Current concepts in end-to-side neurorrhaphy

Abstract

In peripheral nerve injury, end-to-side neurorrhaphy involves coaptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve. It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft. Experimental and clinical data suggests that end-to-side neurorrhaphy can provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. The most accepted mechanism of nerve regeneration following end-to-side neurorrhaphy is collateral sprouting. The source of the regenerating axons traveling in the epineurium of the donor nerve is thought to be the proximal Ranvier's nodes at the site of end-to-side neurorrhaphy, however, histologic evidence is still lacking. Partial neurotomy of the donor nerve may enhance regeneration of motor neurons through end-to-side neurorrhaphy and reinnervation of motor targets.

Keywords: Collateral sprouting; End-to-side neurorrhaphy; Nerve regeneration; Peripheral nerve injury.

Figure 1

Double end-to-side neurorrhaphy with 0.6-cm regeneration distance between the proximal and distal stump of the recipient nerve (black arrows). In both neurorrhaphies, coaptation was performed with 3 interrupted 9-0 nylon sutures placed at 120°.

Figure 2

End-to-side neurorrhaphy between the tibial nerve (double asterisk) and the peripheral stump of the peroneal nerve (single asterisk) 90 days after surgery. Note the smooth transition from one trunk to the other resembling normal bifurcation of the tibial nerve. Also note the newly formed vessels at the outer layer of the nerve trunks traveling from the donor tibial nerve to the recipient peroneal nerve.