Using intact nerve to bridge peripheral nerve defects: An alternative to the use of nerve grafts

This preliminary study was conducted to determine whether a regenerating pe ripheral nerve in a rat model can use the epineurium of an intact nerve to bridge a nerve gap defect. To create the intact nerve bridge a l-cm segment of the peroneal nerve is resected leaving a gap defect. The proximal and d istal peroneal nerve stumps are sutured l-cm apart, in an end-to-side fashi on, to the epineurium of the intact tibial nerve. The following experimenta l groups were used (n = 12): group A, immediate primary repair of resected segment; group B, intact nerve bridge technique; group C, nerve autograft; and group D, gap in situ control. Evaluation 12 weeks after surgery include d measurement of the tibialis anterior muscle contraction force, axonal cou nting, wet weight of the tibialis anterior muscle, and histologic examinati on. The results of this animal study support 3 main conclusions: regenerati ng axons can use the epineurium of an intact nerve to bridge a gap in nerve continuity; when using functional recovery to assess regeneration, there i s no significant difference between standard nerve autografts and the intac t nerve bridge technique; and based on histologic examination, the intact n erve bridge technique does not injure the intact tibial nerve used to bridg e the gap defect. Taken together, the results of this preliminary animal st udy suggest that the intact nerve bridge technique may be a potential alter native to standard nerve autografts in appropriate circumstances. Further i nvestigation in a higher animal model is warranted before considering clini cal application of the intact nerve bridge technique. (J Hand Surg 2001;26A :315-325. Copyright (C) 2001 by the American Society for Surgery of the Han d.).