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The Role of Different Methods of Nerve Ablation in Prevention of Neuroma

Chim, Harvey M.D.; Miller, Erin M.D.; Gliniak, Christy B.S.; Cohen, Mark L. M.D.; Guyuron, Bahman M.D.


In the May 2013 Experimental article by Chim et al. entitled “The Role of Different Methods of Nerve Ablation in Prevention of Neuroma” ( Plast Reconstr Surg . 2013;131:1004–1012), there is an error in the second sentence of the second paragraph of the Introduction. The phrase “zygomaticotemporal branch of the facial nerve” should have read “zygomaticotemporal branch of the trigeminal nerve” (correction in italics). The correct version of the sentence is as follows: “In the senior author’s (B.G.) practice, however, a significant number of patients present for migraine surgery, with one of the trigger sites requiring ablation of the zygomaticotemporal branch of the trigeminal nerve.”

Plastic and Reconstructive Surgery. 132(1):250, July 2013.

Plastic and Reconstructive Surgery: May 2013 - Volume 131 - Issue 5 - p 1004–1012
doi: 10.1097/PRS.0b013e3182879ec2
Experimental: Original Articles

Background: The aim of this study was to compare the incidence of neuroma formation and neuropathic pain following different techniques of nerve ablation in a rat sural nerve model.

Methods: Rat sural nerve was subjected to four different techniques of ablation with standardized creation of a 1-cm gap (n = 15 in each group). These included nerve avulsion, transection and burying in muscle, transection and folding of nerve, and transection alone. Animals were killed after 3 months. Explanted nerves were sectioned and stained with Masson trichrome and S-100 stain against neural tissue. The maximal neural cross-sectional area and neural-to-connective tissue ratio was quantified. Quantitative reverse-transcriptase polymerase chain reaction (n = 5) was used to analyze relative mRNA expression of ciliary neurotrophic factor and calcitonin gene-related peptide.

Results: Neural cross-sectional area was statistically increased (p < 0.05) compared with controls in folded, muscle buried, and transected specimens but decreased in avulsed specimens. The neural-to-connective tissue ratio was statistically decreased in the avulsed group. Relative mRNA expression of ciliary neurotrophic factor was lowest in muscle buried (4 percent of control) (p < 0.05) and avulsed specimens (15 percent of control) (p < 0.05) and higher in folded (52 percent of control) and transected specimens (75 percent of control). Relative mRNA expression of calcitonin gene-related peptide was highest in folded specimens (302 percent of control) (p < 0.05).

Conclusions: Folding and transection lead to increased histologic evidence of neuroma formation, whereas folding leads to neuropathic pain, assayed by calcitonin gene-related peptide expression. Avulsion and muscle burying are preferable techniques for nerve ablation and inhibit nerve regeneration, evidenced by decreased ciliary neurotrophic factor expression. Avulsion offers an alternative to muscle burying when there is no muscle in the vicinity to bury the transected nerve.

Cleveland, Ohio

From the Department of Plastic Surgery and the Department of Pathology, Case Western Reserve University.

Received for publication July 17, 2012; accepted November 30, 2012.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Department of Plastic Surgery, Case Western Reserve University, 29017 Cedar Road, Cleveland, Ohio 44124,

©2013American Society of Plastic Surgeons