Neurocap Use for the Treatment of Iatrogenic Neuropathic Pain: Preliminary Operative Results in 3 Patients

Ru, J. Alexander de; Thomeer, Hans G. X. M.; Tijink, Bernard M.; Doormaal, Tristan P.C. van

doi:10.1177/0145561320912048

“…31 de Ru et al documented the treatment of three patients who underwent transection of the causative nerves, including two greater auricular nerves and a supraorbital nerve, followed by capping of their nerve ends with a NEUROCAP, which resulted in a marked reduction in pain scores. 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 49year-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.…”

Section: Discussionmentioning

confidence: 99%

“…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

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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 colla-gen-coated PGA nerve conduit is a promising nerve-end capping device suitable to treat painful amputation neuroma.…”

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

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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“…Recently, nerve capping treatment using several bioabsorbable nerve conduits has been introduced for painful amputation neuromas, mainly in animal studies and partly in clinical cases [14][15][16][17][18][19][20]. Surgical removal of the neuroma and capping the resected nerve stump with a nerve conduit could reduce the development of a symptomatic end-neuroma, protecting the nerve end from the surrounding scarring [17,18].…”

Section: Introductionmentioning

confidence: 99%

“…More recently, Neurocap (Polyganics, Groningen, Netherlands) has been commercially available as a peripheral nerve capping device for the surgical treatment of neuromas in Europe and clinically provides significant pain relief [16]. Neurocap is a bioabsorbable This study aimed to investigate the effectiveness of nerve capping with the closed-end version of the nerve conduit, which is commercially available, using a rat sciatic nerve amputation model, focusing on neuropathic pain, histological scar formation, and neuroinflammation.…”

Section: Introductionmentioning

confidence: 99%