Affiliations: Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Zurich University Hospital, Zurich, Switzerland | Department of Experimental Research, Malmö University Hospital, Lund University, Malmö, Sweden | Department of Mathematical Statistics, Lund University, Sweden | Department of Hand Surgery, Malmö University Hospital, Malmö, Sweden
Note: [] Corresponding author: Hand Surgery Unit, Department of Reconstructive Surgery, Geneva University Hospital, Micheli-du-Crest 24, CH-1211 Geneva 14, Switzerland. Phone: +41 22 372 33 11; fax: +41 22 372 80 04.
Abstract: Bridging large defects in mixed nerves is still an unsolved problem in reconstructive microsurgery. Two main aspects may be distinguished: one is to obtain an appropriate substitute for the lost neural tissue, the second to direct fibers toward their previous end-organs with the highest possible specificity. In the present study, sural nerve block grafts were combined with enclosed gaps at one or both ends of the grafts. Functional outcome at the muscle level as well as the number of motor axons and their cross-sectional distribution were assessed after 3 months. The presence of a proximally placed tube was found to decrease significantly the maximal tetanic force of the tibialis anterior muscle, whereas a distally placed one tended to improve it. Morphological data from acetylcholinesterase histochemistry correlated poorly with functional results but they gave some clues about possible roles played by the chambers, according to their position relatively to the grafts. No definitive evidence for an improved regeneration by use of silicone tubes in addition to the conventional grafts could be demonstrated.
