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Epineural Sheath Jacket as a New Surgical Technique for Neuroma Prevention in the Rat Sciatic Nerve Model: A Preliminary Report
Adam Bobkiewicz; Safak Uygur; Grzegorz Kwiecien; Maria Madajka; Maria Siemionow
Cleveland Clinic, Cleveland, OH

Introduction: Neuroma may form as a result of nerve transection or damage, causing pain and significantly impairing the quality of life. Although many techniques have been developed so far, none has been proven to be superior in prevention of neuroma formation. The purpose of this study was to test the epineural sheath jacket (ESJ) as a new method for the prevention of neuroma formation in the rat sciatic nerve model. Epineural sheath is a naturally occurring material, easily harvestable and expresses proneurogenic and proangiogenic markers supporting nerve regeneration.
Experimental Groups: Six groups were created. Group 1: Nerve stump without any protection; Group 2: Nerve stump buried into the muscle; Group 3: ESJ covering nerve stump; Group 4: ESJ covering nerve stump buried into the muscle; Group 5: ESJ filled with fat graft covering nerve stump; Group6: ESJ filled with fat graft covering nerve stump and buried into the muscle.
Methods: Sciatic nerve was dissected and 2 cm segment was resected. All nerve fascicles were removed using pull out technique creating an empty epineural sheath conduit. The distal part of the conduit was closed and proximal part was trimmed creating 7 mm long tube of protective ESJ. Finally, ESJ was applied over the proximal nerve stump using epineural sleeve technique (Groups 3-6). In Groups 5 and 6 ESJ was filled with autologous fat. Functional assessment included pin-prick (PP), toe –spread (TS) tests and Tinel sign analyzed twice a week. At six weeks nerve samples were harvested for histological and immunohistochemical analyses.
Results: The PP and TS tests did not reveal any significant differences between tested Groups. Positive Tinel sign was observed at 5 and 6 week follow- up in Groups 1 and 2, confirmed by paw withdraw, squeaking and behavioral changes. During nerve exploration at 6 weeks, significant adhesions to the surrounding tissues were seen in Groups 1 and 2, whereas neuroma- like formation characterized by distension and disorganization of the proximal stump of the transected nerve was observed in Group 1. In contrast, the structure and integrity of the ESJ was preserved in Groups 3-6. Histological and immunohistochemical analyses are in progress.
Conclusion: We confirmed feasibility of ESJ application as a new method against neuroma formation. The protective effect of ESJ was proved by prevention of neuroma formation in Groups 3- 6 confirmed by clinical and functional assessments. Histological and immunohistochemical analyses are in progress.


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