Original Communications
Clinical application of intraoperative measurement of choline acetyltransferase activity during functioning free muscle transfer*,**

https://doi.org/10.1053/jhsu.2001.26202Get rights and content

Abstract

Intraoperative measurement of choline acetyltransferase (CAT) activity was used for evaluation of the functional status of donor nerves during functioning free muscle transfer (FFMT). Twelve patients underwent the procedure. Seven patients had a brachial plexus injury, 3 Volkmann's contracture, 1 chronic peroneal nerve injury, and 1 forearm extensor muscle loss after wide resection of soft tissue sarcoma. The purpose of reconstruction using FFMT was to achieve wrist extension in 4 patients, simultaneous elbow flexion and finger extension in 3, elbow flexion in 2, finger extension in 1, finger flexion in 1, and ankle extension in 1 patient. The gracilis muscle was transferred in all cases. The donor nerves for FFMT that were evaluated by CAT activity included 5 spinal accessory nerves, 4 posterior interosseous nerves, 2 anterior interosseous nerves, and 1 deep peroneal nerve. Fascicles with greater than 2,000 cpm CAT activity were considered to reliable and used as donor motor nerves. All muscles had reinnervation by 3.2 months (range, 2-5 months) and obtained useful recovery. Intraoperative measurement of CAT activity can provide direct and quantitative information about the functional status of donor nerves during FFMT. (J Hand Surg 2001;26A:645-648. Copyright © 2001 by the American Society for Surgery of the Hand.)

Section snippets

Technique of CAT activity measurement

The formation of acetylcholine labeled with 14C from choline and acetyl-coenzyme A labeled with 14C was used to assess CAT activity.

Each nerve sample was divided into fascicles and tagged with varying lengths of 10-0 monofilament nylon stitches to keep track of the individual fascicles. A 1.5-mm-long specimen was resected from each fascicle; CAT activity was then measured according to the modified method of Engel et al.2 The sample was put into a plastic microtube containing 20 μL buffer A (50

Results

All transferred muscles survived without any postoperative vascular complications. The results of CAT activity in donor fascicles are listed in Table 1. The fascicles that had greater than 2,000 cpm CAT activity were used as donor motor fascicles under our previously described criteria.5 The CAT activity of donor fascicles ranged from 2,094 to 5,499 cpm with a mean activity of 2,832 ± 874 (mean ± SD) cpm. One fascicle was used as a donor motor fascicle in 4 cases and 2 fascicles in 8 cases. All

Discussion

The functional outcome after FFMT depends on the quality of the donor nerves, patient's age, and postoperative complications.8, 9 More motor fascicles in the donor nerves are associated with stronger recovery of the transferred muscle. We preliminarily reported the usefulness of CAT activity measurement in evaluating the functional status of donor nerves when the quality of the donor nerve is in doubt.6 We had hypothesized that the fascicles with CAT activity greater than 2,000 cpm were

References (10)

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    For successful FFMT, the donor nerve must be a pure motor nerve, with no surrounding scar tissue, and ideally with a synergistic function to the muscle the transfer is replacing. If there is any question on the viability of the donor nerve, an intraoperative biopsy should be performed to confirm its health.35 This action is undertaken before the functional muscle is harvested.

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*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

**

Reprint requests: Yasunori Hattori, MD, PhD, Department of Orthopaedic Surgery, Ogori Daiichi General Hospital, 862-3, Shimogo, Ogori, Yoshiki-gun, Yamaguchi, Japan 754-0002.

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