Preventing Amputation Neuromas with Autogenous Vein Grafting

Background: Amputation neuromas are a frequent sequela of peripheral nerve transection, with no universally accepted prevention strategy. Implantation of transected nerve ends into veins has been described in experimental and clinical reports; however, controlled histologic validation remains limited. The present study was designed to validate, in a within-subject animal model, whether autogenous vein ensheathment prevents neuroma formation following nerve transection. Methods: A controlled, within-subject animal study was conducted using 10 Sprague–Dawley rats. Each rat underwent bilateral transection of the saphenous nerve. On one side, the proximal nerve stump was ligated and ensheathed within an autogenous femoral vein segment (experimental group), while the contralateral stump underwent transection and ligation alone (control group). After 18 weeks, sites were harvested and examined grossly and histologically. Neuroma formation was assessed as a binary histologic outcome using established morphologic criteria. Groups were compared using Fisher’s Exact Test (p < 0.05). Results: No gross bulb-shaped neuromas were observed. Histology demonstrated neuroma formation in all 10 control nerves and in none of the 10 vein-ensheathed nerves (p < 0.001). Control nerves showed disorganized, divergent fascicles embedded within dense connective tissue. In contrast, experimental nerves regenerated within the vein conduit in an organized, fascicular pattern with preserved perineurial boundaries and without extension into adjacent scar. Conclusion: In this animal model, autogenous vein ensheathment prevented histologic neuroma formation after nerve transection. These findings provide histologic validation supporting vein conduits as a protective microenvironment for regenerating nerves. Further investigation is warranted to define functional outcomes and clinical relevance.