A CONTRIBUTION TO THE BIOLOGY OF PERIPHERAL NERVES IN TRANSPLANTATION

In autoplastic transplanted nerves a degenerative process occurs which resembles the ordinary Wallerian degeneration, but appears a little more slowly than the latter. The cells of Schwann are in a condition of survival and are capable of multiplication after the transplantation. In homoplastic transplanted nerves I have found a degenerative process resembling a Wallerian degeneration, somewhat delayed. The cells of Schwann multiply, and for some time at least are in a condition of survival. After twelve to fourteen days an abundant and increasing immigration of lymphocytes is observed, and from the eighteenth day the cells of Schwann develop a necrobiotic appearance. In heteroplastic transplanted nerves numerous myelin ovoids are formed during the first four to five days, but there is no proliferation of the cells of Schwann, and no Wallerian degeneration is seen. The graft becomes necrotic within about two weeks. The formation of ovoids that occurs during the first four to five days after the performance of the heteroplastic transplantation does not reveal the condition of the life of the graft. This formation of myelin ovoids is found in the nerve fibers when they have been kept in an incubator for twenty-four hours in Ringer solution (Nageotte(12)) or in homologous or heterologous serum, but it is not found in the fibers after their incubation in isotonic salt solution (Nageotte), the presence of calcium being necessary for the occurrence of ovoid formation. Heteroplastic transplanted nerves become necrotic. They are unsuitable for bridges in cases of nerve defects, and my results explain the failure of the attempts at heteroplastic transplantation of nerves in human beings. If we wish to bridge a nerve defect by implantation we must use autoplastic or homoplastic grafts. The occurrence of a Wallerian degeneration in these grafts during the first two to three weeks after the transplantation should make bridging a promising operation; for in this period the grafts resemble the peripheral part of a divided nerve and must be assumed to be capable of regeneration, and thus are very different from dead material. I have studied the process of regeneration, and shall communicate in a future article my results of bridging defects, which are encouraging as far as the function is concerned. My results with homoplastic transplantation of nerves have a bearing on the homoplastic transplantation of limbs, which has been successfully performed in dogs by Carrel. None of his dogs lived long enough to show any function of the transplanted leg. The practical value of this operation is dependent, of course, upon the return of function, and especially on the regeneration of the nerves in the transplanted leg. The results with homoplastic transplantation of nerves seem to indicate the possibility of a regeneration of the nerves in a homoplastic transplanted leg.