The effect of devascularization on the regeneration of lacerated peripheral nerves: an experimental study.

The functional, biochemical, and histological changes in a severed median nerve, 9 months after epineurial repair, were studied in 14 monkeys. In seven the mesoneurium had been stripped 5 cm proximal and 5 cm distal to the site of repair, and in seven the nerve had been stripped only over a 0.5 cm area, just enough to allow repair. In the first group the mean muscular strength in the abductor pollicis brevis was 197 gm, as compared to 257 gm in the second group. The amount of collagen in the perineurium was 57 microgram/mg, as compared to 43 microgram/mg, and the incidence of the h-l-h-nl cross-link was 16% to 21%, as compared to 9% to 11%. If the regeneration of the lacerated nerve was compromised by the deposition of collagen resulting from mobilization of the distal segment, as suggested by the decrease in the strength of the abductor pollicis brevis muscle, then any mobilization of a nerve necessary to obtain a sutured junction with minimum tension should be limited to the proximal segment.