The Treatment of Painful Neuroma on the Lower Extremity by Resection and Nerve Stump Transplantation Into a Vein

Koch, Horst; Hubmer, Martin; Welkerling, Heike; Sandner‐Kiesling, Andreas; Scharnagl, E.

doi:10.1177/107110070402500706

Cited by 40 publications

(35 citation statements)

References 31 publications

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“…Various techniques have been described to minimize neuroma formation with variable outcomes [4]–[7]. To date, the most promising and practical method of neuroma treatment has been surgical removal and transplantation of the nerve stump into a vein, the so-called nerve capping technique [4], [8]. However, its usage is limited by the size of available veins [9].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

et al. 2014

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“…Transection of a peripheral nerve may result in the formation of a painful neuroma and numerous surgical strategies have been proposed to prevent this occurrence. 3 In particular, previous evidences 12,14,15,20 have been published suggesting that veins could be used to prevent neuroma formation, and it has been demonstrated that burying transected nerve stumps into an adjacent vein left in place was an effective method in preventing neuroma formation.…”

Section: Discussionmentioning

confidence: 99%

“…Nerve covering can be obtained either by burying the nerve stump into a nearby anatomic structure or by capping it with either biological or synthetic material. [7][8][9][10][11][12][13][14][15][16][17][18][19] Among the various attempts, burying of the nerve stump into an adjacent vein have been tested both experimentally 12,15,20 and with patients 10,11,13,14,21 with promising results. Vein tissue are used in nerve surgery also in case of nerve defects where free vein grafts can be used as conduits for bridging the gap.…”

mentioning

confidence: 99%

A free vein graft cap influences neuroma formation after nerve transection

et al. 2009

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: Our results confirm that vein-covering of a transected nerve stump can be effective in reducing neuroma formation. Moreover, unlike previous works that buried the nerve into an adjacent vein left in place, our experiments showed that also the use of a free vein graft cap can hinder neuroma formation. Although translation of rat experiments to the clinics should be dealt with caution, our data suggest a careful clinical use of the technique. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.

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“…Among those studies presenting short-term results, there were three on neuroma resection and transposition of the proximal nerve stump into the lumen of a vein [2][3][4]. An experimental study and two of the clinical studies on this technique were published by the author [3][4][5].…”

Section: Introductionmentioning

confidence: 97%

“…An experimental study and two of the clinical studies on this technique were published by the author [3][4][5]. This retrospective study was conducted to evaluate the mid-term results of this method in part of the same patient group.…”

Section: Introductionmentioning

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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The Treatment of Painful Neuroma on the Lower Extremity by Resection and Nerve Stump Transplantation Into a Vein

Cited by 40 publications

References 31 publications

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

Mechanisms of Nerve Capping Technique in Prevention of Painful Neuroma Formation

A free vein graft cap influences neuroma formation after nerve transection

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

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