Affiliations: Division of Plastic and Reconstructive Surgery, Washington University School
of Medicine, St. Louis, MO, USA
Note: [] Corresponding author: Terence M. Myckatyn, MD, Division of
Plastic and Reconstructive Surgery, Washington University School of Medicine,
660 South Euclid Ave., Campus Box 8238, St. Louis, MO 63110-1010, USA. Tel.: +1
314 362 4588; Fax: +1 314 362 4536; E-mail: myckatynt@wudosis.wustl.edu
Abstract: End-to-side (ETS) nerve repair, in which the distal stump of a
transected nerve is coapted to the side of an uninjured donor nerve, offers a
technique for repair of peripheral nerve injuries where the proximal nerve
stump is unavailable or a significant nerve gap exists. Details of animal
models are explored including motor and sensory regeneration to further clarify
the mechanism of collateral sprouting while eliminating false positive results
from contaminating axons. Some experimental studies support the conclusion that
sensory or motor reinnervation may be derived from collateral sprouting while
others suggest that reinnervation requires an injury to the donor nerve.
Clinical experience with ETS neurorrhaphy includes management of upper
extremity nerve injury, facial reanimation, reconstruction following tumor
ablation, and the prevention of neuroma formation. Our interpretation of the
ETS literature suggests that sensory axons may sprout without deliberately
attempting to injure them, while motor axons regenerate only in response to a
deliberate injury. Experimental and clinical experience with ETS neurorrhaphy
has rendered mixed results. Our interpretation of the literature suggests that
the success of this technique is dependent upon axonal injury of motor and
possibly sensory nerves. While continued clinical and laboratory
experimentation with ETS nerve repair is warranted, it should not yet replace
more established techniques of nerve repair.
