End-to-Side Anastomosis of Transected Nerves to Prevent Neuroma Formation

Low, C. K.; Chew, Sung Hock; Song, In Chin; Ng, Teck Hin; Low, Y P

doi:10.1097/00003086-199912000-00034

Cited by 26 publications

(27 citation statements)

References 7 publications

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“…Apart from these findings we did not detect neuromatous signs on proximal peroneal nerve endings within end-to-side repair regions, which were thought to be potential sites for neuroma development, and also at proximal tibial nerve endings in group V. Our Figure 8 Appearance of neuroma at the cross-section from the proximal tibial nerve in group VI (×24,000, EM). findings, which are in compliance with those of previous studies mentioned in literature [2,3,10,13,15], reinforce evidences related to effectiveness of end-to-side neurorrhaphy of proximal nerve stump to the adjacent nerve in the management of neuroma, thanks to axonal transport achieved within this region.…”

Section: Discussionsupporting

confidence: 92%

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Ayan¹,

Bora²,

Karakaplan

et al. 2007

Hand (New York, N,Y.)

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Objective Neuroma is a psychologically and physically disabling problematic condition without any current standard therapy. For that reason, we investigated whether endto-side anastomosis of the proximal end of the transected nerve into the adjacent nerve will prevent the development of neuroma in different types of nerve injuries. Study design In this study, hind legs of 18 Sprague-Dawley female rats were used. Six groups were formed. In group I, peroneal nerves were transected and its proximal end was attached end-to-side through the epineural window to the adjacent tibial nerve. In group II, contrary to group I, an epineural window was created in the tibial nerve and the same number of sutures were employed. In group III, tibial nerve was transected proximal to the end-to-side repair site, whereas in group IV, distal segment of the nerve was cut, and an end-to-end repair procedure was repeated. In group V, unlike group I, an approximately 1-cm segment was resected and removed distal (from tibial nerve) to the endto-side repair site. In group VI, an epineural window was created in the tibial nerve and the same number of sutures were used, and also a 1-cm distal nerve segment was resected. The rats were followed for 2 months, and then all of the groups were evaluated histopathologically, and weights of the posterior muscle groups of hind legs were evaluated. Findings and Conclusions No neuroma formation was observed in the proximal stumps of peroneal nerve segments in end-to-side repair sites in groups I, III, IV, and V, and proximal stumps of the tibial nerve in group V. In group VI, neuroma formation was observed in the proximal end of the tibial nerve. When weights of the posterior muscle groups of hind legs in groups I and II were comparatively assessed, statistically significant difference HAND (2007) was not detected. In conclusion, based on histological data obtained for proximal nerve ends and segments distal to the end-to-side repair sites, we think that end to side neurorrhaphy of the proximal end of the damaged nerve to adjacent nerve will prevent the development of neuroma without injuring the intact nerve segment.

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Section: Discussionsupporting

confidence: 92%

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Ayan¹,

Bora²,

Karakaplan

et al. 2007

Hand (New York, N,Y.)

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“…Recent research in the rehabilitation literature has focused on amputation-related quality of life adjustment predictors such as perceived social stigma and body image (6). The adjustment required to adapt to the loss of a limb is a complicated psychological phenomenon beyond the scope of this review.…”

Section: Discussionmentioning

confidence: 99%

The combined plastic surgery/physical medicine and rehabilitation amputee clinic at the University of Western Ontario

Neinstein¹,

Death²

2008

Plastic Surgery

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R Neinstein, AB Death, BS Gan. The combined plastic surgery/physical medicine and rehabilitation amputee clinic at the University of Western Ontario. Can J Plast Surg 2008;16(1):23-26.Since the autumn of 2001, a multidisciplinary plastic surgery (PS) and physical medicine and rehabilitation (PMR) outpatient amputee clinic has been in place at St Joseph's Health Centre/Parkwood Hospital in London, Ontario. To date, more than 140 new patients have been seen in combined consultations. The present paper reviews the demographics, interventions and outcomes of the patients seen between 2001 and 2005. The majority of primary PMR patients had problems that prevented optimal use of their lower extremity prostheses. These problems included nonhealing pressure ulcers, infections, painful neuromas, amputation stump shape abnormalities and fixed joint contractures. Most patients had surgical intervention. In terms of overall clinical success, 53% of the PMR patients and 77% of the PS patients had their problems resolved. The multidisciplinary collaboration in the PS/PMR outpatient amputee clinic provides a unique service that benefits upper and lower extremity amputees. T he fundamental principle of plastic surgery (PS) is to restore form and function. Thus, it seems logical that plastic surgeons should be involved with those who have absence of form, such as amputee patients. Many of the problems associated with amputation are related to the shape of the stump, which often requires soft tissue rearrangement. Other stump problems include osteocutaneous adhesions, bony prominences, poor soft tissue coverage or redundant skin, and chronic wounds. Despite an almost natural fit with PS, most amputee care is provided by specialists in physical medicine and rehabilitation (PMR) and not by plastic surgeons. To our knowledge, there is no previous description of a combined PS and PMR clinic devoted to treating amputee patients. At the University of Western Ontario, London, Ontario, such a combined clinic was established in the autumn of 2001. While initially a bimonthly clinic, the demand rose quickly and the clinic became a monthly occurrence. The purpose of the present paper is to review the operative and nonoperative contributions plastic surgeons can make to an amputee clinic and to review the benefits of the multidisciplinary PS/PMR outpatient amputee clinic at the Parkwood Rehabilitation Hospital, University of Western Ontario. METHODSRetrospective data were collected on all patients seen in the combined PS/PMR outpatient amputee clinic at St Joseph's Health Centre/Parkwood Rehabilitation Hospital between autumn 2001 and summer 2005. Demographic data, including clinical problems and questions, number of visits, type of intervention, outcome and complications, were reviewed. Only patients who had a treatment plan instituted (either nonoperative or operative) were included. Patients who were seen within the study period but had no treatment instituted at the time of the review were not included. Treatment success (whether surgica...

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Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Furthermore, it has been suggested that collagen scar formation at the cut end of the nerve obstructs sprouting of axons into appropriate distal fascicles, and thereby limits nerve regeneration. 1,2,[5][6][7] However, research attempting to inhibit collagen accumulation in neuroma formation has been of limited functional success. 1,2,[5][6][7][8] Importantly, it has been reported that melatonin decreases wound collagen content, and removing the pineal gland increases collagen content, which can be reversed by melatonin adminstration following pinealectomy.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,[5][6][7] However, research attempting to inhibit collagen accumulation in neuroma formation has been of limited functional success. 1,2,[5][6][7][8] Importantly, it has been reported that melatonin decreases wound collagen content, and removing the pineal gland increases collagen content, which can be reversed by melatonin adminstration following pinealectomy. [9][10][11][12][13] Transforming growth factor (TGF)-b, from a family of regulatory polypeptides, is involved in many vital processes including inflammation and wound healing.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Immunohistochemical profile of transforming growth factor-β1 and basic fibroblast growth factor in sciatic nerve anastomosis following pinealectomy and exogenous melatonin administration in rats

Turğut

Öktem

Uysal

et al. 2006

Journal of Clinical Neuroscience

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End-to-Side Anastomosis of Transected Nerves to Prevent Neuroma Formation

Cited by 26 publications

References 7 publications

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

Effect of End-to-Side Repair of Proximal Nerve Stumps of Transected Peripheral Nerves on the Development of Neuroma (Experimental Study)

The combined plastic surgery/physical medicine and rehabilitation amputee clinic at the University of Western Ontario

Immunohistochemical profile of transforming growth factor-β1 and basic fibroblast growth factor in sciatic nerve anastomosis following pinealectomy and exogenous melatonin administration in rats

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