Case report
Cadaveric Nerve Allotransplantation in the Treatment of Persistent Thoracic Neuralgia

https://doi.org/10.1016/j.athoracsur.2014.06.092Get rights and content

When relief from neuralgia cannot be achieved with traditional methods, neurectomy may be considered to abate the stimulus, and primary opposition of the terminal nerve ending is recommended to prevent neuroma. Nerve repair with autograft is limited by autologous nerves available for large nerve defects. Cadaveric allografts provide an unlimited graft source without donor-site morbidities, but are rapidly rejected unless appropriate immunosuppression is achieved. An optimal treatment method for nerve allograft transplantation would minimize rejection while simultaneously permitting nerve regeneration. This report details a novel experience of nerve allograft transplantation using cadaveric nerve grafts to desensitize persistent postoperative thoracic neuralgia.

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Postoperative neuralgia can be a debilitating consequence of routine surgical interventions [2]. After axonal injury the segment of the axon distal to the cut end degenerates and is absorbed by Schwann cells. The proximal segment then fuses and swells, forming a “retraction bulb.” Synaptic function is lost asaxoplasmic transport stops and noneurotransmitters are secreted. The nucleus of the injured axon undergoes chromatolysis in anticipation of axonal regeneration. In an effort to restore

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