS) neurorrhaphy is a potential strategy for treating nerve lesions without usable proximal nerve stump. A number of interesting clinical and experimental studies have been carried out on ETS nerve repair during the first years of the 20th century. End-to-side nerve repair was then almost abandoned for more than 50 years. The rediscovery of ETS nerve repair was attributed to the experimental work of Viterbo.Two mechanisms have been suggested for axonal regeneration: terminal and collateral sprouting. While in collateral sprouting axonal outgrowth occurs along the length of the uninjured axons, in terminal sprouting, axonal regeneration takes place at the distal most aspect of either injured or uninjured axons. Clinical experience with ETS nerve repair includes management of upper extremity nerve injury, facial reanimation, reconstruction after tumor ablation, and the prevention of neuroma formation.The aim of this review article was 2-fold: (1) overviewing the most interesting experimental investigations and clinical studies published so far; (2) calling for more basic research on ETS nerve repair indicating the several unanswered questions that this concept asks to the microsurgical community.
周围神经损伤极其使人衰弱，一直是重建外科医生长期面临的挑战。端侧神经缝合术是治疗没有可用近端神经残端的神经损伤的一种潜在策略。在20世纪的头几年，已经针对端侧神经修复开展了许多有趣的临床和实验研究。之后，端侧神经修复几乎被搁置了50多年。端侧神经修复的重新发现归功于维泰博的实验工作。对于轴突再生提出了两种机制：终末发芽和侧支发芽。在侧支发芽中，轴突沿着未受损轴突的长度生长，而在终末发芽中，轴突再生发生在受损或未受损轴突的最远端。端侧神经修复的临床经验包括上肢神经损伤的处理、面部重建、肿瘤切除术后的重建以及神经瘤形成的预防。这篇综述文章的目的有两个：（1）概述迄今为止发表的最有趣的实验研究和临床研究；（2）呼吁对端侧神经修复进行更多基础研究，指出这一概念向显微外科领域提出的几个未解决的问题。
