Division of General Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, TX.
Shriners Hospital for Children, Galveston, TX.
Ann Plast Surg. 2024 Jan 1;92(1):106-119. doi: 10.1097/SAP.0000000000003714. Epub 2023 Oct 23.
BACKGROUND/AIM OF THE STUDY: Nerve capping is a method of neuroma treatment or prevention that consists of the transplantation of a proximal nerve stump into an autograft or other material cap, after surgical removal of the neuroma or transection of the nerve. The aim was to reduce neuroma formation and symptoms by preventing neuronal adhesions and scar tissue. In this narrative literature review, we summarize the studies that have investigated the effectiveness of nerve capping for neuroma management to provide clarity and update the clinician's knowledge on the topic.
A systematic electronic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria was performed in the PubMed database combining "neuroma," "nerve," "capping," "conduit," "treatment," "management," "wrap," "tube," and "surgery" as search terms. English-language clinical studies on humans and animals that described nerve capping as a treatment/prevention technique for neuromas were then selected based on a full-text article review. The data from the included studies were compiled based on the technique and material used for nerve capping, and technique and outcomes were reviewed.
We found 10 applicable human studies from our literature search. Several capping materials were described: epineurium, nerve, muscle, collagen nerve conduit, Neurocap (synthetic copolymer of lactide and caprolactone, which is biocompatible and resorbable), silicone rubber, and collagen. Overall, 146 patients were treated in the clinical studies. After surgery, many patients were completely pain-free or had considerable improvement in pain scores, whereas some patients did not have improvement or were not satisfied after the procedure. Nerve capping was used in 18 preclinical animal studies, using a variety of capping materials including autologous tissues, silicone, and synthetic nanofibers. Preclinical studies demonstrated successful reduction in rates of neuroma formation.
Nerve capping has undergone major advancements since its beginnings and is now a useful option for the treatment or prevention of neuromas. As knowledge of peripheral nerve injuries and neuroma prevention grows, the criterion standard neuroprotective material for enhancement of nerve regeneration can be identified and applied to produce reliable surgical outcomes.
背景/研究目的：神经套扎是一种治疗或预防神经瘤的方法，包括在外科切除神经瘤或切断神经后，将近端神经残端移植到自体移植物或其他材料套中。其目的是通过防止神经元粘连和疤痕组织形成来减少神经瘤的形成和症状。在本叙事文献综述中，我们总结了研究神经套扎治疗神经瘤管理的有效性的研究，以提供清晰度并更新临床医生对该主题的知识。
按照系统评价和荟萃分析的首选报告项目标准，在 PubMed 数据库中进行了系统的电子搜索，将“神经瘤”、“神经”、“套扎”、“导管”、“治疗”、“管理”、“包裹”、“管”和“手术”作为搜索词。然后根据全文文章审查，选择描述神经套扎作为神经瘤治疗/预防技术的人类和动物的英语临床研究。根据神经套扎的技术和材料以及技术和结果，编译了纳入研究的数据。
我们从文献检索中找到了 10 项适用的人类研究。描述了几种套扎材料：神经外膜、神经、肌肉、胶原神经导管、Neurocap（由丙交酯和己内酯组成的合成共聚物，具有生物相容性和可吸收性）、硅橡胶和胶原。总体而言，146 名患者在临床研究中接受了治疗。手术后，许多患者完全无痛或疼痛评分有明显改善，而有些患者在手术后没有改善或不满意。神经套扎术在 18 项临床前动物研究中得到应用，使用了各种套扎材料，包括自体组织、硅酮和合成纳米纤维。临床前研究表明，神经瘤形成的发生率得到了成功降低。
自神经套扎术问世以来，它已经取得了重大进展，现在是治疗或预防神经瘤的一种有用选择。随着对外周神经损伤和神经瘤预防的认识不断提高，可以确定增强神经再生的标准神经保护材料并将其应用于产生可靠的手术结果。
