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Prevention of Painful Neuromas with a Porcine SIS Nerve Cap
Prevention of Painful Neuromas with a Porcine SIS Nerve Cap
Shahryar Tork, MD1, Jennifer Faleris, BS2, Anne Engemann, PhD2, Erick DeVinney, BS2 and Ian L. Valerio, MD, MS, MBA1, (1) Department of Plastic Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, (2) AxoGen, Alachua, FL
The Ohio State University Wexner Medical Center, Department of Plastic and Reconstructive Surgery
2018-02-11
Presenter: Shahryar Tork, MD
Affidavit:
The majority of the work on this project represents the original work of the resident.
Director Name: Gregory D. Pearson, MD
Author Category: Resident Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: General Reconstruction
Introduction:
Following nerve amputations, disorganized axonal regeneration can cause painful neuromas. Isolating amputated nerve ends within biologic conduits, such as porcine small intestine submucosa (pSIS) nerve caps, may improve neuroma management strategies. This study evaluated nerve caps with internal chambering, implanted on an amputated nerve end.
Methods:
The tibial nerves of fifty-seven Sprague Dawley rats were transected, trans-positioned, and secured in a subcutaneous pocket of the lateral hindleg. The nerves were treated with a pSIS Nerve Cap (NC), Open Tube (OT), or were non-treated Surgical Controls (SC). Weekly pain response testing was performed by observing animals after mechanically stimulating transposed nerve ends. Samples were explanted at 8 and 12 weeks and stained with Hematoxylin and Eosin, Masson's Trichrome, or Neurofilament-200. Sample analysis included axonal swirling, axon optical density, nerve width, cap remodeling, and tissue response.
Results:
Compared to the NC group, the SC and OT groups had significantly higher axonal swirling and pain response. The nerve widths were notably wider in the SC versus NC group. The NC and OT groups were considered non-irritants and exhibited similar remodeling. The SC group showed significantly lower axon optical density versus all other groups.
Conclusion:
Application of pSIS nerve caps in this animal model demonstrated increased axon optical density and decreased axonal swirling, distal nerve stump diameters and behavioral pain response. This suggests that nerve caps with internal chambering facilitate axonal alignment and may overcome the challenges observed with conduits; therefore, reducing the likelihood of painful neuroma formation more reliably.
