Abstract
The last 15 years have seen a growing interest regarding a technique for nerve repair named end-to-side coaptation. Since 2000, we have carried out experimental studies on end-to-side nerve repair as well as employed this technique to a series of selected clinical cases. Here we report on the results of this experience.
For experimental studies, we have used the model represented by median nerve repair by end-to-side coaptation either on the ulnar (agonistic) or the radial (antagonistic) nerve. For time course assessment of median nerve functional recovery we used the grasping test, a test which permits to assess voluntary control of muscle function. Repaired nerves were processed for resin embedding to allow nerve fibre stereology and electron microscopy. Results showed that, in either experimental group, end-to-side-repaired median nerves were repopulated by axons regenerating from ulnar and radial donor nerves, respectively. Moreover, contrary to previously published data, our results showed that voluntary motor control of the muscles innervated by the median nerve was progressively recovered also when the antagonistic radial nerve was the donor nerve.
As regards our clinical experience, results were not so positive. We have treated by end-to-side coaptation patients with both sensory (n = 7, collateral digital nerves) and mixed (n = 8, plexus level) nerve lesions. Results were good, as in other series, in sensory nerves whilst they were very difficult to investigate in mixed nerves at the plexus level.
Take together, these results suggest that clinical employment of end-to-side coaptation should still be considered at the moment as the ultima ratio in cases in which no other repair technique can be attempted. Yet, it is clear that more basic research is needed to explain the reasons for the different results between laboratory animal and humans and, especially, to find out how to ameliorate the outcome of end-to-side nerve repair by adequate treatment and rehabilitation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Létiévant E (1873) Traité des Sections Nerveuses. J.B. Baillière et Fils, Paris.
Papalia I, Geuna S, D’Alcontres FS, Tos P (2007) Origin and history of end-to-side neurorrhaphy. Microsurgery 27:56–61.
Geuna S, Tos P, Guglielmone R, Battiston B, Giacobini-Robecchi MG (2001) Methodological issues in size estimation of myelinated nerve fibers in peripheral nerves. Anat Embryol (Berl) 204:1–10.
Battiston B, Tos P, Conforti LG, Geuna S (2007) Alternative techniques for peripheral nerve repair: conduits and end-to-side neurorrhaphy. Acta Neurochir Suppl 100:43–50.
Bontioti E, Dahlin LB, Kataoka K, Kanje M (2006) End-to-side nerve repair induces nuclear translocation of activating transcription factor 3. Scand J Plast Reconstr Surg Hand Surg 40:321–328.
Bontioti E, Kanje M, Lundborg G, Dahlin LB (2005) End-to-side nerve repair in the upper extremity of rat. J Peripher Nerv Syst 10:58–68.
Geuna S, Tos P, Raimondo S, Lee JM, Gambarotta G, Nicolino S, Fornaro M, Papalia I, Perroteau I, Battiston B (2007) Functional, morphological and biomolecular assessment of posttraumatic neuro-muscular recovery in the rat forelimb model. Acta Neurochir Suppl 100:173–177.
Giovanoli P, Koller R, Meuli-Simmen C, Rab M, Haslik W, Mittlböck M, Meyer VE, Frey M (2000) Functional and morphometric evaluation of end-to-side neurorrhaphy for muscle reinnervation. Plast Reconstr Surg 106:383–392.
Papalia I, Geuna S, Tos P, Boux E, Battiston B, Stagno D’Alcontres F (2003) Morphologic and functional study of rat median nerve repair by terminolateral neurorrhaphy of the ulnar nerve. J Reconstr Microsurg 19:257–264.
Al-Qattan MM (2001) Terminolateral neurorrhaphy: review of experimental and clinical studies. J Reconstr Microsurg 17:99–108.
Amr SM, Moharram AN (2005) Repair of brachial plexus lesions by end-to-side side-to-side grafting neurorrhaphy: experience based on 11 cases. Microsurgery 25:126–146.
Frey M, Giovanoli P (2003) End-to-side neurorrhaphy of sensory nerves. Eur J Plast Surg 26:85–88.
Haninec P, Samal F, Tomas R (2007) Direct repair (nerve grafting), neurotization, and end-to-side neurorrhaphy in the treatment of brachial plexus injury. J Neurosurg 106:391–399.
Luo YX (1998) Preliminary investigation of treatment of ulnar nerve defect by end-to-side neurorrhaphy. Plast Reconstr Surg 102:25–28.
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 53:149–154.
Mennen U (2003) End-to-side nerve suture in clinical practice. Hand Surg 8:33–42.
Ogun TC, Ozdemir M, Senaran H, Ustun ME (2003) End-to-side neurorrhaphy as a salvage procedure for irreparable nerve injuries. J Neurosurg 99:180–185.
Pelissier P, Rihai R, Casoli V, Martin D, Baudet J (2001) Les anastomoses nerveuses terminolaterales. Rapport clinique a propos de dix cases. Ann Chir Plast Esthet 46:129–133.
Voche P, Quattara D (2005) End-to-side neurorrhaphy for defects of palmar sensory digital nerves. Br J Plast Surg 58:239–244.
Papalia I, Tos P, Scevola A, Raimondo S, Geuna S (2006) The ulnar test: a method for the quantitative functional assessment of posttraumatic ulnar nerve recovery in the rat. J Neurosci Methods 154:198–203.
Papalia I, Tos P, Stagno d Alcontres F, Battiston B, Geuna S (2003) On the use of the grasping test in the rat median nerve model: a re-appraisal of its efficacy for quantitative assessment of motor function recovery. J Neurosci Methods 127:43–47.
Tos P, Ronchi G, Nicolino S, Audisio C, Raimondo S, Fornaro M, Battiston B, Graziani A, Perroteau I, Geuna S (2008) Employment of the mouse median nerve model for the experimental assessment of peripheral nerve regeneration. J Neurosci Methods 169: 119–127.
Mackinnon S, Dellon AL (1988) Surgery of the Peripheral Nerve. Thieme, New York.
Papalia I, Cardaci A, d’Alcontres FS, Lee JM, Tos P, Geuna S (2007) Selection of the donor nerve for end-to-side neurorrhaphy. J Neurosurg 107:378–382.
Pienaar C, Swan MC, De Jager W, Solomons M (2004) Clinical experience with end-to-side nerve transfer. J Hand Surg Br 29:438–443.
Conflict of interest statement We declare that we have no conflict of interest.
Acknowledgements The authors wish to thank Josette Legagnaux and Jean Luc Vignes and the Laboratoire de Microchirurgie de l’Ecole de Chirurgie de Paris for the valuable expert and technical assistance. This work was supported by grants from the MUR and the Regione Piemonte (Bando Ricerca Sanitaria Finalizzata).
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this chapter
Cite this chapter
Tos, P., Geuna, S., Papalia, I., Conforti, L.G., Artiaco, S., Battiston, B. (2011). Experimental and Clinical Employment of End-to-Side Coaptation: Our Experience. In: Alexandre, A., Masini, M., Menchetti, P. (eds) Advances in Minimally Invasive Surgery and Therapy for Spine and Nerves. Acta Neurochirurgica Supplementum, vol 108. Springer, Vienna. https://doi.org/10.1007/978-3-211-99370-5_37
Download citation
DOI: https://doi.org/10.1007/978-3-211-99370-5_37
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-99369-9
Online ISBN: 978-3-211-99370-5
eBook Packages: MedicineMedicine (R0)