scholarly journals Significant retraction of the sciatic nerve due to neuroma formation after above the knee amputation

2021 ◽  
Author(s):  
John J. Finneran ◽  
Julie N. Robles ◽  
Brian M. Ilfeld
Keyword(s):  
Sciatic Nerve ◽  
Knee Amputation ◽  
Neuroma Formation

Prevention of painful neuromas by oblique transection of peripheral nerves

2006 ◽  
Vol 104 (2) ◽  
pp. 285-289 ◽  
Author(s):  
Wieslaw Marcol ◽  
Katarzyna Kotulska ◽  
Magdalena Larysz-Brysz ◽  
Grazyna Bierzyñska-Macyszyn ◽  
Pawel Wlaszczuk ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Sciatic Nerve ◽  
Peripheral Nerves ◽  
Traditional Method ◽  
Healing Process ◽  
Nerve Transection ◽  
Proximal Stump ◽  
Sciatic Nerves ◽  
Neuroma Formation

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.

scholarly journals Effect of Nerve-Cutting Technique on Nerve Microstructure and Neuroma Formation

2018 ◽  
Vol 11 (01) ◽  
pp. 028-034
Author(s):  
Wayne Rummings ◽  
P. Honeycutt ◽  
Edward Jernigan ◽  
Paul Weinhold ◽  
Reid Draeger
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Sciatic Nerve ◽  
Clinical Importance ◽  
Sprague Dawley ◽  
Tongue Depressor ◽  
Cutting Guide ◽  
Scalpel Blade ◽  
Neuroma Formation ◽  
Scanning Electron

Abstract Background Peripheral neuroma formation results from partial or complete nerve division. Elucidating measures to prevent the development of peripheral neuromas is of clinical importance. The aim of this study was to determine the effect of various surgical nerve-cutting techniques on nerve microstructure and resultant neuroma formation. Methods Twenty Sprague-Dawley rats were randomly assigned to one of the following nerve-cutting techniques: No. 15 scalpel blade with tongue depressor, micro-serrated scissors, nerve-cutting guide forceps with straight razor, and bipolar cauterization. The right sciatic nerve was transected using the assigned nerve-cutting technique. Neuromas were harvested 6 weeks postoperatively, and samples were obtained for histologic analysis. The contralateral sciatic nerve was transected at euthanasia and analyzed with histology and with scanning electron microscopy in a subset of the rats. Results Fifteen of the 20 rats survived the 6-week experiment. Scanning electron microscopy of the No. 15 scalpel blade group showed the most visual damage and disorganization whereas the nerve-cutting guide forceps and micro-serrated scissors groups resulted in a smooth transected surface. Bipolar cauterization appeared to enclose the fascicular architecture within a sealed epineurium. Each neuroma was significantly larger than contralateral controls. There were no significant differences in neuroma caliber between nerve transection groups. No substantial differences in microstructure were evident between transection groups. Conclusion Despite disparate microscopic appearances of the cut surfaces of nerves using various nerve-cutting techniques, we found no significant differences in the caliber or incidence of neuroma formation based on nerve-cutting technique. Nerve-cutting technique used when transecting peripheral nerves may have little bearing on the formation or size of resultant neuroma formation.

scholarly journals Sciatic Nerve and Lumbar Plexus Block for Below Knee Amputation- Newer Approach for Better Haemodynamic Stability and Patient Safety

2021 ◽  
Author(s):  
Jigisha Bharatbhai Mehta ◽  
Ganesh Naik ◽  
Dinesh Chauhan
Keyword(s):  
Patient Safety ◽  
Sciatic Nerve ◽  
Regional Blood Flow ◽  
Present Report ◽  
Lumbar Plexus ◽  
Nerve Blocks ◽  
Knee Amputation ◽  
Haemodynamic Stability ◽  
Lumbar Plexus Block ◽  
Plexus Block

Patients undergoing lower extremity amputation may have multiple co-morbid conditions like diabetes, cardiovascular, hepatic and renal disorders and are at risk of perioperative mortality and morbidity. Peripheral nerve blocks are associated with minimal haemodynamic changes, improved regional blood flow and are ideal for high risk patients who cannot tolerate slightest attenuation in haemodynamic response. The present report is of a 50-year-old female patient admitted for below knee amputation surgery. Sciatic nerve and lumbar plexus block were the mode of anaesthesia. It was found that regional anaesthesia in the form of nerve block provided adequate anaesthesia and analgesia, provided greater haemodynamic stability and patient safety.

scholarly journals Covering the proximal nerve stump with chondroitin sulfate proteoglycans prevents traumatic painful neuroma formation by blocking axon regeneration after neurotomy in Sprague Dawley rats

2020 ◽  
pp. 1-11
Author(s):  
Fu-Lin He ◽  
Shuai Qiu ◽  
Jian-Long Zou ◽  
Fan-Bin Gu ◽  
Zhi Yao ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Axon Regeneration ◽  
Scar Tissue ◽  
Chondroitin Sulfate Proteoglycans ◽  
Sprague Dawley ◽  
Nerve Stump ◽  
Related Factors ◽  
Positive Group ◽  
Sprague Dawley Rats ◽  
Neuroma Formation

OBJECTIVENeuropathic pain caused by traumatic neuromas is an extremely intractable clinical problem. Disorderly scar tissue accumulation and irregular and immature axon regeneration around the injury site mainly contribute to traumatic painful neuroma formation. Therefore, successfully preventing traumatic painful neuroma formation requires the effective inhibition of irregular axon regeneration and disorderly accumulation of scar tissue. Considering that chondroitin sulfate proteoglycans (CSPGs) can act on the growth cone and effectively inhibit axon regeneration, the authors designed and manufactured a CSPG-gelatin blocker to regulate the CSPGs’ spatial distribution artificially and applied it in a rat model after sciatic nerve neurectomy to evaluate its effects in preventing traumatic painful neuroma formation.METHODSSixty female Sprague Dawley rats were randomly divided into three groups (positive group: no covering; blank group: covering with gelatin blocker; and CSPG group: covering with the CSPG-gelatin blocker). Pain-related factors were evaluated 2 and 8 weeks postoperatively (n = 30). Neuroma growth, autotomy behavior, and histological features of the neuromas were assessed 8 weeks postoperatively (n = 30).RESULTSEight weeks postoperatively, typical bulb-shaped neuromas did not form in the CSPG group, and autotomy behavior was obviously better in the CSPG group (p < 0.01) than in the other two groups. Also, in the CSPG group the regenerated axons showed a lower density and more regular and improved myelination (p < 0.01). Additionally, the distribution and density of collagenous fibers and the expression of α–smooth muscle actin were significantly lower in the CSPG group than in the positive group (p < 0.01). Regarding pain-related factors, c-fos, substance P, interleukin (IL)–17, and IL-1β levels were significantly lower in the CSPG group than those in the positive and blank groups 2 weeks postoperatively (p < 0.05), while substance P and IL-17 remained lower in the CSPG group 8 weeks postoperatively (p < 0.05).CONCLUSIONSThe authors found that CSPGs loaded in a gelatin blocker can prevent traumatic neuroma formation and effectively relieve pain symptoms after sciatic nerve neurotomy by blocking irregular axon regeneration and disorderly collagenous fiber accumulation in the proximal nerve stump. These results indicate that covering the proximal nerve stump with CSPGs may be a new and promising strategy to prevent traumatic painful neuroma formation in the clinical setting.

Centrocentral anastomosis in the prevention and treatment of painful terminal neuroma

1985 ◽  
Vol 63 (5) ◽  
pp. 754-758 ◽  
Author(s):  
José González-Darder ◽  
José Barberá ◽  
M. José Abellán ◽  
Antonio Mora
Keyword(s):  
Sciatic Nerve ◽  
Control Parameter ◽  
Histological Study ◽  
Nerve Graft ◽  
Nerve Section ◽  
Content Type ◽  
Proximal Stump ◽  
Neuroma Formation ◽  
Fine Print ◽  
Observation Period

✓ In this experimental study, microsurgical centrocentral anastomosis was applied to an experimental model of painful terminal neuroma resulting from left sciatic nerve section in the rat. The anastomosis consisted of end-to-end suturing of the sciatic nerve fascicles to the tibial branch, with the interposition of a nerve graft taken from the same anastomosed fascicle. As a control parameter for the experiment, the autotomy which follows sciatic nerve section in the rat was evaluated. Autotomy is considered an objective indication of abnormal sensations that are provoked by the formation of a terminal neuroma. Histological study of the proximal stump of the sciatic nerve was also performed. The observation period was 10 weeks. The study demonstrates that centrocentral anastomosis reduces the size of the neuroma formation and the incidence of autotomy.

Effect of a modified Nd:YAG laser technique on neuroma formation: An experimental study in rat sciatic nerve

1999 ◽  
Vol 25 (3) ◽  
pp. 213-218 ◽  
Author(s):  
Thomas Menovsky ◽  
Johan F. Beek ◽  
Marius van der Bergh Weerman ◽  
Jacobus J. van Overbeeke
Keyword(s):  
Experimental Study ◽  
Sciatic Nerve ◽  
Nd:Yag Laser ◽  
Laser Technique ◽  
Rat Sciatic Nerve ◽  
Neuroma Formation
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