Electronic Letters to:

General Orthopaedics: H. Balcin, P. Erba, R. Wettstein, D. J. Schaefer, G. Pierer, and D. F. Kalbermatten A comparative study of two methods of surgical treatment for painful neuroma J Bone Joint Surg Br 2009; 91-B: 803-808 [Abstract] [Full text] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Intravenous lumen prevents traumatic neuroma development

Jiri Sedy   (10 September 2009)

Intravenous lumen prevents traumatic neuroma development 10 September 2009
Jiri Sedy, scientist Inst. of Dental Research, First Fac. of Med., Charles Univ. and General Univ. Hosp., Czech Republic Send letter to journal: Re: Intravenous lumen prevents traumatic neuroma development jirisedy{at}hotmail.com Jiri Sedy	Sir, I read this paper with interest. Balcin et al performed a prospective randomised double-blind study to compare translocation of the nerve stump into either muscle tissue or a subcutaneous vein, in order to find the best treatment for traumatic neuroma of the lower limb. They found that translocation into a vein led to reduced pain, and improved sensory, affective and evaluative dimensions of pain. This finding is of particular interest to our group, examining the mechanism of traumatic neuroma development. We hypothesised previously that traumatic neuroma development involves simultaneous nerve repair and defensive mechanisms (i.e. reactive proliferation of perineurial cells) in the region of concomitant wound and scar contraction.1 Moreover, the development of an easily violable balance between nerve regeneration and damage has been proposed.1 The finding of Balcin et al that transposition of the nerve stump into the vein leads to a significantly better outcome thus indirectly supports our hypothesis and adds important data to the whole problem. Most importantly, the authors showed that it is a venous lumen per se, which represents the proper, less scarring environment preventing the development of traumatic neuroma and not the blood flow, proposed by several authors to be the main factor, that “may remove the neurotrophic factors released by the nerve stump”. Most likely, the natural endothelium-proliferative potential as well as post-thrombotic re-canalising abilities of veins represent the main factors in prevention of scar formation and prevents the myofibroblast-based contraction of surrounding tissue and further reactive proliferation of perineurial cells of the nerve stump. In conclusion, I would like to congratulate the authors on their excellent results, which represent a further step towards the understanding of pathophysiology and treatment of traumatic neuroma. Jiří Šedý, MD, DMD, PhD, Institute of Dental Research, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 1. Foltán R, Klíma K, Špačková J, Šedý J. Mechanism of traumatic neuroma development. Med Hypotheses 2008;71:572-6.