Prevention and treatment of amputation neuroma by an atelocollagen tube in rat sciatic nerves

Sakai, Yasuo; Ochi, Mitsuo; Uchio, Yuji; Ryoke, Koji; Yamamoto, Sachiko

doi:10.1002/jbm.b.30219

Cited by 30 publications

(35 citation statements)

References 22 publications

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“…However, no studies have yet to convincingly confirm whether or not the observed behavior is directly related to pain [15]. Although quantitative assessment of tactile allodynia [37] or thermal hyperalgesia [38] in the rat paw is a simple method to assess the neuropathic pain in the current study, the presence of autotomy precludes this approach.…”

Section: Discussionmentioning

confidence: 86%

“…Although quantitative assessment of tactile allodynia [37] or thermal hyperalgesia [38] in the rat paw is a simple method to assess the neuropathic pain in the current study, the presence of autotomy precludes this approach. Therefore, the common pain-related markers, c-fos [15], [39] and substance P [40], [41], were then selected to evaluate the pain status of the neuromas. Our findings in this study showed that the expression of c-fos in the dorsal horn of L4 spinal cord was significantly decreased in the capping group compared to the no-capping group both at 2 weeks and 8 weeks after neurectomy; on the other hand, the substance P release was also inhibited in the neuromas of the capping group when compared with that of the no-capping group.…”

Section: Discussionmentioning

confidence: 99%

“…However, its usage is limited by the size of available veins [9]. Therefore, a variety of synthetic materials have been developed for this purpose [10]–[15]. It is speculated that the nerve capping technique allows for epineurial healing over the severed fascicles within the chamber, lessening improperly and irregularly regenerating nerve fibers, thus preventing the formation of traumatic neuromas.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

et al. 2014

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Nerve capping techniques have been introduced as a promising treatment modality for the treatment of painful neuroma with varied outcomes; however, its exact mechanism is still unknown. RhoA is one of the members of the RAS superfamily of GTPases that operate as molecular switches and plays an important role in peripheral nerve regeneration. Our aim was to investigate the structural and morphologic mechanisms by which the nerve capping technique prevents the formation of painful neuromas after neuroectomy. We also hoped to provide a theoretical basis for this treatment approach. An aligned nanofiber conduit was used for the capping procedure and the sciatic nerve of Sprague-Dawley rats was selected as the animal model. Behavioral analysis, extent of neuroma formation, histological assessment, expressions of pain markers of substance P and c-fos, molecular biological changes as well as ultrastructural features were investigated and compared with the findings in a no-capping control group. The formation of traumatic neuromas was significantly inhibited in the capping group with relatively “normal” structural and morphological features and no occurrence of autotomy and significantly lower expression of pain markers compared to the no-capping group. The gene expression of RhoA was consistently in a higher level in the capping group within 8 weeks after surgery. This study shows that capping technique will alter the regeneration state of transected nerves and reduce painful neuroma formation, indicating a promising approach for the treatment of painful neuroma. The initiation of the “regenerative brake” induced by structural as well as morphological improvements in the severed nerve is theorized to be most likely a key mechanism for the capping technique in the prevention of painful neuroma formation.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

et al. 2014

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“…Recently, various laser methods were proved to be effective in such prevention of neuroma development 19. Nerve fibers outgrow can be also hindered pharmacologically,20 by systemic application of melatonin,21 or local application of atelocollagen or alginate around sectioned nerve 22. Other methods, like epineural flap technique to cap the proximal nerve stump, are seldom but still used in the surgical practice 16.…”

Section: Discussionmentioning

confidence: 99%

Reduction of post‐traumatic neuroma and epineural scar formation in rat sciatic nerve by application of microcrystallic chitosan

et al. 2011

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Injury of peripheral nerve is associated with the development of post-traumatic neuroma at the end of the proximal stump, often being the origin of neuropathic pain. This type of pain is therapy-resistant and therefore extremely nagging for patients. We examined the influence of the microcrystallic chitosan gel applied to the proximal stump of totally transected sciatic nerve on the neuroma formation and neuropathic pain development in rats. In 14 rats, right sciatic nerve was transected and the distal stump was removed to avoid spontaneous rejoining. In the chitosan (experimental) group (n = 7), the proximal stump was covered with a thin layer of the microcrystallic chitosan gel. In control animals (n = 7), the cut nerve was left unsecured. Autotomy, an animal model of neuropathic pain, was monitored daily for 20 weeks following surgery. Then, the animals were perfused transcardially and the proximal stumps of sciatic nerves were dissected and subjected to histologic evaluation. The presence, size, and characteristics of neuromas as well as extraneural fibrosis were examined. In chitosan group, the incidence and the size of the neuroma were markedly reduced, as compared with the control group; however, there was no difference in autotomy behavior between groups. In addition, extraneural fibrosis was significantly reduced in chitosan group when compared to the control group. The results demonstrate beneficial influence of microcrystallic chitosan applied to the site of nerve transection on the development of post-traumatic neuroma and reduction of extraneural fibrosis, however without reduction of neuropathic pain.

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“…New methods and techniques in nerve surgery such as collagen nerve guides and tubes are being studied for the treatment of painful neuromas [15,16]. Up to now these techniques have been applied in animal experiments with encouraging results but as yet no clinical work has been published.…”

Section: Discussionmentioning

confidence: 99%

Painful neuroma – mid-term results of resection and nerve stump transposition into veins*

Koch

2011

Eur Surg

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Background: Modification of the milieu around the nerve stump to prevent recurrent neuroma formation after resection of a painful neuroma is one of the treatment modalities for this condition. Good shortterm results have been reported for nerve stump transplantation into veins but long-term results for this method are lacking.Methods: Twenty-five patients were included in this retrospective study after neuroma resection and nerve stump transplantation into veins. In 17 cases, neuromas were treated on the upper extremity, in eight cases on the lower extremity. Pre-and postoperative subjective painrelated impairment in daily life was evaluated using a four-grade scale. Pain on percussion was assessed using a visual analogue scale (VAS, 10 grades). Subjective acceptance of the procedure was quantified with a four-grade scale. Average follow-up was 43.6 months.Results: A reduction of subjective pain-related impairment in daily life from 3.12 to 1.56 (average) was achieved, as was a significant decrease of pain on percussion. Subjective acceptance of surgery averaged 1.6.Conclusions: To date, there is a paucity of data on mid-and long-term results of surgical treatment of painful neuroma. Our mid-term results of neuroma resection and transposition of the nerve stump into veins are favourable and encouraging. Our data also indicate that the results do not deteriorate with time. Furthermore, our mid-term results compare favourably with the results of other treatment options. This treatment modality is relatively fast and easy to perform for experienced microsurgeons and gives good results in a difficult group of patients.

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Prevention and treatment of amputation neuroma by an atelocollagen tube in rat sciatic nerves

Cited by 30 publications

References 22 publications

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Reduction of post‐traumatic neuroma and epineural scar formation in rat sciatic nerve by application of microcrystallic chitosan

Painful neuroma – mid-term results of resection and nerve stump transposition into veins*

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