Comparison with reverse end to side nerve grafts and end to end nerve grafts at periferal nerve repair ( experimental study at rats )

Peripheral nerves could be injured due to various etiologies such asneoplasm, trauma, compression status, inflammatory disease, infections, surgicalprocedures etc. Several nerve repairing methods can be used according to etiologicalproperties of the injury, its severity, and anatomical localization. In clinical practiceneurotization of more than one muscle through solely intact nerve may be required.In such cases, a number of modifications for the end-to-side repair have been tried inrelated literature. These modifications are usually multiple or serial types of end-tosiderepair.In this study, we aimed to neurotize two different muscles via solely an intactnerve, using nerve graft and reverse end-to-side repair that has been alreadyintroduced into the literature. For this reason, 6 experimental groups were designed:? Group 1: Sham group;? Group 2: Non-treatment group;? Group 3: End-to-end repair group;? Group 4: Reverse end-to-side repair group.Intact nerve end was sutured to epineural window at the middle of thehorseshoe shaped nerve graft and axonal sprouting was achieved through both endsof the nerve graft. In order to better assess the physiology of reverse end-to-siderepair, Group 5 and Group 6 were created. In Group 5, the ends of the graft weresutured to different tissues and in Group 6, one of the ends of the graft was ligated inorder to explore the processes neurotropism.Walking analysis, EMG, and electron microscopical myelined / non-myelinedaxon count were used in the evaluation of the study.Walking analysis and EMG findings were statistically significant in Group 4(reverse end-to-side repair) comparing to Group 3 (end-to-end repair). In electronmicroscopical examination of the nerve biopsies obtained from the ends of the nervegraft, the number of the myelined and non-myelined axons was statistically greater inreverse end-to-side repair group (Group 4) compared to end-to-end repair group(Group 3).In this study, the priority of neurotropism was also assessed among nerve,muscle tissue, and ligation. It was found that the affinity of the nerve tissue wassuperior then the other tissues. This study may be a good model for neurotropismstudies where an appropriate environment has been provided for axonal progression.When the results are evaluated, this study shows that two different musclescan be neurotized by solely intact nerve via using reverse end-to-side repair and anerve graft.