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American Association for Hand Surgery

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Modulation of Nerve Regeneration After Median Nerve Transection and Repair: Weekly Versus Biweekly Electrical Stimulation
Lindsay R Kosinski, MD1, Christopher J. Lama, MS1, Elliott Rebello, BS1, Jonathan Ge, BS(c)1, Neill Y Li, MD2, Sami Tuffaha, MD3, Joseph A. Gil, MD1 and Julie Katarincic, MD1, (1)Brown University, Providence, RI, (2)Alpert Medical School of Brown University, Providence, RI, (3)Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

Introduction
Peripheral nerve regeneration via electrical stimulation (ES) on nerve repair in a rat model has been shown to potentiate axonal growth and functional recovery. However, prior methods of ES lack reliability and reproducibility in their assessment of functional recovery due to inherent behavioral variation and an inability to perform serial measurements. Additionally, few animal studies have investigated the additive effect of serial stimulations with regard to accelerated and improved end organ functionality over time. In this study, we sought to evaluate the additive effect of weekly versus biweekly serial ES on median nerve regeneration after transection and repair in a rat model using a stimulated grip strength testing (sGST) method. We hypothesized that biweekly stimulation would demonstrate accelerated and superior functional recovery when compared to once weekly ES.

Materials & Methods
Twenty-one Lewis rats were randomized into three groups (n=7): 1) median nerve transection, repair, and biweekly ES, 2) median nerve transection, repair, and weekly ES, and 3) weekly ES without manipulation of the median nerve. ES was performed via two needle point electrodes placed percutaneously into the right axilla proximal to the pectoralis major insertion (pulsed DC current, 0.25 ms pulse duration, 3V at 50 Hz). The tested forelimb of anesthetized rats was placed in abduction at 90 degrees with the elbow and wrist secured in extension. Under ES, the maximum force generated prior to the loss of grip strength from a clenched paw was measured via force transducer. Three trials of sGST were performed with one minute rest between trials, and the maximum force was recorded weekly. This was repeated at weekly or biweekly intervals for 12 weeks. In all groups, a 1-cm segment of the ulnar nerve was excised to ensure only muscles innervated by the median nerve were contributing to the force measurements.

Results
Both the weekly and biweekly experimental groups demonstrated longitudinal functional recovery in grip strength measurements over the course of 11 weeks. However, weekly ES exhibited greater rate of functional recovery compared to biweekly ES, with significantly different grip strengths in seven out of the eleven weeks by post-hoc comparative t-tests.

Conclusions
In our preliminary analysis, biweekly electrical stimulation does not create an environment to enhance or accelerate peripheral nerve regeneration when compared to once weekly electrical stimulation.


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