IDEAS AND INNOVATIONS
Use of poly
-lactide-ε-caprolactone (Neurolac) conduit
for enveloping traumatic neuromas
Muhammad Ali Hussain
Received: 3 April 2012 / Accepted: 14 January 2013 /Published online: 7 February 2013
Springer-Verlag Berlin Heidelberg 2013
occurs at nerve repair sites causing morbidity to the patients.
There are various methods available in literature to treat
neuromas and recurrence of neuromas. Poly
caprolactone conduits are normally used to treat the nerve
defects and help regeneration of the nerve. This case study
describes a novel method with Neurolac conduits for the
management of recurrent neuromas with promising results.
This will open a new horizon for the clinicians to manage
difficult and recurrent neuromas. We have described the tech-
nique with illustrations, which will help the reader to under-
stand the steps involved in the procedure.
Level of Evidence: Level V, therapeutic study.
Neuroma is a benign neoplasm composed chiefly of neurons
and nerve fibres, usually arising from a nerve tissue. Pain
radiating from the lesion to the periphery of the affected
nerve is usually intermittent but may become continuous
and severe. A traumatic neuroma is an unorganized bulbous
or nodular mass of nerve fibres and Schwann cells produced
by hyperplasia of nerve fibres and their supporting tissues
after accidental or purposeful sectioning of the nerve [1, 2].
A wide variety of surgical [3–11] and non-surgical treat-
ments [12–18] has been documented; however, each treat-
ment modality has its own limitations, and their outcome
can be variable. Known surgical complications are function-
al fascicles being sacrificed and the non-functional ones
repaired when performing a separational plasty. Further-
more, resection of neuromas and burying of the stumps into
muscles, bones, or veins can only be used for non-functional
or non-critical nerves or where repair is not suitable [5–11].
Nerve stripping an entire nerve branch results in loss of
function and therefore can only be done with a sensory
branch with an insignificant area of sensory supply .
Non-surgical treatments include local injections of alcohol
or steroids with variable outcomes. Evidence has shown that
steroid injections can give short-term pain relief , but
articles by Greenfield et al.  and Rusmussen et al. 
show that majority of patients still experience symptoms
with a large proportion undergoing subsequent surgery.
Alcohol injections have better outcomes in comparison to
steroid injections [15, 16]; however, the efficacy deteriorates
if used without ultrasound guidance . Poly
caprolactone (Neurolac; Polyganics, Groningen, Nether-
lands) is a synthetic, bioabsorbable, and transparent nerve
guide used in peripheral nerve repair. The Neurolac conduit
has been shown to be superior to autologous nerve grafts in
the case of a short nerve gap (<1 cm) in the repair of trans-
ected peripheral nerves in animal models [19, 20]. In
humans, Neurolac conduit has been shown to have compa-
rable results to primary end-to-end anastomosis in the repair
of transected peripheral nerves in the hand  and has also
been used to reconstruct common plantar digital nerves .
To date, there are no published studies looking into the use
-lactide-ε-caprolactone conduit in the treatment of
M. A. Hussain (*)
Department of Plastic and Reconstructive Surgery,
The Canberra Hospital, ACT, Canberra 2605, Australia
Eur J Plast Surg (2013) 36:657–660