Prevention of painful neuromas by oblique transection of peripheral nerves

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Object

Neuroma formation often occurs at the proximal stump of the transected nerve, complicating the healing process after gap injuries or nerve biopsies. Most such neuromas cause therapy-resistant neuropathic pain. The purpose of this study was to determine whether oblique transection of the proximal stump of the sciatic nerve can prevent neuroma formation.

Methods

The sciatic nerves of 10 rats were transected unilaterally at an angle of 30°, and the peripheral segments of the nerves were removed. In 10 control animals the sciatic nerves were transected at a perpendicular angle. Twenty weeks after surgery the nerves were reexposed and collected. The presence of neuromas was determined by two board-certified pathologists on the basis of histopathological evaluations.

Conclusions

The oblique transection of peripheral nerves, contrary to perpendicularly transected nerves, is rarely followed by classic neuroma development. Moreover, neuropathic pain is significantly reduced compared with that following the traditional method of nerve transection.

Abbreviations used in this paper: OT = obliquely transected; PT = perpendicularly transected.

Article Information

Address reprint requests to: Wieslaw Marcol, M.D., Ph.D., Department of Physiology, Medical University of Silesia, ul. Medyków 18, 40-752 Katowice, Poland. email: Vie@alpha.net.pl.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Schematic depicting cutting of the nerve trunk at a 30° angle. F = fibrin glue.

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    Photomicrographs featuring transverse sections of neuromas. Collagen appears slightly blue in tissues from the PT (A and B) and OT (C and D) groups. Note the better arrangement of the regenerating nerve tissue and significantly less scar tissue, especially in the central part of the neuroma in the OT group (peripheral part of the regenerating nerve [arrow]). H & E (A and C), Masson trichrome (B and D). Original magnification × 200.

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