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Exploration of the Fascicular Shift Procedure in the Reconstruction Of Large Nerve Defects
Oskar C. Aszmann, MD, Marie Hahn, MD,
Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna Division of Plastic and Reconstructive Surgery, CD Laboratory for Restoration of Extremity Function, Vienna, Austria
Introduction: Over the last decade, a number of models have investigated the usefulness of different biologic and/or synthetic matrices as alternatives to conventional nerve grafts. Still the autologous nerve graft is the gold standard, even though a pure sensory nerve is often used to reconstruct a mixed nerve. Recent experiments showed mixed nerves have a higher functional outcome when reconstructed with like nerve grafts. We present a new concept in the reconstruction of large proximal nerve defects that overcomes this problem: the fascicular shift. Material and Methods: The fascicular shift was tested at the rat's sciatic nerve using 45 Lewis rats. In the experimental group, a 15mm nerve proximal defect was created and reconstructed with a fascicular group, harvested directly distal of the gap. This group was compared to one sham-operated group and three positive control groups. The outcome of nerve regeneration was measured using retrograde labeling, histomorphometric analysis and electrophysiological investigations. Results: The investigation of the tibial and the common peroneal nerve indicates enhanced regeneration of the tibial nerve compared to the common peroneal nerve. The results show that our proposed method achieves superior regeneration than the gold standard technique of sensory grafting. Conclusion: This method allows using a transplant without causing donor-site morbidity. This fact, combined with the more robust regeneration, makes this novel method immensely attractive for large proximal nerve defects, such as it is necessary in brachial plexus reconstruction and other large nerve defects.
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