Analysis of an End Neuroma 6 Months after Capping with a Bioresorbable Polycaprolactone Cap (NEUROCAP®) in a Human Model

Power, Dominic; George, Samuel; Pohl, Ute

doi:10.31487/j.scr.2020.01.02

“…6 Second, it is known that capped nerve ends may still form neuromas; consequently, the NEUROCAP is not necessarily the ultimate solution. 10 These neuromas may still be painful, as shown in our case, which may be caused by traction on the neuroma or proximal nerve end (so-called mechanosensitivity). 11 Potential disadvantages of TMR, which include size mismatch and the sacrifice of another nerve, should be kept in mind.…”

Section: Lessonsmentioning

confidence: 53%

Targeted muscle reinnervation for a recurrent traumatic neuroma of the sural nerve: illustrative case

Opijnen¹,

Hazelbag

²

,

Ruiter³

2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Traumatic neuromata often recur after resection. Recently, targeted muscle reinnervation (TMR) has been shown to be a promising alternative for the treatment of traumatic neuroma, also in nonamputees. This case shows that TMR can also be applied for this indication in recurrent traumatic neuroma. OBSERVATIONS A 55-year-old patient with a history of cerebral palsy presented with a painful swelling in his right knee, 40 years after multiple Achilles tendon surgeries for contractures. On imaging, the lesion was suspect for a traumatic neuroma of the posterior sural nerve. After two failed resections, TMR was performed by connecting the proximal end of the sural nerve to the motor branch of the lateral gastrocnemius muscle. During outpatient visits at 3, 6, and 12 months, the patient reported significantly less pain compared to before the TMR. He had no weakness of plantar flexion. Postoperative imaging, however, showed atrophy of the lateral gastrocnemius muscle. LESSONS This case shows that TMR can be a successful strategy to treat recurrent traumatic neuroma after previous failed transection of single neuromata in nonamputee cases. In the authors’ patient, TMR did not result in motor deficit, but more research is needed to investigate this consequence of TMR for this indication.

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“…A peripheral nerve-end capping device, NEUROCAP (Polyganics, Groningen, Netherland), has been clinically used for the treatment of painful amputation neuroma mainly in Europe since 2017. 14,15,31,32 However, no nerve-end capping device is commercially available in Asia, including Japan. Based on the results of the current study, the Nerbridge colla-gen-coated PGA nerve conduit is a promising nerve-end capping device suitable to treat painful amputation neuroma.…”

Section: Discussionmentioning

confidence: 99%

“…14 George et al also demonstrated that nerve-end capping with NEUROCAP was effective in a case of digital end-neuroma. 32 Parker and Merced-O'Neil presented a 49-year-old female treated by capping of the intermetatarsal neuroma with a processed porcine extracellular matrix wrap, Axoguard (AxoGen, FL), the distal open end of which was sealed using MicroClip (Synovis, AL), and implanting it into the intrinsic muscle belly. 13 Our own work presented the first clinical case of a painful digital amputation neuroma of a 49-year-old female successfully treated by nerve-end capping with a collagen nerve conduit, Renreve (Nipro, Osaka, Japan).…”

Section: Discussionmentioning

confidence: 99%

Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report

Onode

¹

,

Uemura

²

,

Hama

³

et al. 2022

J Reconstr Microsurg

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Background The treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation. Methods Forty-seven rats were divided into two groups: no capping (transected nerve stump without capping; n = 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit; n = 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation. Results While autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end. Conclusion Nerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.

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“…A peripheral nerve-end capping device, NEUROCAP (Polyganics, Groningen, Netherland), has been clinically used for the treatment of painful amputation neuroma mainly in Europe since 2017. 14,15,31,32 However, no nerve-end capping device is commercially available in Asia, including Japan. Based on the results of the current study, the Nerbridge collagen-coated PGA nerve conduit is a promising nerve-end capping device suitable to treat painful amputation neuroma.…”

Section: Discussionmentioning

confidence: 99%

Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects

Onode

¹

,

Uemura

²

,

Hama

³

et al. 2022

J Reconstr Microsurg

0

View full text Add to dashboard Cite

Background The treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation. Methods Forty-seven rats were divided into two groups: no capping (transected nerve stump without capping; n = 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit; n = 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation. Results While autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end. Conclusion Nerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.

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Analysis of an End Neuroma 6 Months after Capping with a Bioresorbable Polycaprolactone Cap (NEUROCAP®) in a Human Model

Cited by 4 publications

References 14 publications

Targeted muscle reinnervation for a recurrent traumatic neuroma of the sural nerve: illustrative case

Targeted muscle reinnervation for a recurrent traumatic neuroma of the sural nerve: illustrative case

Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report

Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects

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