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The surgical outcome in recurrent chronic nerve compression remains unsatisfactory. Clinically, it has been reported that vein grafts can be used to wrap the nerve, following nerve decompression, to improve the functional recovery of the nerve. In order to determine the safety and feasibility of the technique of vein wrapping of nerve, this study assessed the effect of vein-graft wrapping around normal nerve. In each of 30 rats, a segment of femoral vein was wrapped around the sciatic nerve. Functional, electrophysiologic, and histologic testing was performed at 9, 12 and 15 weeks postoperatively, and the results showed no significant differences between the experimental and control groups. Neither scar tissue between the nerve and the vein graft, nor demyelinization or degeneration of the nerve fibers were identified histologically. The study demonstrated that autogenous vein-graft wrapping did not result in any pathologic nerve entrapment. The technique of vein wrapping of nerve appears to be safe, feasible, and reliable. The results supported further study for the use of vein-graft wrapping in the surgical management of recurrent chronic nerve compression.

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Our case report describes a 60-year-old female patient with a past medical history of Stage IB breast cancer, status post lumpectomy and adjuvant chemotherapy, admitted to our hospital with the chief complaints of fever, myalgia, and muscle weakness. A physical exam revealed proximal muscle weakness and a facial rash. A full workup was done, and the muscle biopsy showed evidence of a necrotizing myopathic process, which confirmed our diagnosis. This led to a diagnosis of necrotizing myopathy, deemed to be paraneoplastic after other possible differentials were ruled out. The patient showed improvement after a five-day course of intravenous immunoglobulin (IVIG) and high-dose steroids. Necrotizing myopathy, as a paraneoplastic process, has been scarcely described. In the context of our case, we review the characteristics and relevant existing literature about paraneoplastic necrotizing myopathy as well as emphasize the need to include it as a differential in the setting of malignancy.