Comparrison of End - to - side Loop Neurorrhaphy with Epineurium Versus without Epineurium

Kim, Cheol Hann; Lee, Joo Heon; Tak, Min Sung; Kim, Yong Bae; Lee, Young Mann; Yang, Soon Jae

Abstract

The high incidence of pain recurrence in traumatic neuromas continues to be a major problem in about 10% of patients. There are more than 100 techniques that have been proposed, but no single reliable method prevents painful neuroma formation. The end-to-side neurorrhaphy published by Viterbo1, and demonstrated encouraging results in prevention of neuroma with end-to-side loop neurorrhaphy. The aim of this study is to compare with the result that end-to-side loop neurorrhaphy with intact epineurium versus resected epineurium. Thirty Spraque-Dawley rats were divide in two group; control and experirnental group. In control group (n = 20), both sciatic nerve are transected and the ends were left unrepaired. In experimental group A (n = 20), the left sciatic nerve are transected and repaired with end-to-side loop neurorrhaphy with intact epineurium. In experimental group B (n = 20), the right sciatic nerve are transected and repaired after removal of epineurium. After 6 weeks, the cantrol and experimental group are sacrificed and examed grossly and histopathologically. In the control group, there were typical neuromas with irregular disorderly growth of axons, spreading out into the surrounding connective tissue. In experimental group A, there was no gross evidence of neuroma formation. In histology, there was some minirnal pattern of disorganized growth of the axons in the end-to-side surface, in only 1 case, but limited to the sutured area without typical spread out growth pattern. In experimental group B, the aspect were similar to the experimental group A. The end-to-side loop neurorrhaphy prevents disorganized axonal spouting seen in typical neuroma. And the interposing epineural sheath has no specific role in prevention of neuroma.