A Photosealed Cap Prevents Disorganized Axonal Regeneration and Neuroma following Nerve Transection in Rats

Scott, Benjamin B.; Wu, Ruby C.; Nietlispach, Viviane; Randolph, Mark A.; Redmond, Robert W.

doi:10.1097/gox.0000000000004168

Cited by 7 publications

(8 citation statements)

References 46 publications

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“…Furthermore, 17 of the 18 specimens had no regeneration of nerve fibers at the 60-day follow-up, demonstrating that this novel method significantly hinders axonal regeneration. As noted by Scott et al, 55 a major benefit of photo-sealing is that the procedure does not require epineurial sutures; the use of sutures inevitably causes trauma to the epineurium and may allow for axonal escape and regeneration, leading to failure of the nerve caps. In addition, they note that sutures may lead to a foreign body response with increased inflammation and fibrosis, which could contribute to neuralgia.…”

Section: Discussionmentioning

confidence: 99%

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Nerve Capping Techniques for Neuroma Management

Sisti,

Uygur,

Lopez-Schultz

et al. 2023

Ann Plast Surg

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Background/Aim of the Study Nerve capping is a method of neuroma treatment or prevention that consists of the transplantation of a proximal nerve stump into an autograft or other material cap, after surgical removal of the neuroma or transection of the nerve. The aim was to reduce neuroma formation and symptoms by preventing neuronal adhesions and scar tissue. In this narrative literature review, we summarize the studies that have investigated the effectiveness of nerve capping for neuroma management to provide clarity and update the clinician's knowledge on the topic. Methods A systematic electronic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was performed in the PubMed database combining “neuroma,” “nerve,” “capping,” “conduit,” “treatment,” “management,” “wrap,” “tube,” and “surgery” as search terms. English-language clinical studies on humans and animals that described nerve capping as a treatment/prevention technique for neuromas were then selected based on a full-text article review. The data from the included studies were compiled based on the technique and material used for nerve capping, and technique and outcomes were reviewed. Results We found 10 applicable human studies from our literature search. Several capping materials were described: epineurium, nerve, muscle, collagen nerve conduit, Neurocap (synthetic copolymer of lactide and caprolactone, which is biocompatible and resorbable), silicone rubber, and collagen. Overall, 146 patients were treated in the clinical studies. After surgery, many patients were completely pain-free or had considerable improvement in pain scores, whereas some patients did not have improvement or were not satisfied after the procedure. Nerve capping was used in 18 preclinical animal studies, using a variety of capping materials including autologous tissues, silicone, and synthetic nanofibers. Preclinical studies demonstrated successful reduction in rates of neuroma formation. Conclusions Nerve capping has undergone major advancements since its beginnings and is now a useful option for the treatment or prevention of neuromas. As knowledge of peripheral nerve injuries and neuroma prevention grows, the criterion standard neuroprotective material for enhancement of nerve regeneration can be identified and applied to produce reliable surgical outcomes.

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Section: Discussionmentioning

confidence: 99%

“…Scott et al 55 also investigated the use of autologous vein capping in a rat model. Specifically, they investigated a photo-sealing method to secure the caps, rather than relying on sutures to hold the caps in place.…”

Section: Discussionmentioning

confidence: 99%

Nerve Capping Techniques for Neuroma Management

Sisti,

Uygur,

Lopez-Schultz

et al. 2023

Ann Plast Surg

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“…14 Although further studies would be needed, it is not unreasonable to expect that the difference in strength between PTB and suture-repaired nerves would diminish over time, especially given that PTB repairs are able to accelerate regeneration. 10 15 Another consideration in regard to the interpretation of the biomechanical properties of the PTB repairs is where the strain is placed along the nerve during stressing of suture and PTB repairs. In suture repairs, the nerve directly attached to either side of the repair site (<1 mm) is stretched when the entire nerve is stretched.…”

Section: Discussionmentioning

confidence: 99%

Photochemical Tissue Bonding of Amnion Allograft Membranes for Peripheral Nerve Repair: A Biomechanical Analysis

King,

McGuire,

Bejar-Chapa

et al. 2023

J Reconstr Microsurg

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Background Photochemical tissue bonding (PTB) is a technique for peripheral nerve repair in which a collagenous membrane is bonded around approximated nerve ends. Studies using PTB with cryopreserved human amnion have shown promising results in a rat sciatic nerve transection model including a more rapid and complete return of function, larger axon size, and thicker myelination than suture repair. Commercial collagen membranes, such as dehydrated amnion allograft, are readily available, offer ease of storage, and have no risk of disease transmission or tissue rejection. However, the biomechanical properties of these membranes using PTB are currently unknown in comparison to PTB of cryopreserved human amnion and suture neurorrhaphy. Methods Rat sciatic nerves (n = 10 per group) were transected and repaired using either suture neurorrhaphy or PTB with one of the following membranes: cryopreserved human amnion, monolayer human amnion allograft (crosslinked and noncrosslinked), trilayer human amnion/chorion allograft (crosslinked and noncrosslinked), or swine submucosa. Repaired nerves were subjected to mechanical testing. Results During ultimate stress testing, the repair groups that withstood the greatest strain increases were suture neurorrhaphy (69 ± 14%), PTB with crosslinked trilayer amnion (52 ± 10%), and PTB with cryopreserved human amnion (46 ± 20%), although the differences between these groups were not statistically significant. Neurorrhaphy repairs had a maximum load (0.98 ± 0.30 N) significantly greater than all other repair groups except for noncrosslinked trilayer amnion (0.51 ± 0.27 N). During fatigue testing, all samples repaired with suture, or PTBs with either crosslinked or noncrosslinked trilayer amnion were able to withstand strain increases of at least 50%. Conclusion PTB repairs with commercial noncrosslinked amnion allograft membranes can withstand physiological strain and have comparable performance to repairs with human amnion, which has demonstrated efficacy in vivo. These results indicate the need for further testing of these membranes using in vivo animal model repairs.

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“…14 Since the initial description of silicone nerve capping by Tupper and Booth, various biocompatible materials have been described, including acellular nerve allografts, porcine small intestinal submucosa, polygycolic acid conduit, and photosealed caps with human amniotic membrane or autologous vein. 12,[43][44][45] While an ideal material for nerve capping has yet to be firmly established, the utility of nerve capping in preventing neuroma formation has been increasingly established in the literature. 14,15,[36][37][38] These include early human applications via lactide and caprolactone copolymers (NEUROCAP; Polyganics) 46,47 currently undergoing clinical trials (NCT02993276).…”

Section: Nerve Cappingmentioning

confidence: 99%

The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports

Hwang,

Chegireddy,

Remy

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain. Methods: The technical feasibility of nerve capping after GON/LON transection was evaluated in cadaver dissections and intraoperatively. Patient-reported outcomes in the 3- to 4-month period were compiled from clinic visits. At 1-year follow-up, subjective outcomes and Migraine Headache Index scores were tabulated. Results: Two patients underwent nerve capping as a treatment for headaches refractory to medical therapy and surgical decompressions with significant improvement to total resolution of pain without postoperative complications. These improvements on pain frequency, intensity, and duration remained stable at a 1-year time point (Migraine Headache Index score reductions of –180 to –205). Conclusions: Surgeons should be equipped to address the proximal nerve stump to prevent neuroma and neuropathic pain recurrence. Next to known contemporary nerve reconstruction techniques such as targeted muscle reinnervation/regenerative peripheral nerve interface and relocation nerve grafting, nerve capping is another viable method for surgeons to address the proximal nerve stump in settings of GON and LON pain. This option exhibits short operative time, requires only limited dissection, and yields significant clinical improvement in pain symptoms.

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A Photosealed Cap Prevents Disorganized Axonal Regeneration and Neuroma following Nerve Transection in Rats

Cited by 7 publications

References 46 publications

Nerve Capping Techniques for Neuroma Management

Nerve Capping Techniques for Neuroma Management

Photochemical Tissue Bonding of Amnion Allograft Membranes for Peripheral Nerve Repair: A Biomechanical Analysis

The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports

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