Document Detail


[Treatment of painful neuromas via end-to-side neurorraphy].
MedLine Citation:
PMID:  20683811     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: Management of the painful neuroma has been subject to controversy since the earliest descriptions of this disabling problem. Today, treatment is limited to resection of the neuroma and implantation of the nerve in a muscle at a location where it is safe from irritation and trauma. This however is not attainable in many cases and it is our clinical experience, that nerves without a target remain a source of constant discomfort and pain. Recently we reported of the feasibility of neuroma prevention through end-to-side neurorraphy into adjacent sensory and/or motor nerves to provide a target for axons deprived of their endorgan. Here we report of our first clinical experience with this method in sixteen patients with longstanding upper and lower extremity neuromas.
PATIENTS AND METHODS: 16 patients were included in this study. All had neuromas of different sensory nerves of both the upper and lower extremity. 11 were of iatrogenic origin, 5 were caused by different traumas. 8 had previous attempts to surgically treat the neuroma. Finally, all were treated by end-to-side neurorraphy into adjacent nerves. Postoperatively quantitative sensorymotor testing was performed to evaluate possible changes of nerve function of the recipient nerves. Pain was evaluated by visual analogue score and changes in pain medication.
RESULTS: In no patient a sensory or motor deficit or painful sensations were induced in the target area of the recipient nerve. Some had dysaesthesias for about 6 months, which finally subsided. All but 1 patient improved in their symptoms at a follow-up of more than 2 years.
CONCLUSION: Previous experimental work and present clinical results suggest that axons of a severed peripheral nerve that are provided with a pathway and target through an end-to-side coaptation will either be pruned or establish some type of end-organ contact so that a neuroma can be prevented without inducing sensory or motor dysfunctions in the recipient nerve.
Authors:
O C Aszmann; V Moser; M Frey
Publication Detail:
Type:  Case Reports; English Abstract; Journal Article     Date:  2010-08-03
Journal Detail:
Title:  Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft für Mikrochirurgie der Peripheren Nerven und Gefässe : Organ der Vereinigung der Deutschen Plastischen Chirurgen     Volume:  42     ISSN:  1439-3980     ISO Abbreviation:  Handchir Mikrochir Plast Chir     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-08-04     Completed Date:  2010-12-16     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8302815     Medline TA:  Handchir Mikrochir Plast Chir     Country:  Germany    
Other Details:
Languages:  ger     Pagination:  225-32     Citation Subset:  IM    
Copyright Information:
Georg Thieme Verlag KG Stuttgart New York.
Affiliation:
Abteilung für Plastische und Wiederherstellende und Asthetische Chirurgie, Universitätsklinik für Chirurgie der Medizinischen Universität Wien, Osterreich. oskar.aszmann@meduniwien.ac.at
Vernacular Title:
Die Behandlung chronisch schmerzhafter Neurome mittels End-zu-Seit Neurorraphie.
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MeSH Terms
Descriptor/Qualifier:
Adult
Anastomosis, Surgical / methods*
Arm / innervation*
Female
Follow-Up Studies
Humans
Iatrogenic Disease
Leg / innervation*
Male
Microsurgery / methods*
Nerve Regeneration / physiology
Neuralgia / surgery*
Neuroma / etiology,  surgery*
Peripheral Nerves / surgery*
Peripheral Nervous System Neoplasms / etiology,  surgery*

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