Macroscopic Management of Neuromas in Residual Limbs
Abstract
Since the onset of combat operations in Iraq and Afghanistan in 2001, our US Servicemen and women have sustained more than 2200 major upper and lower extremity amputations. Despite the use of experienced military orthopaedic surgeons, recent studies have found high re-operation rates on these patients. One of the most common causes for revision amputation surgery is due to symptomatic neuroma formation, which generates pain and discomfort. These neuromas form due to the amputations, as the amputated nerve spontaneously regenerates and innervates incorrect areas of the amputated stump. This aberrant growth often leads to pain and discomfort. Therefore, a new goal in amputation surgery has been to prevent neuromas. Despite the frequent rate of revision surgery for neuromas, there is no consensus as to a surgical technique to prevent or treat them. The proposed study brings together researchers with expertise in peripheral nerve research, nerve surgery, bioengineering, and military medicine to develop an innovative strategy to inhibit neuroma formation in military personnel undergoing limb amputation. The proposed study will evaluate the effectiveness of preventing neuromas with the use of a long nerve substitute, i.e., a processed nerve allograft (PNA), attached to the transected nerve. The investigators in this project have previously shown spontaneous regeneration of the nerve end can be controlled using a long PNA. Further, to gain additional control of nerve regeneration at the transected nerve ending, a less severe crush injury will be performed proximally on the nerve. This crush injury will allow the nerve to regenerate away from the inflamed, healing amputation site. Nerve growth will then be guided (and stopped) through the PNA. Using both small and large animal models, the effectiveness of these interventions will be evaluated using sophisticated well-established techniques and analytical tools. These include histology, immunohistochemistry, transgenic animals, and pain marker expression. The findings of this study will provide the necessary scientific foundation in order to proceed with future human clinical trials. This proposal provides a surgical strategy that is simple, definitive, and can be used by our military surgeons to prevent neuroma formation. Surgeons have demonstrated that addressing the persistently painful residual limbs have increased prosthesis wear from 19% to 87% in upper extremity amputees and drastically improved the ambulatory status and dependence upon pain medications in lower extremity amputees. By eliminating neuromas in residual limbs, we will greatly improve the quality of life and increase functional outcomes in our injured Warfighters.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Mar 29, 2016
- Source ID
- W81XWH1510625
Entities
People
- Amy M Moore
Organizations
- United States Army
- Washington University in St. Louis