端側神経縫合の神経発芽のメカニズム

The mechanism of nerve regeneration in this procedure is still not clear. To elucidate it, we designed complete non-injurious end-to-side coaptation methods in rat. The regenerated axons at the coaptatoin site were observed directly using fluorescent dye(DiI) as a neural tracer. In a complete non-injury models, the nerve regenerated electrophysically and histologically. Both right and left flexor muscles of the upper arm contracted simultaneously by the indirect electric stimulation on the grafted nerve. It suggested that the regenerated nerve connected with the recipient nerve by collateral sprouting. DiI stained the regenerated nerve beyond the coaptation site even in a non-injury model. The regenerated nerve was observed from the whole section of the coaptation site and we could also observed the regenerated nerve sprouted from the recipient nerve collaterally. From these results, we conclude that even in the end-to-side neurorrhaphy the nerve regenerated by the collateral sprouting from the donor nerve.

We tried again the end-to-side neurorrhaphy in the recipient nerve for clinical application of avoidance the cutting off the original nerve.We examined several-side at the distal portion of end-to-side neurorraphy. From these result, we confirmed that regeneration is possible at the distal portion of end-to-side neurorraphy.

At the clinical operation, we often use the cross face nerve graft and the cross over operation by anastomosis at the hypoglossal-facial nerve, at the same time. In the cases, two nerves regenerate toward to one target musle. So, we investigated the mechanism of regeneration at such cases.

From these results, we conclude the possibility of the double nerve direction term, in that cases.It seems necessary to examine more detail by changing time of regeneration term from the original nerve root.