Management of Supraclavicular Nerve Transection With Regenerative Peripheral Nerve Interface During Neurogenic...

Area of Science:

• Regenerative medicine
• Peripheral nerve surgery
• Pain management

Background:

• Chronic pain is a significant complication after neurogenic thoracic outlet syndrome (nTOS) surgery, often due to supraclavicular nerve (SCN) injury and neuroma formation.
• Limited literature exists on surgical techniques to address the SCN during nTOS procedures.
• This study investigates the efficacy of regenerative peripheral nerve interface (RPNI) in preventing neuropathic pain and neuroma formation when the SCN is divided.

Purpose of the Study:

• To evaluate the use of RPNI for managing SCN injury during nTOS surgery.
• To assess the potential of RPNI to reduce neuropathic pain and prevent symptomatic neuroma formation.

Main Methods:

• Retrospective review of 12 patients undergoing supraclavicular nTOS surgery with SCN RPNI.
• SCN and its branches were coapted to an autologous free muscle graft (omohyoid in most cases) secured within its epimysium.
• Data collected on patient outcomes, including nTOS symptoms, neuropathic pain, and neuroma formation.

Main Results:

• 12 patients (median age 32) underwent SCN RPNI during nTOS decompression.
• At a mean 11-month follow-up, most patients reported improvement in nTOS symptoms.
• No clinical symptoms of supraclavicular neuromas were observed; persistent discomfort in 5 patients was attributed to ongoing nTOS, not focal neuropathic pain.

Conclusions:

• RPNI of the SCN is a viable surgical adjunct for supraclavicular nTOS when nerve division is necessary.
• No clinically evident neuromas were observed at short-term follow-up using this technique.
• Further controlled studies are required to establish the independent impact of RPNI on patient outcomes.