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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(01): e1-e10
DOI: 10.1055/s-0040-1722201
Original Article

Neuroma Prevention and Implantation Effects of NEUROCAP in Rat Sciatic Nerve Model

Steven L. Peterson
1   Portland VA Medical Center, Portland, Oregon
,
Harm de Vries
2   Polyganics, Groningen, The Netherlands
,
Kami Collins
3   NAMSA, Brooklyn Park, Minnesota
,
Hilde Geraedts
2   Polyganics, Groningen, The Netherlands
,
Michael J. Wheatley
4   Kaiser Permanente NW, Portland, Oregon
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Abstract

Introduction Symptomatic neuroma with neuropathic pain can develop following peripheral nerve injury. Current interventions for symptomatic neuroma have unpredictable results. NEUROCAP (Polyganics, Groningen, The Netherlands) is a bioresorbable nerve capping device intended to protect a peripheral nerve end and separate the nerve from the surrounding environment, to prevent the recurrence of a symptomatic neuroma.

Materials and Methods This study aims to assess the implantation effects of the NEUROCAP device in a rat sciatic nerve model during 12 months (±2 days). Forty-one adult male Sprague-Dawley rats were used in this study. They were randomly divided into a capping or test group, or a noncapping or control group for different time points of survival (12 weeks, 6 months, and 12 months). The objective of this study was evaluated regarding procedural data, adverse events, clinical observations, and histopathology.

Results The overall general health of the animals was adequate throughout the study, with the exception of autotomy during the first 4 months of survival. Eight animals were euthanized early due to autotomy, excluded from the study and seven of them have been replaced. Autotomy was an expected outcome and a known limitation of the animal model, particularly as this was a full sciatic nerve transection model. Neuroma formation was observed in the control group while there was no neuroma formation present in the test group. The control group showed increased nerve outgrowth and more chaotic fascicles in comparison with the test group. The test group also had a higher percentage of myelinated fibers compared to the control group. These results indicate a preventive mode of action of the NEUROCAP with regard to neuroma formation after nerve transection in a rat sciatic nerve model.

Conclusion The results indicate that NEUROCAP is safe and effective in preventing the recurrence of neuroma formation and inhibiting nerve outgrowth.

Keywords

symptomatic end-neuroma - rat sciatic nerve model - nerve-capping experimental design - NEUROCAP


Publication History

Received: 29 October 2019

Accepted: 01 November 2020

Article published online:
08 January 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Laing T, Siddiqui A, Sood M. The management of neuropathic pain from neuromas in the upper limb: surgical techniques and future directions. Plast Aesth Res 2015; 2 (04) 165-170
    CrossrefPubMedGoogle Scholar
  • 2 Harden RN. Chronic neuropathic pain. Mechanisms, diagnosis, and treatment. Neurologist 2005; 11 (02) 111-122
    CrossrefPubMedGoogle Scholar
  • 3 Vernadakis AJ, Koch H, Mackinnon SE. Management of neuromas. Clin Plast Surg 2003; 30 (02) 247-268 , vii
    CrossrefPubMedGoogle Scholar
  • 4 Balcin H, Erba P, Wettstein R, Schaefer DJ, Pierer G, Kalbermatten DF. A comparative study of two methods of surgical treatment for painful neuroma. J Bone Joint Surg Br 2009; 91 (06) 803-808
    CrossrefPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 Biazar E, Khorasani MT, Montazeri N. et al. Types of neural guides and using nanotechnology for peripheral nerve reconstruction. Int J Nanomedicine 2010; 5: 839-852
    CrossrefPubMedGoogle Scholar
  • 7 Bertleff MJ, Meek MF, Nicolai JP. A prospective clinical evaluation of biodegradable neurolac nerve guides for sensory nerve repair in the hand. J Hand Surg Am 2005; 30 (03) 513-518
    CrossrefPubMedGoogle Scholar
  • 8 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 , discussion 67–68
    CrossrefPubMedGoogle Scholar
  • 9 Stoll G, Müller HW. Nerve injury, axonal degeneration and neural regeneration: basic insights. Brain Pathol 1999; 9 (02) 313-325
    CrossrefPubMedGoogle Scholar
  • 10 Theodosiou M, Rush RA, Zhou XF, Hu D, Walker JS, Tracey DJ. Hyperalgesia due to nerve damage: role of nerve growth factor. Pain 1999; 81 (03) 245-255
    CrossrefPubMedGoogle Scholar
  • 11 Nordin M, Nyström B, Wallin U, Hagbarth KE. Ectopic sensory discharges and paresthesiae in patients with disorders of peripheral nerves, dorsal roots and dorsal columns. Pain 1984; 20 (03) 231-245
    CrossrefPubMedGoogle Scholar
  • 12 Maggi SP, Lowe III JB, Mackinnon SE. Pathophysiology of nerve injury. Clin Plast Surg 2003; 30 (02) 109-126
    CrossrefPubMedGoogle Scholar
  • 13 Otfinowski J, Pawelec A, Kałuza J. Implantation of peripheral neural stump into muscle and its effect on the development of posttraumatic neuroma. Pol J Pathol 1994; 45 (03) 195-202
    PubMedGoogle Scholar
  • 14 Herndon JH. Neuromas. In: Green DP, Hotchkiss RN. eds. Operative Hand Surgery. Edinburgh: Churchill Livingstone; 1993: 1387-1400
    Google Scholar
  • 15 Taneerananon T, Hussain MA, Jhattu H, Li J, Klaassen M, Milovic V. Use of poly dl-lactide-ε-caprolactone (Neurolac) conduit for enveloping traumatic neuromas. Eur J Plast Surg 2013; 36 (10) 657-660
    CrossrefPubMedGoogle Scholar
  • 16 Barett S, Zgonis T. Nerve-Related Injuries and Treatments for the Lower Extremity. PA: Elsevier; 2016. ;(033)2: 239-240
    Google Scholar
  • 17 Sunderland S. The connective tissues of peripheral nerves. Brain 1965; 88 (04) 841-854
    CrossrefPubMedGoogle Scholar
  • 18 Zeltser R, Beilin B, Zaslansky R, Seltzer Z. Comparison of autotomy behavior induced in rats by various clinically-used neurectomy methods. Pain 2000; 89 (01) 19-24
    CrossrefPubMedGoogle Scholar