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Title: The use of end-to-side repair of peripheral nerves for neurotization after loss of nerve tissue in a large animal model
Author: Kettle, Sarah J. A.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2004
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This study uses a large animal model to compare two variations of end-to-side neurorrhaphy techniques with conventional clinically established methods of nerve repair to assess the feasibility of end-to-side suture as a technique for possible future clinical use. All the experiments were randomized and the author performed all the surgery. The nerve repairs were assessed electrophysiologically and histologically and the muscles supplied by the repaired nerves were assessed physiologically. There were no significant differences in the outcomes of nerve repair between different conventional techniques. End-to-side nerve repair did support nerve regeneration but it was or nothing. When innervation of the distal nerve slump and the recipient FCR muscle did occur, the functional outcomes were inferior to conventional techniques of nerve repair apart from the twitch and tetanic tensions of the FCR muscle. Double end-to-side nerve repair consistently supported nerve regeneration but this repair was inferior to conventional techniques to nerve repair in all measures of outcome except twitch and tetanic muscle tensions. It is likely that regenerating axons used the epineurial and perineurial layers of the donor nerve segment between the two neurorrhaphy sites as a conduit for axon growth as well as regenerating axons from collateral sprouts in the end-to-side pathway. The function of the donor ulnar nerves in terms of conduction velocity was compromised in the double end-to-side repair but not the end-to-side repair. Assessment of the donor FCU muscles in terms of the muscle physiological experiments also needs to be properly tested. Further study is needed to assess the effects of placing the proximal neurorrhaphy site further away from the distal site in a double end-to-side neurorrhaphy, on nerve regeneration. It is not clear from this work why some of the end-to-side neurorrhaphies supported nerve regeneration and some did not, especially in the light of the fact than none of the repairs had dehisced macroscopically. Although end-to-side neurorrhaphy did support nerve regeneration with sometimes good return of muscle function, the use of this technique as a clinical tool at this time cannot be recommended.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available