Giglia Giuseppe, Rosatti Fernando, Giannone Antonino Giulio, Gambino Giuditta, Zizzo Maria Grazia, Florena Ada Maria, Sardo Pierangelo, Toia Francesca
Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy.
Euro-Mediterranean Institute of Science and Technology (IEMEST), 90139 Palermo, Italy.
J Pers Med. 2023 Dec 4;13(12):1682. doi: 10.3390/jpm13121682.
Vascularized nerve grafts (VNGs) have been proposed as a superior alternative to free nerve grafts (FNGs) for complex nerve defects. A greater regenerative potential has been suggested by clinical and experimental studies, but conclusive evidence is still lacking.
In this experimental study, 10 adult male Wistar rats received a non-vascularized orthotopic sciatic nerve graft on their right side, and a vascularized orthotopic sciatic nerve graft nerve on their left side. Functional outcome following nerve regeneration was evaluated through electrodiagnostic studies, target muscles weight and histomorphology, and data of VNGs and FNGs were compared.
The results of this study showed a significant difference in the motor unit number of Gastrocnemius Medialis (GM) estimated by MUNE in the VNG side compared to the FNG side. No other significant differences in axonal regeneration and muscle reinnervation were evident at either electrodiagnostic, histomorphology studies or muscle weight.
This experimental model showed slight differences in nerve regeneration between VNGs and FNGs, but cannot support a high clinical advantage for VNGs. The results of this study show that VNGs are not strongly superior to FNGs in the rat model, even in avascular beds. Clinical advantages of VNGs are likely to be limited to extensive and thick nerve defects and can only be assessed on experimental model with bigger animals. Also, we showed that the MUNE technique provided a reliable and reproducible evaluation of functional outcomes in the rat sciatic nerve and defined a reproducible protocol for functional evaluation of muscle reinnervation.
对于复杂的神经缺损，血管化神经移植（VNG）已被提议作为游离神经移植（FNG）的一种更优替代方案。临床和实验研究表明其具有更大的再生潜力，但仍缺乏确凿证据。
在本实验研究中，10只成年雄性Wistar大鼠右侧接受非血管化原位坐骨神经移植，左侧接受血管化原位坐骨神经移植。通过电诊断研究、靶肌肉重量和组织形态学评估神经再生后的功能结果，并比较VNG和FNG的数据。
本研究结果显示，与FNG侧相比，VNG侧通过运动单位数目估计（MUNE）法测得的内侧腓肠肌（GM）运动单位数量存在显著差异。在电诊断、组织形态学研究或肌肉重量方面，轴突再生和肌肉再支配均未发现其他显著差异。
该实验模型显示VNG和FNG在神经再生方面存在细微差异，但无法支持VNG具有高度的临床优势。本研究结果表明，在大鼠模型中，即使在无血管床中，VNG也并不明显优于FNG。VNG的临床优势可能仅限于广泛且粗大的神经缺损，并且只能在更大动物的实验模型中进行评估。此外，我们表明MUNE技术为大鼠坐骨神经功能结果提供了可靠且可重复的评估，并为肌肉再支配的功能评估定义了可重复的方案。
