Abstract
End-to-side neurorrhaphy may offer a practical solution in limited cases of nerve reconstruction when no donor nerve or nerve transfer is available for direct end-to-end nerve suture, or when extremely long distances for nerve regeneration cause irreversible atrophy of the targets. We report our experience with the successful clinical use of a completely new technique of end-to-side neurorrhaphy for motor reinnervation of free functional muscle transplants. Since 1995 we have used end-to-side nerve repair for motor or sensory reinnervation in 13 cases. A free functional muscle graft was reinnervated by an end-to-side neurorrhaphy in four patients after tumor resection (two myocutaneous latissimus dorsi flaps), Volkmann's contracture (one myocutaneous latissimus dorsi flap), and in a long-standing brachial plexus lesion (one gracilis muscle flap). All four patients showed reinnervation of their muscle graft through the end-to-side nerve suture site. Two functional muscle grafts to the upper extremity had positive outcome of M3–M4 for elbow and finger extension in one case, and M4 for finger flexion in one case more than 2 years after transplantation. The transplant in the brachial plexus lesion is too early for a final functional result. One patient had a M3 for knee extension 8 months postoperatively. In the clinical cases there was no downgrading of the muscle functions supplied by the "donor" nerve. Good and clinically relevant reinnervation of a functional muscle graft is possible through an end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, shortening of long distances for nerve regeneration, and prevention of long nerve grafts in proximal lesions are good indications for reinnervation of a functional muscle transplant by end-to-side neurorrhaphy without harm to the donor nerve. Donor nerves supplying synergists should be preferred.
Similar content being viewed by others
References
Al-Qattan MM, al-Thunyan A (1998) Variables affecting axonal regeneration following end-to-side neurorrhaphy. Br J Plast Surg 51:238
Frey M, Girsch W, Giovanoli P (1998) Possibilities for reconstruction in brachial plexus paralysis: neurotization. Langenbecks Arch Chir 115:550
Giovanoli P, Koller R, Meuli-Simmen C, Rab M, Haslik W, Mittlbock M, Meyer VE, Frey M (2000) Functional and morphometric evaluation of end-to-side neurorrhaphy for muscle reinnervation. Plast Reconstr Surg 106:383
Kanje M, Arai T, Lundborg G (2000) Collateral sprouting from sensory and motor axons into an end to side attached nerve segment. Neuroreport 11:2455
Kayikcioğlu A, Karamursel S, Agaoglu G, Kecik A, Celiker R, Cetin A (2000) End-to-side neurorrhaphies of the ulnar and median nerves at the wrist: report of two cases without sensory or motor improvement. Ann Plast Surg 45:641
Kennedy R (1901) On the restoration of coordinated movement after nerve crossing, with interchange of function of the cerebral cortical centers. Philos Trans R Soc Lond B Biol Sci 194:127
Lutz BS, Chuang DC, Hsu JC, Ma SF, Wei FC (2000) Selection of donor nerves-an important factor in end-to-side neurorrhaphy. Br J Plast Surg 53:149
Lutz BS, Ma SF, Chuang DC, Wei FC (2000) Role of the target in end-to-side neurorrhaphy: reinnervation of a single muscle vs. multiple muscles. J Reconstr Microsurg 16:443
Mennen U (1999) End-to-side nerve suture-a technique to repair peripheral nerve injury. S Afr Med J 89:1188
Okajima S, Terzis JK (2000) Ultrastructure of early axonal regeneration in an end-to-side neurorrhaphy model. J Reconstr Microsurg 16:313
Santamaria E, Wei FC, Chen IH, Chuang DC (1999) Sensation recovery on innervated radial forearm flap for hemiglossectomy reconstruction by using different recipient nerves. Plast Reconstr Surg 103:450
Tubiana R, Masquelet AC (1988) Functional classification of the upper limb paralyses. Hand Clin 4:557
Viterbo F, Teixeira E, Hoshino K, Padovani CR (1998) End-to-side neurorrhaphy with and without perineurium. Rev Paul Med 116:1808
Viterbo F, Trindade JC, Hoshino K, Mazzoni A (1994) Two end-to-side neurorrhaphies and nerve graft with removal of the epineural sheath: experimental study in rats. Br J Plast Surg 47:75
Viterbo F, Trindade JC, Hoshino K, Mazzoni Neto A (1992) Latero-terminal neurorrhaphy without removal of the epineural sheath. Experimental study in rats. Rev Paul Med 110:267
Yoleri L, Songur E, Yoleri O, Vural T, Cagdas A (2000) Reanimation of early facial paralysis with hypoglossal/facial end-to-side neurorrhaphy: a new approach. J Reconstr Microsurg 16:347
Zhang F, Cheng C, Chin BT, Ho PR, Weibel TJ, Lineaweaver WC, Buncke HJ (1998) Results of termino-lateral neurorrhaphy to original and adjacent nerves. Microsurgery 18:276
Yüksel F, Kiṣlaoğlu Ş, et al (1997) End-to-side neurorrhaphy supported by transposed active nerve fibers: its functional end result in a rat model. Eur J Plast Surg 21:57–62:1997
Acknowledgements
We thank Dr. Tatjana Paternostro-Sluga, who specializes in electroneurodiagnostic and clinical follow-up studies at the Department of Physical Medicine and Rehabilitation, University of Vienna, for her detailed electroneurodiagnostic and clinical motor function studies in our patients. Her work made it possible to evaluate objectively evaluation the results of end-to-side neurorrhaphy independently of the treating surgeons. We thank Mag. Susanne Friedl, who was a great help in preparing the manuscript. Our research work on experimental muscle transplantation using end-to-side neurorrhaphy was performed with the sponsorship of the Oesterreichische Nationalbank (grant no. 7791). This research was presented at the 2001 Meeting of the American Society of Reconstructive Microsurgery, Coronado Bay, Calif., 13–16 January 2001, and at the 11th Annual Meeting of the European Association of Plastic Surgeons, Berlin, 1–3 June, 2000.
Author information
Authors and Affiliations
Corresponding author
Additional information
An invited commentary to this paper can be found at http://dx.doi.org/10.1007/s00238-003-0477-x
Rights and permissions
About this article
Cite this article
Frey, M., Giovanoli, P. End-to-side neurorrhaphy of motor nerves: reinnervation of free muscle transplants—first clinical application. Eur J Plast Surg 26, 89–94 (2003). https://doi.org/10.1007/s00238-003-0476-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00238-003-0476-y