• Ching-Hua Hsieh, Seng-Feng Jeng, Tsu-Hsiang Lu, Johnson Chia-Shen Yang, Min-Wei Hsieh, Yi-Chun Chen, and Cheng-Shyuan Rau.
• Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan.
• J Trauma. 2009 Mar 1; 66 (3): 737-42.

BackgroundTo predict the severity of nerve traction injury by skin biopsy with quantification of intraepidermal nerve fibers density (IENFD).MethodsTraction injuries to the right sciatic nerve of Sprague-Dawley rats with the use of different weights (0, 25, 50, 100, 200, 400, and 600 g) were performed. Sham operations were performed on the left sciatic nerve. After a period of 7 days, IENFD derived from quantification of protein gene product 9.5-immunoreactive intraepidermal nerve fibers of the hindpaw skin were calculated to compare with numbers of intact teased fibers of tibia nerve.ResultsThere were 100% +/- 0%, 94% +/- 5%, 52% +/- 8%, 48% +/- 6%, 42% +/- 7%, 9% +/- 3%, and 0% +/- 0% of teased nerve fibers remained intact after traction injury with 0 g, 25 g, 50 g, 100 g, 200 g, 400 g, and 600 g weights, respectively. When compared with IENFD of the control rats (ipsilateral paw: 21.6 +/- 0.6; contralateral paw: 20.1 +/- 0.8 fibers/mm), there were loss of nearly half of the small fibers after 50 g, 100 g, and 200 g weight traction injury in ipsilateral paw (10.1 +/- 1.2, 7.4 +/- 1.5, and 8.3 +/- 2.2 fibers/mm, respectively) and contralateral paw (11.4 +/- 0.9, 9.6 +/- 0.6, and 10.0 +/- 1.5 fibers/mm, respectively). After 400 g and 600 g weight traction injury, there was severe (0.2 +/- 0.2 fibers/mm) to complete destruction of the small fibers in ipsilateral paw and marked reduction in contralateral paw (5.5 +/- 0.7 and 4.3 +/- 0.7 fibers/mm, respectively).ConclusionsWith the ability to classify the nerve traction injury into a mild, moderate, or severe injury, correlations can be made between skin biopsy with IENFD and the severity of nerve traction injury. However, the extent of nerve injury cannot be differentiated within group of moderate injury with the use of three different traction weights.

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