Download PDF
J Hand Microsurg 2017; 09(01): 017-027
DOI: 10.1055/s-0037-1602126
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Influence of Blood Flow on the Neuroma Formation after Transposition of the Nerve Stump into Vein: Experimental and Clinical Study

Hossam El-Din Ali Ismail
1   Plastic Surgery Unit, Mansoura University, Mansoura, Egypt
,
Mohamed Ali Kasem
2   Department of Neurosurgery, Mansoura University, Mansoura, Egypt
,
Fatma El-Hossiney Mostafa
3   Department of Pathology, Mansoura University, Mansoura, Egypt
› Author Affiliations
Further Information

Publication History

08 August 2016

06 March 2017

Publication Date:
10 April 2017 (online)

    Permissions and Reprints

Abstract

We study the influence of blood flow on the neuroma formation after transposition of the nerve stump into a vein. A total of 30 rats were divided into two groups. In group (I), a 10-mm segment of the femoral vein was excluded from the blood stream. A venotomy was performed in the middle of this segment. The proximal nerve stump of femoral nerve was transposed into the lumen of the femoral vein via a venotomy and held with an epineural suture through the venous wall. In group (II), the same technique was used as in group (I) but without exclusion of the vein segment from blood flow. The control side of the femoral nerve was transected and then was left in place. All animals were sacrificed after 28 weeks. Histopathological evaluation was performed postoperatively; serial transverse sections were made to find the largest diameter of the neuroma. Selected specimens were processed for electron microscopy examination. The following parameters were assessed in both the groups: cross-sectional area of neuromas; myelinated axons; and neural tissue to connective tissue ratio. In group (I), the proximal end of the tibial nerve formed a nonclassic neuroma. In group (II), the proximal end of the tibial nerve formed a nonclassic neuroma smaller in diameter than group (I). The proximal end of the femoral nerve of the control sides in both groups formed a classic neuroma larger in diameter than the experimental sides in both the groups. A Kruskal–Wallis H test showed that there was a statistically significant difference in myelinated axons between the different groups, X2 (3) = 36.19, p < 0.001. The average neural tissue to connective tissue ratio in the control group (I) ranged from 39.2 to 85.8%, but on the experimental side, it was more or less equalized. The average of a neural tissue to connective tissue ratio of the group (II) ranged from 59.1 to 63.9% in the treatment sides as compared to 28.6 to 82.4% in the control sides. The clinical experience utilizing the same technique in the treatment of 10 patients of painful neuromas of the superficial radial nerve and digital nerves were presented with encouraging results. The blood flow has a considerable effect on neuroma formation. We recommend a further study to know the fine details about the exact role of blood as the bloodstream may carry away neurotrophic factors that may also be released by the nerve stump itself.

Keywords

influence of blood flow on the neuroma formation - transposition of the nerve stump into vein on neuroma - management of neuroma
 

  • References

  • 1 Herndon JH. Neuromas. In: Green DP, , ed. Operative Hand Surgery. Edinburgh, Scotland: Churchill Livingstone; 1982: 939-955
    Google Scholar
  • 2 Yüksel F, Kişlaoğlu E, Durak N, Uçar C, Karacaoğlu E. Prevention of painful neuromas by epineural ligatures, flaps and grafts. Br J Plast Surg 1997; 50 (3) 182-185
    CrossrefPubMedGoogle Scholar
  • 3 Chiu DTW, Janecka I, Krizek TJ, Wolff M, Lovelace RE. Autogenous vein graft as a conduit for nerve regeneration. Surgery 1982; 91 (2) 226-233
    PubMedGoogle Scholar
  • 4 Tada H, Hirayama T, Atsuta Y, Takemitsu Y. Experimental study of neurotization of denervated muscles with nerve-to-vein transfer. Microsurgery 1991; 12 (6) 396-401
    CrossrefPubMedGoogle Scholar
  • 5 Herbert TJ, Filan SL. Vein implantation for treatment of painful cutaneous neuromas. A preliminary report. J Hand Surg [Br] 1998; 23 (2) 220-224
    CrossrefPubMedGoogle Scholar
  • 6 Koch H, Haas F, Hubmer M, Rappl T, Scharnagl E. Treatment of painful neuroma by resection and nerve stump transplantation into a vein. Ann Plast Surg 2003; 51 (1) 45-50
    CrossrefPubMedGoogle Scholar
  • 7 Laborde KJ, Kalisman M, Tsai TM. Results of surgical treatment of painful neuromas of the hand. J Hand Surg Am 1982; 7 (2) 190-193
    CrossrefPubMedGoogle Scholar
  • 8 Mackinnon SE, Dellon AL, Hudson AR, Hunter DA. Alteration of neuroma formation by manipulation of its microenvironment. Plast Reconstr Surg 1985; 76 (3) 345-353
    CrossrefPubMedGoogle Scholar
  • 9 Herndon JH. Neuromas. In: Green DP, , ed. Operative Hand Surgery. New York, NY: Churchill Livingstone; 1988: 1405-1430
    Google Scholar
  • 10 Battista A, Cravioto H. Neuroma formation and prevention by fascicle ligation in the rat. Neurosurgery 1981; 8 (2) 191-204
    CrossrefPubMedGoogle Scholar
  • 11 Durak N, Yüksel F, Kislaoglu E. Effectiveness of epineural barriers as a flap and free graft in reducing neuroma formation in the rat following sciatic nerve severance. Eur J Plast Surg 1995; 18 (6) 272-275
    PubMedGoogle Scholar
  • 12 Dellon AL, Mackinnon SE. Treatment of the painful neuroma by neuroma resection and muscle implantation. Plast Reconstr Surg 1986; 77 (3) 427-438
    CrossrefPubMedGoogle Scholar
  • 13 Goldstein SA, Sturim HS. Intraosseous nerve transposition for treatment of painful neuromas. J Hand Surg Am 1985; 10 (2) 270-274
    CrossrefPubMedGoogle Scholar
  • 14 Petropoulos PC, Stefanko S. Experimental observations on the prevention of neuroma formation. Preliminary report. J Surg Res 1961; 1: 241-248
    CrossrefPubMedGoogle Scholar
  • 15 Petropoulos PC, Stefanko S. Experimental studies of posttraumatic neuromas under various physiologic conditions. J Surg Res 1961; 1: 235-240
    CrossrefPubMedGoogle Scholar
  • 16 Gorkisch K, Boese-Landgraf J, Vaubel E. Treatment and prevention of amputation neuromas in hand surgery. Plast Reconstr Surg 1984; 73 (2) 293-299
    CrossrefPubMedGoogle Scholar
  • 17 Swanson AB, Boeve NR, Lumsden RM. The prevention and treatment of amputation neuromata by silicone capping. J Hand Surg Am 1977; 2 (1) 70-78
    CrossrefPubMedGoogle Scholar
  • 18 Smith JR, Gomez NH. Local injection therapy of neuromata of the hand with triamcinolone acetonide. A preliminary study of twenty-two patients. J Bone Joint Surg Am 1970; 52 (1) 71-83
    CrossrefPubMedGoogle Scholar
  • 19 Al-Qattan MM. Prevention and treatment of painful neuromas of the superficial radial nerve by the end-to-side nerve repair concept: an experimental study and preliminary clinical experience. Microsurgery 2000; 20 (3) 99-104
    CrossrefPubMedGoogle Scholar
  • 20 Ismail HA, Abohegazy M. Centro-central nerve union in the treatment of amputation stump neuroma of the upper limb: clinical experience. Egypt J Plast Reconstr Surg 2011; 35 (2) 239-244
    PubMedGoogle Scholar
  • 21 Strauch B, Ferder M, Lovelle-Allen S, Moore K, Kim DJ, Llena J. Determining the maximal length of a vein conduit used as an interposition graft for nerve regeneration. J Reconstr Microsurg 1996; 12 (8) 521-527
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Koch H, Herbert TJ, Kleinert R, Hubmer M, Scharnagl E, Pierer G. Influence of nerve stump transplantation into a vein on neuroma formation. Ann Plast Surg 2003; 50 (4) 354-360
    CrossrefPubMedGoogle Scholar
  • 23 Low CK, Chew SH, Song IC, Ng TH. Implantation of a nerve ending into a vein. Clin Orthop Relat Res 2000; (379) 242-246
    PubMedGoogle Scholar