RU2376650C1 - Method of directional regeneration of muscular rami of facial nerve in experiment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention is related to medicine, namely to neurosurgery. For nerve tubulisation they use polyvinyl chloride conductor made of two identical parts, middle part of which is made of two matched semi-tubes fixed with two seams, at the same time external parts of polyvinyl chloride conductor have the shape of tubes. Ends of nerves are inserted into clearance of polyvinyl chloride conductor via side holes arranged at the beginning of semi-tubes in middle part of conductor. External ends of polyvinyl chloride conductor are brought out on skin, are fixed and used as catheters for introduction of medical preparations, and after inosculation of nerve ends both parts of conductor are withdrawn by ends pulling, without cutting.

EFFECT: wider assortment of means for execution of directional regeneration of nerve.

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Description

The invention relates to medicine, namely to neurosurgery, and is intended for the reinnervation of facial tissues in case of damage to the muscle branches of the facial nerve.

Damages and diseases of the facial nerve take the first place among the lesions of the cranial nerves and the second place among the pathologies of the peripheral nervous system. A significant place among the causes of injuries of the extracranial part of the facial nerve is occupied by the iatrogenic factor, this is due to the complexity of topographic anatomy and other factors. The main mechanisms of surgical trauma of the facial nerve are: coagulation, dissection, damage during suturing, compression by hematoma or clamp. A common cause of postoperative paralysis of facial muscles is an operation to excise a tumor of the facial nerve itself and surrounding formations in order to ensure the radical nature of the operation. Other causes of damage to the facial nerve or its branches can be open and closed injuries of the maxillofacial region, which have a strong tendency to increase due to an increase in general injuries.

The relevance of techniques that use direct stitching of a damaged nerve is lost when diastasis occurs between its ends, especially on the face, where it is difficult to precisely bring together and match the stitched ends of the nerve.

To synthesize the ends of the nerve using tubulation methods, various synthetic tubes, cases from their own tissue, and segments of blood vessels were used (I.F.Matyushin "Operations on nerves, tendons, muscles", 1976, p.13; E.I. Chumasov, N . I. Chalisova, bull. Experimental Biology, 1983, No. 11, pp. 104-107; G. Lundborg, HA Hansson - Surg., 1980, v.5, p. 35; G. Lundborg, LB Dahlin, N. Danielson et al. - Exp. NeuroL., 1982, v. 76, p. 361.).

There are also methods in which tubulization is used as isolation of the suture line between the ends of nerves by a vascular allograft (G.N. Akoyev, G.S. Kokin, E.I. Chumasov, L.I. Kolosova, etc. Issues of Neurosurgery, No. 6, 1988, p. 32-36), a vascular autograft (DTW Chiu, I. Janecka, TJ Krizek et al. - Surgery, 1982, v. 91, p. 226), a propolis coupling, a PVC pipe (G.M .Patakhov, M.O. Omarov, M.M.Bakuev and others. Patent for the invention No. 2288651).

However, each of these methods has its drawbacks: the use of segments of blood vessels leads to additional trauma associated with impaired function of the extracted vessel; the difficulty of selecting a suitable vascular graft for diameter; the walls of blood vessels and cases of their own tissue do not have sufficient strength properties and can be squeezed by surrounding tissues, which prevents the growth of axons.

The use of allografts is often accompanied by a reaction of tissue incompatibility, and leaving synthetic tubes in the wound is often the cause of macrophage and allergic reactions to a foreign body with the development of inflammatory processes and cicatricial deformities of the nerve. Propolis couplings under the influence of body temperature can soften, deform and create an obstacle to the regeneration of nerve fibers.

Prototype

As a prototype, the method of regeneration of peripheral nerves in the lumen of the implanted vessels was chosen (E.I. Chumasov, N. I. Chalisova, bull. Experimental Biology, 1983, No. 11, pp. 104-107). This method consists in the fact that in the beginning a descending aorta was dissected under donor rats under ether anesthesia and placed in a Hanks solution at 37 ° C. The other animals under nembutal anesthesia (5 mg per 100 g) were sciatic nerve 2 cm above the knee joint. The proximal end of the nerve was injected 2-3 cm into the lumen of a segment of the implanted aorta 1.5-2 cm long and fixed using MK-7 surgical glue with the vessel wall. An implant with a nerve was located among the denervated thigh muscles, and the wound was sutured in layers.

The disadvantages of the prototype are: 1) the problem of donor material is that the aorta is a large vital vessel; 2) the use of allografts often causes a reaction of tissue incompatibility and the development of inflammatory processes with subsequent cicatricial deformities of the connected nerves; 3) the relatively low density of the vessel wall can cause the germination of individual elements of nerve fibers into it; 4) the large diameter of the aorta does not make it possible to use it for tubulation of smaller nerves, in particular the motor branches of the facial nerve.

The aim of the invention is the optimization of existing methods of directed regeneration of the nerve.

SUMMARY OF THE INVENTION

The essence of the proposed method is as follows: with the help of a microsurgical technique, the ends of the damaged muscle branch of the facial nerve are extracted from the surrounding tissues. Using a microsurgical technique under the magnification of a binocular magnifier or an operating microscope, the damaged ends are excised. For tubulation of the nerve, a polyvinyl chloride conductor is used, consisting of two identical parts, selected according to the diameter of the nerve (Figure 1, pos. I). From the middle third of the tubular conductor, a longitudinal section begins to its inner end, so that the outer part in this case looks like a tube, and the inner part, starting from the middle third, looks like a half-tube (Figure 1, item II).

The inner semi-tubular surfaces of both parts of the conductor are compared, so that their sections and lumen are opposite each other, and fix them outside with two thin catgut interrupted sutures (Figure 1, item III).

Next, the selected ends of the nerves are inserted between the mapped internal semi-tubular parts of the conductor through the side openings located in the middle third of the conductor at the beginning of the sections (Fig. 1, pos. IV).

The outer ends of both parts of the conductor, having the form of tubes, are displayed on the skin and fixed to it with interrupted sutures (Figure 1, pos. V). They are used as catheters for perineural injections of medicinal substances, and for them, after the fusion of the ends of the nerve, both parts of the conductor are removed.

EXAMPLE: white mongrel rat

A 2-cm left-side incision was made, projecting from the ear to the corner of the mouth, and the muscular branch of the facial nerve was isolated. A 1 cm long nerve section was excised. Under the magnification of the binocular magnifier, using the microsurgical technique, the ends of the nerves were placed in the proposed tube, the ends of which were brought out to the skin along the edges of the incision and fixed with sutures. The wound was sutured in layers. Two weeks later, the ends of the tubes were released and extended in different directions.

This method performed 50 operations on outbred white rats. Two weeks later, axon germination of the central segment into the distal along the polyvinyl chloride tube was observed, without the formation of cicatricial neuromas with a gradual restoration of motor function. After 3-4 months, as shown by visual observations (restoration of mobility of the lateral region, upper lip and mustache of the corresponding side) and examination of the reflex during electrodiagnostics, the conductivity of the operated branch of the facial nerve was restored.

Claims (1)

A method of directed regeneration of a nerve, including tubulation, characterized in that a polyvinyl chloride conductor consisting of two identical parts is used for tubulation of a nerve, the middle part of which consists of two matched semi-tubes fixed with two sutures, while the outer parts of the PVC conductor are in the form of tubes, nerve ends the outer ends of the polyvinyl chloride wire are introduced into the lumen of the polyvinyl chloride conductor through the lateral holes located at the beginning of the half-tubes in the middle part of the conductor nick outputted to the skin, is fixed and is used as a catheter for drug administration, while after the nerve ends intergrowth both sides of the conductor is removed by pulling the ends, without making a cut.

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