Supercharge Nerve Transfer to Enhance Motor Recovery, a Laboratory Study

J Hand Surg Am, 2013 · DOI: 10.1016/j.jhsa.2012.12.020 · Published: March 1, 2013

Simple Explanation

This study investigates a surgical technique called a 'supercharge' end-to-side (SETS) nerve transfer to improve nerve regeneration after an incomplete nerve injury. The SETS procedure involves connecting a healthy, expendable nerve to the side of an injured nerve to boost its recovery. The experiment used rats with an incomplete sciatic nerve injury, where the injured nerve was partially repaired with a nerve graft. One group received the SETS procedure in addition to the graft, while control groups received either the graft alone or the SETS procedure alone. The results showed that the group receiving the SETS transfer along with the nerve graft experienced significantly better nerve regeneration, as indicated by increased nerve fiber counts, improved motor neuron activity in the spinal cord, and enhanced muscle force.

Study Duration

8 weeks

Participants

54 Lewis rats

Evidence Level

Level 1, Animal Study

Key Findings

1
SETS transfer significantly increased myelinated axonal counts in the distal tibial nerve compared to the IRM and SETS groups at 5 and 8 weeks.
2
Retrograde labeling confirmed increased motoneuron counts in the SETS-IRM group, indicating more motor neurons were contributing to muscle innervation.
3
Functional recovery at 8 weeks showed a significant increase in muscle-specific force in the SETS-IRM group compared to the IRM group, demonstrating improved motor function.

Research Summary

The study evaluated the effectiveness of a supercharge end-to-side (SETS) nerve transfer in augmenting recovery from incomplete nerve injuries in a rat model. The SETS procedure was performed in conjunction with an incomplete recovery model (IRM) and compared against IRM alone and SETS alone control groups. The SETS-IRM group exhibited significantly increased myelinated axonal counts, motoneuron counts, and muscle-specific force compared to the control groups. These findings suggest that the SETS transfer enhances nerve regeneration and functional recovery in incomplete nerve injuries. The results indicate that SETS distal nerve transfer may be beneficial for treating nerve injuries with incomplete regeneration, particularly in cases where long regeneration distances lead to delayed muscle reinnervation and suboptimal functional outcomes.

Practical Implications

Clinical Application

SETS nerve transfer may be a useful surgical option for nerve injuries with incomplete regeneration, such as Sunderland II or III degree injuries.

Improved Motor Recovery

The SETS transfer enhances motor recovery by increasing the number of regenerating axons and promoting earlier muscle reinnervation.

Protective Effect on Muscle

SETS transfer may provide a protective effect on muscle function by preventing atrophy and fibrosis associated with prolonged denervation.

Study Limitations

1
Study conducted on rats may not fully translate to human physiology
2
Electron microscopy was performed by a non-blinded operator
3
Specific mechanisms of the SETS transfer's protective effect on muscle not fully elucidated

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