Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan.
Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital; Chang Gung University and Medical College, Taipei, Taiwan.
J Reconstr Microsurg. 2023 Jul;39(6):435-443. doi: 10.1055/s-0042-1758186. Epub 2022 Nov 30.
Long nerve grafts will affect muscle recovery. Aim of this study is to investigate if supercharged end-to-side (SETS) sensory nerve transfer to long nerve graft can enhance functional outcomes in brachial plexus animal model.
A reversed long nerve graft (20-23-mm) was interposed between C6 and musculocutaneous nerve (MCN) in 48 SD rats. The sensory nerves adjacent to the proximal and distal coaptation sites of the nerve graft were used for SETS. There were four groups with 12 rats in each: (A) nerve graft alone, (B) proximal SETS sensory transfer, (C) distal SETS sensory transfer, and (D) combined proximal and distal SETS sensory transfers. Grooming test at 4, 8, 12 and 16 weeks, and compound muscle action potentials (CMAP), biceps tetanic muscle contraction force, muscle weight and MCN axon histomorphologic analysis at 16 weeks were assessed.
Grooming test was significantly better in group C and D at 8 weeks ( = 0.02 and = 0.04) and still superior at 16 weeks. There was no significant difference in CMAP, tetanic muscle contraction force, or muscle weight. The axon counts showed all experimental arms were significantly higher than the unoperated arms. Although the axon count was lowest in group C and highest in group D ( = 0.02), the nerve morphology tended to be better in group C overall.
Distal sensory SETS transfer to a long nerve graft showed benefits of functional muscle recovery and better target nerve morphology. Proximal sensory inputs do not benefit the outcomes at all.
长神经移植会影响肌肉恢复。本研究旨在探讨超长神经移植中增强型端侧感觉神经转移（SETS）是否能改善臂丛动物模型的功能结果。
在 48 只 SD 大鼠中，将反向的长神经移植（20-23mm）置于 C6 和肌皮神经（MCN）之间。将神经移植近、远端吻合口附近的感觉神经用于 SETS。共有 4 组，每组 12 只大鼠：（A）神经移植组，（B）近端 SETS 感觉神经转移组，（C）远端 SETS 感觉神经转移组，（D）近端和远端 SETS 感觉神经联合转移组。术后 4、8、12 和 16 周进行梳理试验，16 周时进行复合肌肉动作电位（CMAP）、二头肌强直肌肉收缩力、肌肉重量和 MCN 轴突组织形态学分析。
8 周时，C 组和 D 组的梳理试验明显更好（ = 0.02 和 = 0.04），16 周时仍保持优势。CMAP、强直肌肉收缩力或肌肉重量无显著差异。轴突计数显示所有实验组均显著高于未手术组。虽然 C 组的轴突计数最低，D 组的轴突计数最高（ = 0.02），但总体而言，C 组的神经形态更倾向于更好。
长神经移植中远端感觉 SETS 转移显示出对功能肌肉恢复的益处，以及更好的靶神经形态。近端感觉输入对结果没有任何益处。
