Novel experimental surgical strategy to prevent traumatic neuroma formation by combining a 3D-printed Y-tube with an autograft

被引:19
作者
Bolleboom, Anne [1 ,2 ]
de Ruiter, Godard C. W. [3 ]
Coert, J. Henk [4 ]
Tuk, Bastiaan [2 ]
Holstege, Jan C. [1 ]
van Neck, Johan W. [2 ]
机构
[1] Erasmus Univ, Med Ctr, Dept Neurosci, Rotterdam, Netherlands
[2] Erasmus Univ, Med Ctr, Dept Plast & Reconstruct Surg, Rotterdam, Netherlands
[3] Med Ctr Haaglanden, Dept Neurosurg, The Hague, Netherlands
[4] Univ Utrecht, Med Ctr, Dept Plast & Reconstruct Surg, Utrecht, Netherlands
关键词
neuroma; sciatic nerve; nerve regeneration; axon; rat; 3D printing; peripheral nerve; PERIPHERAL-NERVE REGENERATION; PAIN; MANAGEMENT; ALLODYNIA; REPAIR;
D O I
10.3171/2017.8.JNS17276
中图分类号
R74 [神经病学与精神病学];
学科分类号
100204 [神经病学];
摘要
OBJECTIVE Traumatic neuromas may develop after nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often resistant to therapy, and excision of the neuroma frequently leads to recurrence. In this study, the authors present a novel surgical strategy to prevent neuroma formation based on the principle of centro-central anastomosis (CCA), but rather than directly connecting the nerve ends to an autograft, they created a loop using a 3D-printed polyethylene Y-shaped conduit with an autograft in the distal outlets. METHODS The 3D-printed Y-tube with autograft was investigated in a model of rat sciatic nerve transection in which the Y-tube was placed on the proximal sciatic nerve stump and a peroneal graft was placed between the distal outlets of the Y-tube to form a closed loop. This model was compared with a CCA model, in which a loop was created between the proximal tibial and peroneal nerves with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended-arm Y-tube. Results were analyzed at 12 weeks of survival using nerve morphometry for the occurrence of neuroma formation and axonal regeneration in plastic semi-thin sections. RESULTS Among the different surgical groups, the Y-tube with interposed autograft was the only model that did not result in neuroma formation at 12 weeks of survival. In addition, a 13% reduction in the number of myelinated axons regenerating through the interposed autograft was observed in the Y-tube with autograft model. In the CCA model, the authors also observed a decrease of 17% in the number of myelinated axons, but neuroma formation was present in this model. The closed Y-tube resulted in minimal nerve regeneration inside the tube together with extensive neuroma formation before the entrance of the tube. The extended-arm Y-tube model clearly showed that the majority of the regenerating axons merged into the Y-tube arm, which was connected to the autograft, leaving the extended plastic arm almost empty. CONCLUSIONS This pilot study shows that our novel 3D-printed Y-tube model with interposed autograft prevents neuroma formation, making this a promising surgical tool for the management of traumatic neuromas.
引用
收藏
页码:184 / 196
页数:13
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