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DOI: 10.1055/s-0038-1654751
Effect of Nerve-Cutting Technique on Nerve Microstructure and Neuroma Formation
Funding Funding for the project was through the NIH NIDDK STRT Grant T35-DK007386 and from the University of North Carolina, Department of Orthopaedics Research Fund. Histology work was performed by the UNC-Chapel Hill CGIBD Histology Core Facility (NIH P30 DK 034987).Publication History
Received: 01 January 2018
Accepted after revision: 16 April 2018
Publication Date:
27 September 2018 (online)
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.
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References
- 1 Sunderland S. Nerves and nerve injuries. J Neurol Neurosurg Psychiatry 1968; 32 (02) 165
- 2 Lundborg G. Nerve regeneration and repair. A review. Acta Orthop Scand 1987; 58 (02) 145-169
- 3 van der Avoort DJJC, Hovius SER, Selles RW, van Neck JW, Coert JH. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients. J Plast Reconstr Aesthet Surg 2013; 66 (10) 1330-1334
- 4 Lewin-Kowalik J, Marcol W, Kotulska K, Mandera M, Klimczak A. Prevention and management of painful neuroma. Neurol Med Chir (Tokyo) 2006; 46 (02) 62-67
- 5 Brogan DM, Kakar S. Management of neuromas of the upper extremity. Hand Clin 2013; 29 (03) 409-420
- 6 Guse DM, Moran SL. Outcomes of the surgical treatment of peripheral neuromas of the hand and forearm: a 25-year comparative outcome study. Ann Plast Surg 2013; 71 (06) 654-658
- 7 Fischer DW, Beggs JL, Shetter AG, Waggener JD. Comparative study of neuroma formation in the rat sciatic nerve after CO2 laser and scalpel neurectomy. Neurosurgery 1983; 13 (03) 287-294
- 8 Watson J, Gonzalez M, Romero A, Kerns J. Neuromas of the hand and upper extremity. J Hand Surg Am 2010; 35 (03) 499-510
- 9 Isaacs J. Treatment of acute peripheral nerve injuries: current concepts. J Hand Surg Am 2010; 35 (03) 491-497
- 10 Rocha EA, Pinheiro ALB, Oliveira MG. Quantitative evaluation of intact peripheral nerve structures after utilization of CO2 laser, electrocautery, and scalpel. J Clin Laser Med Surg 2001; 19 (03) 121-126
- 11 Fligny I, Wu JS, Samonte BR, Fried MP. Comparative study of laser and scalpel nerve transections. Lasers Surg Med 1992; 12 (01) 43-50
- 12 Liboon J, Funkhouser W, Terris DJ. A comparison of mucosal incisions made by scalpel, CO2 laser, electrocautery, and constant-voltage electrocautery. Otolaryngol Head Neck Surg 1997; 116 (03) 379-385
- 13 Greenwood J. Two point coagulation: a new principle and instrument for applying coagulation current in neurosurgery. Am J Surg 1940; 50 (02) 267-270
- 14 Hnatuk LA, Li KT, Carvalho AJ, Freeman JL, Bilbao JM, McKee NH. The effect of bipolar electrocautery on peripheral nerves. Plast Reconstr Surg 1998; 101 (07) 1867-1874
- 15 Moradzadeh A, Brenner MJ, Whitlock EL. et al. Bipolar electrocautery: a rodent model of Sunderland third-degree nerve injury. Arch Facial Plast Surg 2010; 12 (01) 40-47
- 16 Houschyar KS, Momeni A, Pyles MN. et al. The role of current techniques and concepts in peripheral nerve repair. Plast Surg Int 2016; 2016: 4175293
- 17 Zohar Y, Sadov R, Strauss M, Djialdetti M. Ultrastructural study of peripheral nerve injury induced by monopolar and bipolar diathermy. Ann Otol Rhinol Laryngol 1996; 105 (09) 673-677
- 18 Toia F, Giesen T, Giovanoli P, Calcagni M. A systematic review of animal models for experimental neuroma. J Plast Reconstr Aesthet Surg 2015; 68 (10) 1447-1463
- 19 Cravioto H, Battista A. Clinical and ultrastructural study of painful neuroma. Neurosurgery 1981; 8 (02) 181-190
- 20 Ko JH, Kim PS, O'Shaughnessy KD, Ding X, Kuiken TA, Dumanian GA. A quantitative evaluation of gross versus histologic neuroma formation in a rabbit forelimb amputation model: potential implications for the operative treatment and study of neuromas. J Brachial Plex Peripher Nerve Inj 2011; 6: 8
- 21 Ertürk A, Hellal F, Enes J, Bradke F. Disorganized microtubules underlie the formation of retraction bulbs and the failure of axonal regeneration. J Neurosci 2007; 27 (34) 9169-9180