American Society for Peripheral Nerve
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Histopathology Findings of Diabetic Neuropathy and RPNIs for Prevention of Postoperative Pain
Gordana Georgieva, MD; Bisera Nikolovska, MD PhD; Blagoja Srbov, MD; Sofija Tusheva, MD; Stefania Azmanova Mladenovska, MD; Sofija Pejkova, MD PhD
University Clinic for Plastic and Reconstructive Surgery, Medical Faculty, University "St.Cyril and Methodius", Skopje, Macedonia, The former Yugoslav Republic of

Introduction: Peripheral vascular disease and diabetic neuropathy are mean reasons for diabetic foot syndrome. Poor glycaemic control through the years causes peripheral neuropathy and in one portion of the patients is presented with pain, tingling or burning sensation. Impaired wound healing, infection and osteomyelitis contribute to diabetic gangrene and necrosis that leads to lower limb amputation. The aim of this study is to show the histopathological verification of diabetic neuropathy in patients with preoperative pain and indication for lower limb amputation.
Materials and methods: We conducted a prospective study at our clinic in patients with diabetes who had lower limb amputation with Regenerative peripheral nerve interfaces as a prophylactic surgical procedure. We analyzed the demographics, comorbidities, duration of diabetes, diabetic foot ulcer history, histopathology of the nerves, preoperative and postoperative pain.
Results: A total of 15 patients that had lower limb amputation with RPNIs as a surgical technique were included in our study. Results showed male predominance (87%). Average age of the patients was 78 years. Four of the patients had above knee amputation and 11 had below knee amputation. Eighty percent of the patients had diabetes more than 15 years and 73% had more than two comorbidities (renal failure, cardiovascular disease, history of ischemic stroke). Only one patient had diabetic foot wound more than 10 years, 40% had impaired wound healing more than two years, another 40% more than 6 months. Histopathology examination of the transected nerves showed demyelination and axonal degeneration in all of the nerves as main hallmarks of diabetic neuropathy. Histopathology results correlated with preoperative pain in the patients. VAS score was used to analyze the postoperative pain. Ninety-two percent of the patients reported significantly pain reduction first week post amputation and all of the patients were pain free 6 months after surgery with RPNIs.
Conclusion: According to the results of the study, diabetic neuropathy noted through clinical and histopathology findings developed through the years living with hyperglycemia. Peripheral neuropathy has a major role in lower limb amputations in patients with diabetes. These patients also suffer from phantom limb pain and stump pain so regenerative peripheral nerve interfaces should be used as a prophylactic surgical technique to prevent postoperative pain.


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