INCREASED AXONAL REGENERATION OVER LONG NERVE GAPS USING AUTOLOGOUS NERVE-MUSCLE SANDWICH GRAFTS

Poor recovery is seen after repair of long defects in peripheral nerve s when denatured muscle grafts or regeneration chambers providing phys ical support alone are used. The presence of Schwann cells and neurotr ophic factors is required for axons to migrate significant distances. In this study we have used immunohistochemical techniques and axon cou nts to quantify the regeneration seen when 5 cm defects in rabbit scia tic nerve were repaired with a composite graft consisting of 2-3 mm le ngths of fresh autologous nerve sandwiched between 1 cm frozen-thawed muscle grafts. This technique led to a similar pattern of regeneration as that seen in autologous nerve grafts, used as controls, and a sign ificantly (P < 0.0001) greater axonal and Schwann cell regeneration co mpared with that seen in frozen-thawed muscle grafts of the same total length. In conclusion, we present a simple technique for incorporatin g a depot of Schwann cells and other essential components into a nerve conduit which has a marked effect on axonal regeneration across long defects. (C) 1996 Wiley-Liss, Inc.