Neuroma Prevention by Nerve to Artery Coaptation: A Pilot Study

Neuroma formation is a notable complication that can occur following amputation. Newer techniques are proving to be successful in preventing neuroma formation by providing the proximal nerve segment with an end organ to help with organized growth. Redirecting arterial blood flow to the nerve endings may be an effective mechanism of preventing neuroma formation. The aim of this study was to demonstrate that by coapting the proximal end of a transected nerve with a functional artery as a vascular end organ, neuroma formation can be prevented.

Six Sprague-Dawley rats were used for the control and experimental groups. Subjects underwent hind limb dissection to identify the femoral neurovascular bundle. The control group underwent an in situ neurectomy of the femoral nerve, and the experimental group had the addition of a femoral artery arteriotomy and an end-to-side coaptation of the proximal nerve segment into the functional artery. The rats were killed after 90 days, and a histologic analysis was performed using S100 stains.

For the control group, the average number of axons was found to be 13 (3-33). For the experimental group, the average number of axons was 4.6 (1-12). The average diameter of the axons was 109.75 μm (range, 74-230 μm) and 157.37 μm (range, 100-278 μm) for the control and experimental groups, respectively. The average area of neural tissue was 16,707.76 μm² (range, 4,470-59,642 μm²) and 24,709.46 μm² (range, 8,222-64,529 μm²) for the control and experimental groups, respectively. No statistically notable difference was found between the control and experimental groups for mean number, diameter, or area of axons.

The nerve-artery coaptation may be able to reliably prevent neuroma formation in acutely transected nerves. Histopathologic analysis showed that the experimental group had more organized growth. Future studies should be performed to see how this technique could be translated to human patients.

Prevention-Bench Research V.