The 2003 Annual Meeting of OASYS_NEW

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Experimental Study of Partial Nerve Injury in Rat Tibial Nerve

Kerns JM1, Malushte T1, Safanda J2, and Gonzalez M3. (1) Anatomy, Rush Medical College, 600 S Paulina, Chicago, IL, USA, (2) Orthopedic Surgery, University of Illinois at Chicago, Chicago, USA, (3) Orthopedic Surgery, University of Illinois at Chicago, Cook County Hospital, Chicago, IL, USA

A partial nerve lesion with a neuroma in continuity presents a surgical challenge. The standard treatment is to isolate and graft the damaged fascicles while preserving those that are intact. This treatment may compromise intact fascicles causing an immediate loss of retained function. We propose the use of a bridge graft by-passing a neuroma in continuity, while leaving intact fascicles undisturbed. The procedure borrows from the concept of end-to-side nerve repair/regeneration. However, it may be desirable to leave the lesion unrepaired. In the present study we utilized walking track analysis as a functional outcome measure. In anesthetized young adult rats (Fisher 344 strain) a partial lesion (3mm long notch involving one-half the thickness) was made in the tibial nerve fascicle midthigh on one side. Animals recovered for 21 days and the lesion site was reexamined. In the conventional interposed graft group, the defect was dissected out and a segment of the peroneal nerve from a donor rat was sutured into place using 10-0 sutures. In the second bridge-bypass group, a 10mm peroneal nerve segment from a donor rat was positioned around the undisturbed defect in an end-to-side fashion. Graft ends were placed into small perineurial windows on each end to encourage the entry/exit of nerve sprouts. In a third sham control group, the defect was isolated but no graft was introduced. Rats were given pain medication and housed in standard conditions for a post-repair recovery period. The main outcome measure was the Tibial Functional Index (TFI) from standard walking tracks obtained preoperatively and at weekly intervals following the initial lesion and repair surgery. Results show that the functional loss one week following the partial lesion is nearly complete in all animals (TFI mean=10.5%; +/- 3.8 sem). All three groups showed some improvement by 21 dpo (TFI mean=52.2%; +/- 6.3 sem) prior to the repair. One week following the re-exposure/repair, each group showed an additional loss. At 14 and 21 days post-repair, functional improvement was again demonstrated for all three groups. Preliminary results suggest the bridge-bypass graft repair is slightly better than the interposed graft repair and both are better than the sham control. Histological confirmation of the recovery is at 8 weeks post repair when the rats are euthanized. An index of recovery from denervation atrophy is also obtained for the gastrocnemius muscle. A more definitive conclusion awaits further study.