Autologous Muscle-Derived Nerve Wrap for Prevention of Symptomatic Microneuromas in Primary Nerve Repair.

William J Bruce,Brian A Mailey,Amanda L Brown,Michael R Romanelli

doi:10.7759/cureus.22513

Abstract

Regeneration of peripheral nerves after repair is incomplete. Painful microneuromas may form at the site of an appropriately performed primary microsurgical nerve repair leading to a persistent Tinel’s sign and hypersensitivity in that location. Here, we describe an autologous option using a free muscle-derived nerve wrap with the intent to capture axonal escape at the site of primary nerve coaptation. We demonstrate this technique on a patient undergoing primary nerve repair of a laceration to the superficial branch of the radial nerve using extensor digitorum communis muscle as a donor graft. This has become our preferred technique over commercially available nerve wraps as the muscle wrap is autologous, not limited by cost, and has the potential to limit microneuroma formation at the coaptation site.

Highlights

Peripheral nerve injuries are common and diagnosed between 1% and 5% of patients treated for traumatic injuries [1]
Each coaptation site experiences a 30-50% reduction in axon count distal to the neurorrhaphy [2]. This decrease in axon density is thought to result from perineural scarring, decreased Schwann cell activity, and “axon escape”- better described as misdirected axon sprouting - all of which impede distal axon growth and signal transduction and can lead to the formation of painful neuromas [3]
Commercial nerve wraps can be used as an adjunct to primary repair and are intended to decrease perineural scarring and improve distal axon regeneration resulting in better distal functional recovery [3,5]

Summary

Introduction

Peripheral nerve injuries are common and diagnosed between 1% and 5% of patients treated for traumatic injuries [1]. Commercial nerve wraps can be used as an adjunct to primary repair and are intended to decrease perineural scarring and improve distal axon regeneration resulting in better distal functional recovery [3,5] These wraps are not demonstrated to prevent the formation of neuropathic pain at the coaptation site. We present the biologic autologous muscle-derived nerve (BAM)-wrap intended for use at the time of nerve repair when donor muscle is available within the surgical field This technique can stabilize and prevent tension at the repair and may limit painful and hypersensitive microneuromas by drawing on the effectiveness of RPNIs for the prevention of neuroma formation. A local muscle is harvested, trimmed to the appropriate size, and fashioned into a cuff around the coaptation site

Discussion

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Findings

Disclosures