American Society for Peripheral Nerve

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The Effect of Perineurotomy on Nerve Regeneration In Diabetic Rats
Cihan Sahin, MD; Huseyin Karagoz, MD; Fuat Yuksel, MD; Dilek Akakin, MD; Nukhet Dagbasi, MD; Ersin Ulkur, MD
GATA Haydarpasa Training Hospital, Istanbul, Turkey

PURPOSE: It is known that diabetic neuropathy is the result of endoneurial edema caused by various biochemical reactions triggered by hyperglycemia. Internal and external restrictive structures create a double crush effect to the nerve structure. According to the double-crush hypothesis, the treatment should be applied to all entrapment points along the course of the nerve instead of a single site. Decompression of the nerve at different levels is one of the adjuncts of the overall treatment plan for diabetic neuropathy. However nerve decompression doesn’t change the internal nerve pressure. We compared this with compartment syndrome of extremities. Therefore the treatment to reduce the internal pressure must be perineurotomy which correspond to fasciotomy in extremities.

The aim of this study was to investigate the effect of perineurotomy on repair of the nerve injury in diabetic rats. We thought that if nerve decompression and perineurotomy is applied at the same time we may treat the ‘double crush’.

MATERIALS AND METHODS: We used 40 rats. Four groups (healthy control, healthy perineurotomy, diabetic control, and diabetic perineurotomy) were created. Streptozotocin-induced diabetes was created at two groups. In all groups the schiatic nerve was transected and sutured epineuraly. Additionally, perineurotomy was performed to schiatic nerve and its’ branches in healthy and diabetic perineurotomy groups. Walking track analysis was used for functional assessment. The nerve biopsies were taken at postoperative 12th weeks, photo and electron microscopic evaluation were carried out. Number of myelinated fibers was counted. Mann Whitney U and Kruskal Wallis tests were used for statistics.

RESULTS: Sciatic function index of diabetic perineurotomy was better than the other groups. According to number of the myelinated fiber, the difference between healthy control and healthy perineurotomy group weren’t significant (p>0,05). But the difference between diabetic control and diabetic perineurotomy groups were significant in favour of diabetic perineurotomy group (p<0,05).

A various degree of axonal degeneration was noted in the diabetic control group, was compared to healthy control and perineurotomy groups. Axonal degeneration was evident in the untreated diabetics, while the profile of the diabetic perineurotomy group was almost similar to that in non-diabetic controls.

Perineurotomy prevented degeneration of axons to some degree in diabetic rats, although few degenerated axons were still observed.

CONCLUSIONS: We conclude that perineurotomy increases the regeneration of the nerve in diabetic rats. Perineurotomi may be useful adjunctive procedure with nerve repair in diabetic patients after further experimental and clinical trials.


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