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Title: Morphology of donor and recipient nerves utilised in nerve transfers to restore upper limb function in cervical spinal cord injury
Austin Authors: Messina, Aurora;Van Zyl, Natasha;Weymouth, Michael D;Flood, Stephen J;Nunn, Andrew;Cooper, Catherine A;Hahn, Jodie B;Galea, Mary P 
Affiliation: Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
Department of Occupational Therapy, Austin Health, Heidelberg, Victoria, Australia
Department of Plastic and Reconstructive Surgery, Austin Health, Heidelberg, Victoria, Australia
Victorian Spinal Cord Service, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 27-Sep-2016
Publication information: Brain Sciences 2016; 6(4): E42
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.
DOI: 10.3390/brainsci6040042
Journal: Brain Sciences
PubMed URL:
Type: Journal Article
Subjects: Morphology
Nerve transfer surgery
Peripheral nerves
Spinal cord injury
Appears in Collections:Journal articles

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