Morphological Foundations of Restoration of Motor Innervation in Injuries of Peripheral Nerves

The problem of restoration of motor innervation is considered to be challenging due to a significant proportion of the peripheral nerve damage in the general structure of peacetime and wartime injuries, as well as a high risk of permanent function loss of the affected limb. Injuries of the peripheral nerves result in a complex of pathophysiological processes from both – the side of damaged nerve stems and the side of denervated target tissues. Moreover, the morphological picture of tissue changes is both degenerative and regenerative simultaneously. The process of secondary degeneration of the distal segments of crossed axons is similar to aseptic inflammation and is a prerequisite for the subsequent regeneration of nerve fibers. The process of reinnervation of the distal segment of the crossed nerve stem has a certain similarity with the development of peripheral nerves in the embryonic period, but the branches of regenerating axons move in the distal direction along the preserved neuriluminal tubes. A prolonged absence of motor innervation causes pronounced dystrophic changes in muscle fibers and intercellular spaces filling with the fibrous connective tissue; this, in turns, may result in a lack of functional limb restoration even if the terminal branches of the damaged nerve are adequately reinnervated. The restoration of contractile activity of reinnervated muscles is morphologically determined by the functional hypertrophy of the preserved muscle fibers, since the complete restoration of the innervation of all muscle fibers is practically not achievable due to the peculiarities of the peripheral nerve suture technique and the patterns of nerve fiber regeneration. Thus, an understanding of the patterns and morphological manifestations of degenerative-regenerative processes in tissues with injuries of peripheral nerves will allow substantiating the need for reconstructive plastic interventions on nerve stems from morphological points of view, based on the possibilities of achieving significant functional results.

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