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World J Orthop. Nov 18, 2011; 2(11): 102-106
Published online Nov 18, 2011. doi: 10.5312/wjo.v2.i11.102
Current concepts in end-to-side neurorrhaphy
Marios G Lykissas
Marios G Lykissas, Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States
Author contributions: Lykissas MG solely contributed to this paper.
Correspondence to: Marios G Lykissas, MD, PhD, Division of Pediatric Orthopaedic Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 217, Cincinnati, OH 45229, United States. mariolyk@yahoo.com
Telephone: +1-513-6527207 Fax: +1-513-6363928
Received: May 18, 2011
Revised: October 2, 2011
Accepted: October 9, 2011
Published online: November 18, 2011

In peripheral nerve injury, end-to-side neurorrhaphy involves coaptation of the distal stump of a transected nerve to the trunk of an adjacent donor nerve. It has been proposed as an alternative technique when the proximal stump of an injured nerve is unavailable or the nerve gap is too long to be bridged by a nerve graft. Experimental and clinical data suggests that end-to-side neurorrhaphy can provide satisfactory functional recovery for the recipient nerve, without any deterioration of the donor nerve function. The most accepted mechanism of nerve regeneration following end-to-side neurorrhaphy is collateral sprouting. The source of the regenerating axons traveling in the epineurium of the donor nerve is thought to be the proximal Ranvier’s nodes at the site of end-to-side neurorrhaphy, however, histologic evidence is still lacking. Partial neurotomy of the donor nerve may enhance regeneration of motor neurons through end-to-side neurorrhaphy and reinnervation of motor targets.

Keywords: End-to-side neurorrhaphy, Collateral sprouting, Nerve regeneration, Peripheral nerve injury