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KMID : 0350519930460010233
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Journal of Catholic Medical College
1993 Volume.46 No. 1 p.233 ~ p.245
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Roie of Degenrated Muscle Graft on Nerve Regenaration of the Rat Sciatic Nerve Deffect
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Abstract
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Iujuries to peripheral nerves still present one of the most challenging surgical problems. Many efforts have been made to overcome this problem using end-to-end anastomosis or nerve graft where direct reapproximation is impossible. But a live nerve autograft has many disabvantages : donor site morbidities, the restrited quantities of the donor nerve, and the sacrifice of a functioning nerve. Therfore, in many instances substitutive grafts have been tried to replace the autogenous nerve graft.
Many reports suggest that the results of these substitutes such as degenerated muscle graft and various tube grafts are as effective as a nerve graft.
Those using degenerated muscle graft show empty basement membrane tubes for the ingress of Schwann cells or growth factors released from the distal nerve stump. Many evidences exist to suggest the possibilty that such growth factors can be
released from skeletal muscle tissue and that they are effective in vivo.
The purpose of this study is to investigate the role of degenerated skeletal muscle and to compare the effect of the entubulation technique using autogenous fascia with that of the degenerated muscle graft in rat peripheral nerve regeneration.
Thirty male Wistar adult rats weighing between 200 and 250 gm were divided into thtee groups ; 1) the fascial tube graft group(n=10), in which a 10 mm length tube of fascia was grafted to a 10 mm length of left sciatic nerve defect ; 2) the degenerated muscle wraped with its fascia graft group(n=10), in which a 10 mm length of degenerated muscle being frozed and thawed was grafted coaxially to the same length of nerve defect ; 3) minced degenerated muscle wrapped with its fascia graft group(n=10), in which a 10 mm length of minced degenerated muscle bfeing wrapped with its fascia was grafted to the same length of nerve dofect. After 60 days, the outcome was assessed through general evaluation, histology, and walking track analysis.
@ES The results were as follows.
@EN 1. The gross functional recovery, such as toe spread and plantar flexion of ankle, was observed in 13% of the fascial tube graft group, 44% of the minced degenerated muscle and fascia graft group, and 63% of the degenerated muscle and fascia
graft group.
2. Sciatic functional index(SFI) of the fascial tube graft group was -88.3±2.4(12% recovery), minced degenrated muscle and fascia graft group -58.8±6.0(41% recovery), and degenerated muscle and fascia graft group -52.2±2.6(48% recovery.)
There were significant differences of sciatic functional index between each group(P<0.05).
3. The total number of myelinated axons infiltrated into the grafts : in the fascial tube graft group was 4060.1±267.5 ; minced degenrated muscle and fascia graft group 5039.4±268.7 ; and degenerated muscle and fascia graft group 5376.7±269.6.
The total number of myelinated axons in the distal segment was 2248.2±164.4 for fascial tube graft group, 3293.7±282,4 for minced degenerated muscle and fascia graft group, and 3838.0±273.1 for degenerated muscle and fascia graft group. All values were
significantly different between each group(P<0.05).
Our results show that the degenrated muscle graft promotes much more axonal regeneration than the minced degenerated muscle and fascial tube graft does, and autogenous fascial tube graft is not so much effective as the other two. From this study,
is is suggested that some possible neuronotrophic factors can be released from degenerated skeletal muscle and stimulate peripheral nerve growth in vivo.
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