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Brain Sci. 2016, 6(4), 42; doi:10.3390/brainsci6040042

Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury

1
Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville 3010, VIC, Australia
2
Department of Plastic and Reconstructive Surgery, Austin Health, Studley Road, Heidelberg 3084, VIC, Australia
3
Victorian Spinal Cord Service, Austin Health, Studley Road, Heidelberg 3084, VIC, Australia
4
Department of Occupational Therapy, Austin Health, Studley Road, Heidelberg 3084, VIC, Australia
*
Author to whom correspondence should be addressed.
Academic Editor: Raymond J. Grill
Received: 14 August 2016 / Revised: 19 September 2016 / Accepted: 21 September 2016 / Published: 27 September 2016
(This article belongs to the Special Issue Acute and Chronic Systemic Alterations Produced by Spinal Trauma)
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Abstract

Loss of hand function after cervical spinal cord injury (SCI) impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN) and anterior interosseus nerves (AIN). They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible. View Full-Text
Keywords: peripheral nerves; spinal cord injury; nerve transfer surgery; morphology peripheral nerves; spinal cord injury; nerve transfer surgery; morphology
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MDPI and ACS Style

Messina, A.; Van Zyl, N.; Weymouth, M.; Flood, S.; Nunn, A.; Cooper, C.; Hahn, J.; Galea, M.P. Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury. Brain Sci. 2016, 6, 42.

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