Dorsal-to-palmar branch neuroanastomosis in horses undergoing palmar digital neurectomy does not reduce neuroma formation or improve outcome.

OBJECTIVE: Chronic foot pain, a common cause of forelimb lameness, can be treated by palmar digital neurectomy (PDN). Complications include neuroma formation and lameness recurrence. In humans, neuroanastomoses are performed to prevent neuroma formation. The aim of the study was to evaluate the outcome of horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN. STUDY DESIGN: Retrospective case series. ANIMALS: Eighty-five horses with PDN and dorsal-to-palmar branch neuroanastomosis. METHODS: Medical records for horses undergoing this procedure at two hospitals between 2015 and 2020 were reviewed. Palmar and dorsal nerve branches of the PDN were transected and end-to-end neuroanastomosis was performed by apposition of the perineurium. Follow-up was obtained from medical records and telephone interviews. Success was defined as resolution of lameness for at least one year. RESULTS: Lameness resolved following surgery in 81/85 (95%) horses with 57/84 (68%) sound at one year. Postoperative complications occurred in 19/85 (22%) cases. The main limitations of the study were an incomplete data set, inaccurate owner recall, and variations in procedure. CONCLUSION: Compared to previous studies, this technique resulted in similar numbers of horses sound immediately after surgery, a comparable rate of postoperative neuroma formation but a higher recurrence of lameness rate at 1 year postoperatively. CLINICAL SIGNIFICANCE: End-to-end neuroanastomosis of the dorsal and palmar branches of the PDN does not reduce the rate of neuroma formation in horses. Long-term outcome was less favorable compared to previously reported PDN techniques.

Management of an Early-Onset, Painful Tibial Nerve Neuroma Using an Autologous Nerve Graft.

This case report describes the treatment of a postoperative painful neuroma of the tibial nerve using an autologous nerve graft in a dog. The patient presented with sudden non-weight-bearing lameness 10 days after iatrogenic tibial nerve injury during preparation of a reverse saphenous conduit flap. The dog showed severe pain at the surgical site without nerve deficits. A magnetic resonance imaging examination revealed an enlarged tibial nerve at the injury site, consistent with a neuroma. Analgesics were administered over 11 days, but the patient remained in severe pain and non-weight-bearing. Therefore, surgical resection was recommended. The fusiform neuroma was resected microsurgically, and a saphenous nerve graft was transplanted using an epineural nerve repair technique. Histopathological examination was consistent with a neuroma. The dog showed immediate pain relief and weight-bearing the day after surgery with normal motor function. The dog made a full recovery by the last follow-up 6 mo after surgery. If patients develop pain and lameness following surgery or nerve injury, neuroma formation must be considered, even shortly after surgery. Microsurgical resection and autologous nerve transplantation using an epineural nerve repair technique is a viable method to treat painful neuromas and minimize the risk for recurrence in dogs.

Neuromas at the castration site in geldings.

BACKGROUND: Inguinal pain, unexplained hind limb lameness, back pain or behavioural problems in geldings could be attributable to painful neuromas that develop as a consequence of crushing and severing the testicular nerves during castration. The presence of neuroma in this anatomical location has never been reported, hence the knowledge of possible clinical relevance is limited. The aim of this study was to histologically investigate the testicular nerves at the castration site in geldings for the presence of neuromas. Proximal spermatic cord remnants were collected from 20 geldings admitted to routine post mortem examination for various reasons. The time of castration was unknown, but it had not been performed during the last year. Spermatic cord specimens were immersed in 10% formalin, trimmed, dehydrated, embedded in paraffin, sectioned and stained with haematoxylin and eosin (HE) for light microscopy. Identification of nerve tissue was done by immuno-localization of nerve specific enolase (NSE). RESULTS: Neuromas were found in 21 spermatic cords from 13 geldings and were bilateral in eight of the horses. The neuromas consisted of areas with small groups of non-neoplastic proliferations of peripheral neural tissue. The tissue included neurofilaments and Schwann cells, intermingled or surrounded with, epineural, perineural and endoneural fibrous tissue. The neural tissue immunostained positive with NSE. CONCLUSIONS: This study showed neuromas of the remnant testicular nerves at the site of castration. Further studies are required to establish if these neuromas in the castration site are painful and if certain castration methods promote their formation. Future studies should also investigate the clinical consequence of these neuromas for the individual horse.

Comparison of neural histomorphology in tail tips from pigs docked using clippers or cautery iron.

Tail docking of pigs is commonly performed to reduce the incidence of unwanted tail-biting behaviour. Two docking methods are commonly used: blunt trauma cutting (i.e. using side clippers), or cutting and concurrent cauterisation using a hot cautery iron. A potential consequence of tail amputation is the development of neuromas at the docking site. Neuromas have been linked to neuropathic pain, which can influence the longer-term welfare of affected individuals. To determine whether method of tail docking influences the extent of neuroma formation, 75 pigs were allocated to one of three treatments at birth: tail docked using clippers; tail docked using cautery iron; tail left intact. Tail docking was performed at 2 days of age and pigs were kept under conventional conditions until slaughter at 21 weeks of age. Tails were removed following slaughter and subjected to histological examination. Nerve histomorphology was scored according to the following scale: 1=discrete well-organised nerve bundles; 2=moderate neural proliferation and disorganisation affecting more than half of the circumference of the tail; 3=marked neural proliferation to form almost continuous disorganised bundles or non-continuous enlarged bundles compressing the surrounding connective tissue. Scores of 2 or 3 indicated neuroma formation. Scores were higher in docked pigs than undocked pigs (P<0.001), but did not differ between pigs docked using clippers and those docked using cautery (P=0.23). The results indicate that tail docking using either clippers or cautery results in neuroma formation, thus having the potential to affect long-term pig welfare.

Histopathological Characterization of Tail Injury and Traumatic Neuroma Development after Tail Docking in Piglets.

Tail docking of neonatal pigs is widely used as a measure to reduce the incidence of tail biting, a complex management problem in the pig industry. Concerns exist over the long-term consequences of tail docking for possible tail stump pain sensitivity due to the development of traumatic neuromas in injured peripheral nerves. Tail stumps were obtained post mortem from four female pigs at each of 1, 4, 8 and 16 weeks following tail amputation (approximately two-thirds removed) by a gas-heated docking iron on post natal day 3. Tissues were processed routinely for histopathological examination. Non-neural inflammatory and reparative epidermal and dermal changes associated with tissue thickening and healing were observed 1 to 4 months after docking. Mild neutrophilic inflammation was present in some cases, although this and other degenerative and non-neural reparative changes are not likely to have caused pain. Traumatic neuroma and neuromatous tissue development was not observed 1 week after tail docking, but was evident 1 month after tail docking. Over time there was marked nerve sheath and axonal proliferation leading to the formation of neuromata, which were either localized and circumscribed or comprised of multiple axons dispersed within granulation tissue. Four months after tail resection, neuroma formation was still incomplete, with possible implications for sensitivity of the tail stump.

Effects of tail docking and docking length on neuroanatomical changes in healed tail tips of pigs.

In pig production, piglets are tail docked at birth in order to prevent tail biting later in life. In order to examine the effects of tail docking and docking length on the formation of neuromas, we used 65 pigs and the following four treatments: intact tails (n=18); leaving 75% (n=17); leaving 50% (n=19); or leaving 25% (n=11) of the tail length on the pigs. The piglets were docked between day 2 and 4 after birth using a gas-heated apparatus, and were kept under conventional conditions until slaughter at 22 weeks of age, where tails were removed and examined macroscopically and histologically. The tail lengths and diameters differed at slaughter (lengths: 30.6±0.6; 24.9±0.4; 19.8±0.6; 8.7±0.6 cm; P<0.001; tail diameter: 0.5±0.03; 0.8±0.02; 1.0±0.03; 1.4±0.04 cm; P<0.001, respectively). Docking resulted in a higher proportion of tails with neuromas (64 v. 0%; P<0.001), number of neuromas per tail (1.0±0.2 v. 0; P<0.001) and size of neuromas (1023±592 v. 0 µm; P<0.001). The results show that tail docking piglets using hot-iron cautery causes formation of neuromas in the outermost part of the tail tip. The presence of neuromas might lead to altered nociceptive thresholds, which need to be confirmed in future studies.

Neuroma formation following partial beak amputation (beak trimming) in the chicken.

Branches of the trigeminal nerve, which innervates the beak in the chicken, were damaged after partial beak amputation (beak trimming) and degeneration in the nerve extended from 2 to 3 mm proximal to the cut stumps. Within 10 days the damaged nerves showed regeneration and axon sprouts had been formed. This neural regeneration was rapid so that by 20 to 30 days bundles of regenerating fibres were present and neuromas formed adjacent to the scar tissue of the stump of the beak. These neuromas became more extensive over the 70 day observation period.

Neuromata in docked lambs' tails.

Docked and undocked lambs tails obtained after slaughter were examined grossly and histopathologically. Stump and complex neuromata were identified in docked tails.

Clinicopathological studies on neurectomy in equids.

Clinical and pathological changes following neurectomy were studied experimentally in 46 male and female equids. Sixty-three operations were performed using either the traditional or the Fackelman and Clodius methods of neurectomy. The effect of arteriovenous ligation was studied in 12 animals and 20 angiograms were performed post mortem to study the arterial pattern of the extremities of the operated limb. Neuroma formation (31 cases) and sloughing of the hoof (five cases) were the two main untoward sequelae. Neurectomy by the technique of Fackelman and Clodius proved superior to the traditional method. No essential changes were observed after ligation of the blood vessels, except in one case where collateral circulation was established.

Attempts to prevent equine post neurectomy neuroma formation through retrograde transport of two neurotoxins, doxorubicin and ricin.

Digital neurectomies, performed to relieve pain and lameness, are often complicated postoperatively by formation of painful neuromas. In this study attempts were made to deliver lethal doses of neurotoxin to the cell bodies of the transected digital nerve fibres via long-distance retrograde axon transport and, thereby, prevent the regenerative changes that lead to neuroma formation. After applying doxorubicin in various ways to the digital nerve stumps of ponies, degenerating or necrotic neurones appeared only sporadically in the spinal ganglia. Although doxorubicin was largely ineffective in retrograde destruction of cell bodies, when absorbed in pledgets on the stumps it exerted a sustained action which prevented Schwann cell proliferation and axon sprouting. Ricin, in contrast to doxorubicin, was effective in retrograde destruction of sensory neurons. Many affected neurons were devoid of polysomes but packed with mitochondria; others had advanced to various stages in cytolysis. Despite its effectiveness, ricin cannot be recommended because of its extreme toxicity. The clinical use of retrograde transport in equine neurectomy will probably depend on future development of hybrid toxins with high neural specificity and low systemic toxicity.

The absence of neuromas in beaks of adult hens after conservative trimming at hatch.

OBJECTIVE: To determine the effects of the amount of break removed and cauterisation time on neuroma formation in hens. DESIGN: A pathology study with controls. ANIMALS: Twenty domestic fowl were beak-trimmed. Three non-beak-trimmed domestic fowl were used as controls. PROCEDURE: Beaks of two age groups with two levels of beak removal and either 2 s or 4 s cauterisation, were investigated macroscopically and microscopically for deformities. RESULTS: Scattered trauma-associated neuromas were present in the beaks of pullets 10 weeks after moderate trimming at hatch. Neuromas were not present in beaks of adult hens that had been similarly trimmed. Sensory corpuscles were present 10 and 70 weeks after moderate trimming, though fewer in number than in intact control hens. In contrast, trauma-associated neuromas persisted in beaks of 70-week-old hens that had been severely trimmed at hatch. A range of deformities that were absent in moderately trimmed hens, were observed in hens with severely trimmed beaks. Receptors were not seen in severely trimmed beaks. CONCLUSION: Beak-trimming at hatch induces the formation of neuromas, regardless of the amount of tissue removed. There is a critical amount of beak tissue that can be removed, beyond which trauma-associated neuromas will not resolve, but will persist in mature hens.

[Interruption of the sensory nerve tract in chronically lame horses]. / Over de onderbreking van de sensibele zenuwbaan bij chronisch kreupele paarden.

Within the framework of the series 'Papers of yesterday and today', two articles on neurotomy by Moubis (1876 and 1878) are used to evaluate the present status of neurectomy. In 1800 neurotomy was replaced by neurectomy because of the reinnervation which occurred after several weeks. On the basis of a literature review and clinical experience in the Department of Large Animal Surgery the indications, conditions, anatomy, operative techniques, complications and results of neurectomy are discussed. Post-operative neuroma formation is the most important complication following palmar digital neurectomy. The many operative techniques and modifications which have been conceived and used are the consequence of the search for technical and surgical variations for prevention of neuroma formation. The ethical aspects of the use and misuse of the neurectomised patient are discussed. The importance of the ethical appreciation of owners and the very important informative function of the veterinary surgeon are emphasised.

Ocular glioneuroma with medulloepitheliomatous differentiation in a goldfish (Carassius auratus).

An intraocular mass in the left eye causing chronic severe exophthalmia in an adult female goldfish (Carassius auratus) is described. The fish shared an aquarium with another goldfish found dead with gross and microscopic lesions consistent with mycobacteriosis. Histological examination of the left eye, histochemical (periodic acid-Schiff [PAS], Alcian blue, Ziehl-Neelsen) and immunohistochemical tests (glial fibrillary acidic protein, human neuronal protein, vimentin, and cytokeratin AE1/AE3) were carried out on the intraocular mass. Neoplastic cells forming an unencapsulated highly cellular proliferation partially covered by an intact corneal epithelium were stained with Alcian blue, which demonstrated an abundant hyaluronic acid-rich extracellular matrix. Multifocally, there were cyst-like dilatations bordered by neuroepithelial cells, which were PAS-positive. The complex neoplastic proliferation was composed of glial-like cells, neuronal-like cells (immunoreactive to glial fibrillary acidic protein and human neuronal protein, respectively) and neuroepithelium, which suggested a retinal origin.

A case report of traumatic neuroma of the cervical spinal cord in a dog.

Traumatic neuroma of the cervical spinal cord was diagnosed in a 14-year-old male mixed-breed dog. A gross view showed two intradural extramedullary masses, measuring 1 and 0.6 cm in length and 0.7 and 0.4 cm in diameter, attached to the left side of the spinal cord at the level of the sixth and seventh cervical vertebrae. Microscopically, the cervical spinal masses comprised interlacing fascicles of axons and Schwann cells surrounded by collagenous stroma. Immunohistochemically, the fascicles were stained positively for neurofilament and S-100 proteins. Ultrastructurally, variably sized myelinated fibers and onion bulb-like structures were observed. To our knowledge, this is the first report of a traumatic neuroma in the cervical spinal cord of a dog.

Comparison of palmar digital neurectomy by the guillotine technique and palmar digital neurotomy associated with end-to-side neurorrhaphy in mares / Comparação entre neurectomia por técnica de guilhotina e neurotomia associada à neurorrafia em alça de balde em nervo digital palmar de éguas

Five mares were submitted to palmar digital neurectomy by the guillotine technique and palmar digital neurotomy followed by end-to-side neurorrhaphy (right and left thoracic limbs, respectively). Mares were checked for local pain sensation using hoof tester and submitted to lameness workup at 15-day intervals. No evidence of painful neuroma formation was detected. Palmar digital nerve (PDN) stump segments were collected within 60 days of surgery. Mean left and right limb PDN stump thickness corresponded to 5.96 mm and 7.16 mm, respectively. Schwann cells prevailed over connective healing tissue in all PDN stumps studied. Well-formed nerve-like structures with better organized nervous tissue and predominance of parallel nerve fiber orientation were documented in left limb PDN stumps. End-to-side neurorrhaphy tended to promote tissue organization, potentially reducing the chances of neuroma formation...

O nervo digital palmar (NDP) lateral do membro torácico direito (MTD) de cinco equinos fêmeas foi submetido à neurectomia pela técnica da guilhotina, e o do membro torácico esquerdo (MTE) à neurotomia e neurorrafia término-lateral. Os animais foram avaliados a cada 15 dias quanto ao teste de sensibilidade cutânea com pressão local com pinça de casco e de claudicação, não sendo notados sinais clínicos de neuroma doloroso. Aos 60 dias pós-cirurgia coletou-se segmentos dos cotos proximais dos NDPs. Os dos MTDs apresentavam em média, a espessura de 7,16 mm e aos dos MTEs de 5,96 mm. Nos cotos proximais dos nervos dos membros direito e esquerdo notou-se predominância de células de Schwann à grande quantidade de tecido conjuntivo cicatricial. Os do MTEs apresentavam estruturas de nervo típico, bem constituídas, com maior organização do tecido nervoso e predomínio de fibras nervosas orientadas paralelamente. A neurorrafia termino-lateral apresentou tendência a ocasionar maior organização entre as estruturas analisadas, o que lhe conferiu menor potencial em desenvolver neuromas dolorosos...

Comparison of palmar digital neurectomy by the guillotine technique and palmar digital neurotomy associated with end-to-side neurorrhaphy in mares / Comparação entre neurectomia por técnica de guilhotina e neurotomia associada à neurorrafia em alça de balde em nervo digital palmar de éguas

Five mares were submitted to palmar digital neurectomy by the guillotine technique and palmar digital neurotomy followed by end-to-side neurorrhaphy (right and left thoracic limbs, respectively). Mares were checked for local pain sensation using hoof tester and submitted to lameness workup at 15-day intervals. No evidence of painful neuroma formation was detected. Palmar digital nerve (PDN) stump segments were collected within 60 days of surgery. Mean left and right limb PDN stump thickness corresponded to 5.96 mm and 7.16 mm, respectively. Schwann cells prevailed over connective healing tissue in all PDN stumps studied. Well-formed nerve-like structures with better organized nervous tissue and predominance of parallel nerve fiber orientation were documented in left limb PDN stumps. End-to-side neurorrhaphy tended to promote tissue organization, potentially reducing the chances of neuroma formation(AU)

O nervo digital palmar (NDP) lateral do membro torácico direito (MTD) de cinco equinos fêmeas foi submetido à neurectomia pela técnica da guilhotina, e o do membro torácico esquerdo (MTE) à neurotomia e neurorrafia término-lateral. Os animais foram avaliados a cada 15 dias quanto ao teste de sensibilidade cutânea com pressão local com pinça de casco e de claudicação, não sendo notados sinais clínicos de neuroma doloroso. Aos 60 dias pós-cirurgia coletou-se segmentos dos cotos proximais dos NDPs. Os dos MTDs apresentavam em média, a espessura de 7,16 mm e aos dos MTEs de 5,96 mm. Nos cotos proximais dos nervos dos membros direito e esquerdo notou-se predominância de células de Schwann à grande quantidade de tecido conjuntivo cicatricial. Os do MTEs apresentavam estruturas de nervo típico, bem constituídas, com maior organização do tecido nervoso e predomínio de fibras nervosas orientadas paralelamente. A neurorrafia termino-lateral apresentou tendência a ocasionar maior organização entre as estruturas analisadas, o que lhe conferiu menor potencial em desenvolver neuromas dolorosos(AU)

Chemical desensitization, palmar neurectomy and post-surgical complications in horse: case report / Dessensibilização química, neurectomia palmar e complicações pós-cirúrgicas em equino: relato de caso

The aim is report the case of a stallion Quarter Horse with 12 years old, with podal chronic degenerative syndrome and partial ankylosis in metacarpal-phalangeal joint of the left forelimb, submitted to palmar chemical neurolysis with ammonium chloride 2 % , externalizing analgesic efficacy and return to sports activity for 40 days. After the period, was performed palmar neurectomy (NP), and with 110 days the horse had painful neuromas, underwent the new surgery. It is necessary to more reports and research involving the NP in equine evaluating: time and quality of analgesia; complications after NP; proprioceptive real risks to the animal and assessment of risk factors in the formation of neuromas(AU)

Objetiva-se relatar o caso de um garanhão da raça Quarto de Milha de 12 anos, portador de síndrome degenerativa crônica podal e anquilose parcial na articulação metacarpo-falângica do membro torácico esquerdo, submetido à neurólise química palmar com cloreto de amônio 2%, exteriorizando eficácia analgésica e retorno à atividade esportiva por 40 dias. Após o período, foi realizado neurectomia palmar (NP), sendo que com 110 dias o equino apresentou neuromas dolorosos, sendo submetido à nova cirurgia. Há necessidade de mais relatos e pesquisas envolvendo a NP em equino avaliando: tempo e qualidade de analgesia; complicações após NP; reais riscos proprioceptivos ao animal e avaliação de fatores de risco na formação de neuromas(AU)

Chemical desensitization, palmar neurectomy and post-surgical complications in horse: case report / Dessensibilização química, neurectomia palmar e complicações pós-cirúrgicas em equino: relato de caso

The aim is report the case of a stallion Quarter Horse with 12 years old, with podal chronic degenerative syndrome and partial ankylosis in metacarpal-phalangeal joint of the left forelimb, submitted to palmar chemical neurolysis with ammonium chloride 2 % , externalizing analgesic efficacy and return to sports activity for 40 days. After the period, was performed palmar neurectomy (NP), and with 110 days the horse had painful neuromas, underwent the new surgery. It is necessary to more reports and research involving the NP in equine evaluating: time and quality of analgesia; complications after NP; proprioceptive real risks to the animal and assessment of risk factors in the formation of neuromas

Objetiva-se relatar o caso de um garanhão da raça Quarto de Milha de 12 anos, portador de síndrome degenerativa crônica podal e anquilose parcial na articulação metacarpo-falângica do membro torácico esquerdo, submetido à neurólise química palmar com cloreto de amônio 2%, exteriorizando eficácia analgésica e retorno à atividade esportiva por 40 dias. Após o período, foi realizado neurectomia palmar (NP), sendo que com 110 dias o equino apresentou neuromas dolorosos, sendo submetido à nova cirurgia. Há necessidade de mais relatos e pesquisas envolvendo a NP em equino avaliando: tempo e qualidade de analgesia; complicações após NP; reais riscos proprioceptivos ao animal e avaliação de fatores de risco na formação de neuromas