Use of Collagen Conduits in Management of Painful Neuromas of the Foot and Ankle

Gould, John; Naranje, Sameer; McGwin, Gerald; Florence, Mason N.; Cheppalli, Suresh

doi:10.1177/1071100713478927

“…Studies have demonstrated that inhibition of neuroma growth benefited the treatment and prevention of neuropathic pain in the management of traumatic painful neuromas 26 27 28 29 . In part II of this study, a lower WR in the SB-431542 group seemingly contributed to deceased severity of pain and a higher WR in the GW9662 group resulted in a higher pain status.…”

Section: Discussionmentioning

confidence: 99%

Significance of alpha smooth muscle actin expression in traumatic painful neuromas: a pilot study in rats

Weng

¹

,

Zhao

²

,

Lin

³

et al. 2016

Sci Rep

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Treatment of painful neuromas remains a challenge and the mechanism of neuroma-associated pain is not yet fully understood. In this study, we aimed to observe the expression of alpha smooth muscle actin (α-SMA) in traumatic neuromas and to investigate its possible roles in the cause of neuropathic pain in a rat model. The rat sciatic nerve was used and the experiment was divided into two parts. In part I, our results showed significantly higher levels of α-SMA and the pain marker c-fos in the autotomy group than in the no-autotomy group. In part II, the expression of α-SMA in neuromas was down- and up-regulated using SB-431542 and GW9662, respectively. A significant correlation between autotomy scores and the expression level of α-SMA was found (R = 0.957; p < 0.001) and the expression level of α-SMA was positively related to the autotomy scores (R2 = 0.915, p < 0.001). We concluded that the expression of α-SMA plays certain roles in the neuroma-associated pain, either as a direct cause of pain or as an indirect marker of existence of local mechanical stimuli. Our findings may provide new insights into the development of new treatment modalities for the management of intractable painful neuromas.

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“…12 13 14 15 Gould et al reported on 69 painful neuromas of the foot and ankle in 50 patients treated with simple excision of the neuroma and capping of the resected nerve stump with a collagen conduit, Neuroflex (Stryker, NJ). 12 de Vrij et al reported 10 patients having end-neuromas of 8 superficial radial nerves and 2 median nerves treated by the capping device, NEUROCAP, with 12 months of follow-up. 31 de Ru et al documented the treatment of three patients who underwent transection of the causative nerves, including two greater auricular nerves and a supraorbital nerve, followed by capping of their nerve ends with a NEUROCAP, which resulted in a marked reduction in pain scores.…”

Section: Discussionmentioning

confidence: 99%

“…11 Moreover, the nerve-end capping technique using a bioabsorbable nerve conduit has been newly developed for treating painful amputation neuroma, both in basic animal studies and clinical cases; this method serves to protect a peripheral nerve stump from surrounding scarring to reduce the development of a symptomatic end-neuroma. [12][13][14][15][16][17][18][19][20][21][22][23] In Japan, a collagen-coated polyglycolic acid (PGA) conduit containing porous collagen fibers within the tube was introduced in 2013; it has been successfully used for the treatment of peripheral nerve defects ever since, producing clinical outcomes similar to autologous nerve grafting. [24][25][26][27] This PGA nerve conduit was also approved for regenerating peripheral nerves by the Food and Drug Administration in the United States in 2016.…”

mentioning

confidence: 99%

Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report

Onode

¹

,

Uemura

²

,

Hama

³

et al. 2022

J Reconstr Microsurg

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Background The treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation. Methods Forty-seven rats were divided into two groups: no capping (transected nerve stump without capping; n = 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit; n = 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation. Results While autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end. Conclusion Nerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.

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“…12 13 14 15 Gould et al reported on 69 painful neuromas of the foot and ankle in 50 patients treated with simple excision of the neuroma and capping of the resected nerve stump with a collagen conduit, Neuroflex (Stryker, NJ). 12 de Vrij et al reported 10 patients having end-neuromas of 8 superficial radial nerves and 2 median nerves treated by the capping device, NEUROCAP, with 12 months of follow-up. 31 de Ru et al documented the treatment of three patients who underwent transection of the causative nerves, including two greater auricular nerves and a supraorbital nerve, followed by capping of their nerve ends with a NEUROCAP, which resulted in a marked reduction in pain scores.…”

Section: Discussionmentioning

confidence: 99%

Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects

Onode

¹

,

Uemura

²

,

Hama

³

et al. 2022

J Reconstr Microsurg

0

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Background The treatment of painful neuroma remains challenging. Recently, a nerve-end capping technique using a bioabsorbable nerve conduit was newly introduced to treat amputation neuroma. A collagen-coated polyglycolic acid (PGA) conduit has been commercially available for the reconstruction of peripheral nerve defects, yielding successful clinical outcomes. However, no experimental research has been conducted using this PGA nerve conduit as capping device for treating amputation neuroma. The purpose of this study was to investigate nerve-end capping treatment with the PGA conduit in the rat sciatic nerve amputation model, focusing on histological scar formation and neuroinflammation. Methods Forty-seven rats were divided into two groups: no capping (transected nerve stump without capping; n = 25) and capping (nerve-end capping with collagen-coated PGA nerve conduit; n = 22). Twelve weeks after sciatic neurectomy, neuropathic pain was evaluated using the autotomy score. Stump neuromas were histologically evaluated or perineural scar and neuroinflammation. Results While autotomy scores gradually exacerbated in both groups, they were consistently lower in the capping group at 4, 8, and 12 weeks postprocedure. Twelve weeks after surgery, the transected nerve stumps in the no-capping group had formed macroscopic bulbous neuromas strongly adhering to surrounding tissues, whereas they remained wrapped with the PGA nerve conduits loosely adhering to surrounding tissues in the capping group. Histologically, distal axonal fibers were expanded radially and formed neuromas in the no-capping group, while they were terminated within the PGA conduit in the capping group. Perineural scars and neuroinflammation were widely found surrounding the randomly sprouting nerve end in the no-capping group. In capped counterparts, scars and inflammation were limited to closely around the terminated nerve end. Conclusion Nerve-end capping with a collagen-coated PGA conduit after rat sciatic neurectomy might prevent neuroma formation by suppressing perineural scar formation and neuroinflammation around the nerve stump, potentially relieving neuropathic pain.

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Use of Collagen Conduits in Management of Painful Neuromas of the Foot and Ankle

Abstract: Level IV, retrospective case series.

Cited by 21 publications

References 24 publications

Significance of alpha smooth muscle actin expression in traumatic painful neuromas: a pilot study in rats

Significance of alpha smooth muscle actin expression in traumatic painful neuromas: a pilot study in rats

Nerve-End Capping Treatment with a Polyglycolic Acid Conduit for Rat Sciatic Neuroma: A Preliminary Report

Addition of a Vascular Bundle Accelerates Bone Union in Femoral Bone Defects

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