The Role of an Aligned Nanofiber Conduit in the Management of Painful Neuromas in Rat Sciatic Nerves

Abstract

Our findings indicate that the aligned nanofiber conduit is a promising biomaterial for the nerve capping technique, and new treatment strategies using aligned nanofiber conduits may be developed for the management of painful amputated neuromas.

Application of a Porcine Small Intestine Submucosa Nerve Cap for Prevention of Neuromas and Associated Pain

“…To obtain a histological correlate of neuroma formation, optical density measurements of the regenerating nerve stumps were performed. 11 There is an inverse relationship between axon density and collagen, therefore, a decrease in axonal optical density measurements is indicative of increased collagen deposition and associated neuroma formation. At 8 weeks, there were no significant differences between the groups.…”

“…10 These standard treatments include surgical methods to remove neuromas or pharmacological therapies directed at pain management. The current standard of care for surgical management of symptomatic neuromas involves either traction neurectomy, which has a high rate of neuroma recurrence, 11,12 or burying the nerve stump into adjacent muscle or bone. 12 While burying the nerve stump in adjacent tissue mitigates external stimulation that causes painful sensation, this procedure can greatly complicate surgery as additional dissection of otherwise healthy tissue is required to secure the nerve stump.…”

“…Another technique that has grown in popularity that also allows for aligned axonal outgrowth involves suturing a long nerve graft, conduit, or cap on to the end of the nerve stump. 11,20 While these techniques have been effective, nerve grafting and conduits do not protect the nerve end from the external environment, which includes growth factors that promote axon growth. Therefore, over time the axons can grow in an aligned manner all the way through the graft or conduit and then form a neuroma as they exit the open distal end where there is no longer a structure to help facilitate aligned growth.…”

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

“…20 Yan et al, in 2 studies, had good outcomes by suturing the sciatic nerve 4 mm into a 1.5-cm long nanofiber conduit. 21,22 We think that there may be differences in the indications for when to use a conduit (in case outgrow of the nerve in an appropriate manner is needed) or to use a cap (to prevent outgrow-like in our cases).…”

“…[9][10][11] Moreover, a variety of materials were developed for capping purposes. [12][13][14] However, a paucity of evidence exists to support one method over the other. This is partly due to the fact that the reporting of outcomes varied widely across the studies.…”