Abstract
Painful neuroma formation is a common and debilitating sequela of traumatic or oncologic nerve amputations. Studies suggest that isolating transected nerve stumps within protective caps during amputation surgery or revision procedures may assist in preventing symptomatic nerve-end neuroma formation. This study evaluated the local effects of two porcine small intestine submucosa (pSIS) nerve caps of differing configurations on a terminal nerve end in an animal model. The tibial nerves of 57 Sprague Dawley rats were transected and transposed to the lateral hind leg. The nerves were treated with one of three SIS materials, including (i) a nerve cap with spiraling chambering, termed spiral nerve cap (SNC), (ii) a nerve cap with bifurcated chambers termed chambered nerve cap (CNC), or (iii) an open tube. The surgical control consisted of nerve stumps that were not treated. Overall tissue response, axonal swirling, optical density of axons, and behavioral pain response were quantified at 8 and 12 weeks postoperatively. There were no notable differences between the performance of the SNC and CNC groups. The pSIS nerve caps mitigated aberrant axonal regeneration and decreased neuroma formation and associated pain response. These findings suggest that nerve caps with internal chambers for axonal outgrowth may improve axonal alignment, therefore reducing the likelihood of symptomatic neuroma formation.Impact statementThis study provides evidence for using nerve caps with internal structure on nerve stumps after amputation surgeries to reduce or prevent symptomatic neuromas. This study showed that porcine small intestine submucosa had a favorable remodeling profile and tissue response, illustrating that this device can be used to (i) minimize soft tissue attachments around the nerves that are capped, (ii) align axonal outgrowth to guide nerve regeneration away from aberrant neuroma formation, and (iii) act as a barrier between the nerve and external stimuli ultimately remodeling into a new soft tissue layer around the nerve stump thus decreasing symptomatic neuroma formation.
Highlights
Painful neuroma formation is a common and debilitating sequela of traumatic or oncologic nerve amputations
This study showed that porcine small intestine submucosa had a favorable remodeling profile and tissue response, illustrating that this device can be used to (i) minimize soft tissue attachments around the nerves that are capped, (ii) align axonal outgrowth to guide nerve regeneration away from aberrant neuroma formation, and (iii) act as a barrier between the nerve and external stimuli remodeling into a new soft tissue layer around the nerve stump decreasing symptomatic neuroma formation
Neuroma pain is typically characterized by spontaneous hyperalgesia and allodynia, which may endure after complete remodeling of the wound,[5] and this pain can be triggered by external stimuli such as the pressure exerted by a prosthetic.[1]
Summary
Painful neuroma formation is a common and debilitating sequela of traumatic or oncologic nerve amputations. Neuromas result from axonal outgrowth through Schwann cell proliferation ahead of an injury site as the cells attempt to restore axonal continuity of the disrupted nerve end(s). The regenerating axons cannot reach their target tissue and instead form a tangled bulbous mass which causes pain, likely due to pathological interactions between axons within the neuroma[1,2] as well as traction between the nerve and scar tissue or ischemic necrosis of the nervous tissue.[1,3,4]. In this population.[7,8,9] In amputees, painful neuromas can make it difficult to mold a well-fitting prosthesis socket and can prevent successful use of a prosthetic, limiting mobility
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