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.
Keywords
neuroma - nerve microstructure - nerve cutting - nerve surgery - peripheral neuroma
