Eur J Plast Surg (2004) 27:47 DOI 10.1007/s00238-004-0607-0 LE TT ER TO T H E E DITOR O. C. Aszmann The influence of harvesting method on morphological changes in sural nerve graft and on the quality of motor and sensory recovery Published online: 10 March 2004 Springer-Verlag 2004 Dear Sir directive axonal growth, but are also needed for non- With interest I have read the article of Dr. Ivo Dzepina. neural cell populations for differentiation and physical This study claims that the use of ‘non-traumatized’ sural integration. In recent years the importance of different nerve grafts provide a better outcome than those harvested surface molecules to aid in nerve regeneration have been with the more traumatizing harvesting method of multiple more appreciated. It has been understood that protruding transverse sections. growth cones of the regenerating axons need a permissive The rationale is that ‘extensive ultrastructural damage substratum to successfully regenerate across longer dis- with multi-focal fragmentation of myelin sheath...’ that tances. In conventional nerve grafts extracellular matrix did not occur in the proposed harvesting technique, which molecules such as laminin-1, fibronectin, as well as more inflicts a longitudinal scar from knee to ankle, present specialized cell surface molecules from either the integrin such dramatic insult to regenerating axons, that the or the cadherin family are ubiquitous. Furthermore, this outcome is significantly poorer. matrix is evidently necessary for appropriate differenti- Much could be said about the patient population, and ation and induction of specific gene expression of a evaluation techniques used, however, I want to simply number of non-neural cells such as Schwann cells, fibro- ask the author what he thinks will happen to the harvest- blasts or migrating macrophages. These in turn will pro- ed nerve after grafting. Yes, the nerve will degener- vide the necessary humeral environment for regenerating ate, Schwann cells will undergo dramatic morphological nerve fibres to survive the transient target-less state. changes, and the so precious myelin sheath will disinte- The conventional nerve graft so far is the only bio- grate! What is left is a disaster of cell debris, macrophages logical resource we have that provides this environment, cleaning the mess and reactive Schwann cells providing a and it is too simplistic a thought to believe that the humoral environment conducive to axonal regeneration. method of harvest will make a difference and I strongly With whatever method the nerve is harvested, after a few disagree with the author’s conclusion. days they will all look alike. Lastly, figure 1 and figure 2 are micrographs of the Regenerating axons require an environment that pro- same specimen of supposedly two different nerves, har- vides polymeric networks of several types of different vested with different techniques! macromolecules that not only serve as physical cues for O. C. Aszmann ( ) Division of Plastic and Reconstructive Surgery, University of Vienna, School of Medicine, Whringer Grtel 18-20, 1090 Vienna, Austria e-mail: email@example.com
European Journal of Plastic Surgery – Springer Journals
Published: Apr 1, 2004
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