Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.

<h4>Background</h4>The gold standard surgical treatment of nerve injury includes direct repair, nerve graft, and neurolysis. The underlying effects (either beneficial or detrimental) of angiogenesis during nerve regeneration by rotational muscle flap have not yet determined. We assess th...

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Main Authors: Hung-Chuan Pan, Ming-Hong Chang, Meei-Ling Sheu, Chun-Jung Chen, Jason Sheehan
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2019-01-01
Series:PLoS ONE
Online Access:https://doi.org/10.1371/journal.pone.0217402
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spelling doaj-8b5e72a66cbd479ca82035b92b3f4f032021-03-04T10:29:45ZengPublic Library of Science (PLoS)PLoS ONE1932-62032019-01-01146e021740210.1371/journal.pone.0217402Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.Hung-Chuan PanMing-Hong ChangMeei-Ling SheuChun-Jung ChenJason Sheehan<h4>Background</h4>The gold standard surgical treatment of nerve injury includes direct repair, nerve graft, and neurolysis. The underlying effects (either beneficial or detrimental) of angiogenesis during nerve regeneration by rotational muscle flap have not yet determined. We assess the neurological outcome and angiogenesis of nerve injury following a rotational muscle flap.<h4>Methods</h4>We retrospectively analyzed the outcome of the patients with severe radial nerve injury by neurolysis and rotational muscle flap; we also mimicked the clinical situation by nerve crush followed by rotational muscle flap in animals to assess associated angiogenesis factor expression.<h4>Results</h4>Twenty-three out of 25 (92%) cases of severe radial nerve injury underwent neurolysis assisted by muscle flap rotation and eventually reached their preinjury neurological outcome. In the animal study, both FITC-dextran and Dil infusion showed a remarkably increased vascular structure in the crushed nerve integrated by the muscle flap and abolished by Avastin injection. The rotational muscle flap significantly increased angiogenesis factor expression, and this was attenuated by Avastin injection. The increased angiogenesis factor expression paralleled the improvement seen in neurobehavioral and electrophysiological studies as well as the significant expression of nerve regeneration markers and the restoration of denervated muscle morphology.<h4>Conclusion</h4>Based on the clinical and animal data analysis, we conclude that muscle flap rotation provides a platform for angiogenesis in the acceleration of nerve regeneration. It appears that the muscle flap rotation augmented the nerve regeneration process which may be beneficial for nerve repair in clinical application.https://doi.org/10.1371/journal.pone.0217402
collection DOAJ
language English
format Article
sources DOAJ
author Hung-Chuan Pan
Ming-Hong Chang
Meei-Ling Sheu
Chun-Jung Chen
Jason Sheehan
spellingShingle Hung-Chuan Pan
Ming-Hong Chang
Meei-Ling Sheu
Chun-Jung Chen
Jason Sheehan
Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
PLoS ONE
author_facet Hung-Chuan Pan
Ming-Hong Chang
Meei-Ling Sheu
Chun-Jung Chen
Jason Sheehan
author_sort Hung-Chuan Pan
title Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
title_short Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
title_full Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
title_fullStr Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
title_full_unstemmed Increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
title_sort increased angiogenesis by the rotational muscle flap is crucial for nerve regeneration.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2019-01-01
description <h4>Background</h4>The gold standard surgical treatment of nerve injury includes direct repair, nerve graft, and neurolysis. The underlying effects (either beneficial or detrimental) of angiogenesis during nerve regeneration by rotational muscle flap have not yet determined. We assess the neurological outcome and angiogenesis of nerve injury following a rotational muscle flap.<h4>Methods</h4>We retrospectively analyzed the outcome of the patients with severe radial nerve injury by neurolysis and rotational muscle flap; we also mimicked the clinical situation by nerve crush followed by rotational muscle flap in animals to assess associated angiogenesis factor expression.<h4>Results</h4>Twenty-three out of 25 (92%) cases of severe radial nerve injury underwent neurolysis assisted by muscle flap rotation and eventually reached their preinjury neurological outcome. In the animal study, both FITC-dextran and Dil infusion showed a remarkably increased vascular structure in the crushed nerve integrated by the muscle flap and abolished by Avastin injection. The rotational muscle flap significantly increased angiogenesis factor expression, and this was attenuated by Avastin injection. The increased angiogenesis factor expression paralleled the improvement seen in neurobehavioral and electrophysiological studies as well as the significant expression of nerve regeneration markers and the restoration of denervated muscle morphology.<h4>Conclusion</h4>Based on the clinical and animal data analysis, we conclude that muscle flap rotation provides a platform for angiogenesis in the acceleration of nerve regeneration. It appears that the muscle flap rotation augmented the nerve regeneration process which may be beneficial for nerve repair in clinical application.
url https://doi.org/10.1371/journal.pone.0217402
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