Novel experimental surgical technique to stop traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft.
J Neurosurg. 2018 Feb 09;:1-13
Authors: Bolleboom A, de Ruiter GCW, Coert JH, Tuk B, Holstege JC, van Neck JW
OBJECTIVE Traumatic neuromas might develop after nerve damage on the proximal nerve stump, which might result in neuropathic ache. These neuromas are sometimes immune to remedy, and excision of the neuroma incessantly results in recurrence. On this examine, the authors current a novel surgical technique to stop neuroma formation primarily based on the precept of centro-central anastomosis (CCA), however reasonably than immediately connecting the nerve ends to an autograft, they created a loop utilizing a 3D-printed polyethylene Y-shaped conduit with an autograft within the distal retailers. METHODS The 3D-printed Y-tube with autograft was investigated in a mannequin of rat sciatic nerve transection by which the Y-tube was positioned on the proximal sciatic nerve stump and a peroneal graft was positioned between the distal retailers of the Y-tube to kind a closed loop. This mannequin was in contrast with a CCA mannequin, by which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Extra management teams consisted of the closed Y-tube and the extended-arm Y-tube. Outcomes had been analyzed at 12 weeks of survival utilizing nerve morphometry for the incidence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the many completely different surgical teams, the Y-tube with interposed autograft was the one mannequin that didn’t lead to neuroma formation at 12 weeks of survival. As well as, a 13% discount within the variety of myelinated axons regenerating by means of the interposed autograft was noticed within the Y-tube with autograft mannequin. Within the CCA mannequin, the authors additionally noticed a lower of 17% within the variety of myelinated axons, however neuroma formation was current on this mannequin. The closed Y-tube resulted in minimal nerve regeneration contained in the tube along with in depth neuroma formation earlier than the doorway of the tube. The extended-arm Y-tube mannequin clearly confirmed that almost all of the regenerating axons merged into the Y-tube arm, which was related to the autograft, leaving the prolonged plastic arm virtually empty. CONCLUSIONS This pilot examine reveals that our novel 3D-printed Y-tube mannequin with interposed autograft prevents neuroma formation, making this a promising surgical device for the administration of traumatic neuromas.
PMID: 29424651 [PubMed – as supplied by publisher]