American Society for Peripheral Nerve

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Novel Experimental Surgical Strategy to Prevent Traumatic Neuroma Formation by Combining a 3D-printed Y-tube with an Autograft
Anne Bolleboom, BSc1; Godard C.W. de Ruiter, MD2; J Henk Coert, MD, PhD3; Bastiaan Tuk, None1; Joan C. Holstege, PhD1; Johan W. van Neck, PhD4; (1)Erasmus University Medical Center, Rotterdam, Netherlands, (2)Neurosurgery, Medical Center Haaglanden, The Hague, Netherlands, (3)University Medical center Utrecht, Utrecht, Netherlands, (4)Plastic-, Reconstructive- and Hand surgery, Erasmus Medical University Center / St. Franciscus Gasthuis, Rotterdam, Netherlands

Object. Traumatic neuromas may develop following nerve injury at the proximal nerve stump, which can lead to neuropathic pain. These neuromas are often therapy resistant and excision of the neuroma frequently leads to recurrence. In this study we present a novel surgical strategy to prevent neuroma formation based on the principle of the centro-central anastomosis (CCA), but instead of directly connecting the nerve ends to an autograft a loop was created using a three-dimensional (3D) printed polyethylene Y-shaped conduit with an autograft in the distal outlets.

Methods. The 3D printed Y-tube with autograft was investigated in the rat sciatic nerve transection model 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 to a centro-central anastomosis model, in which a loop was created between the proximal tibial and peroneal nerve with a peroneal autograft. Additional control groups consisted of the closed Y-tube and the extended arm Y-tube. Results were analyzed after 12 weeks survival with 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 after 12 weeks 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 centro-central anastomosis model we also observed a decrease of 17% in the number of myelinated axons, but in this model neuroma formation was still present. 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.

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