Document Detail


The role of peripheral nerve surgery in the management of painful chronic wounds: indications and outcomes.
MedLine Citation:
PMID:  18594405     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with chronic wounds caused by healing problems often present with chronic pain at the site. Proper wound care with or without appropriate reconstruction usually addresses both the wound and its associated pain. However, wounds occasionally remain painful despite successful reconstruction, particularly when they are complicated by an underlying condition. These patients frequently develop a disabling chronic pain condition despite the application of current treatment modalities. The authors used a novel approach to manage this difficult clinical situation, by addressing the sensory nerve supply to the affected wound region.
METHODS: Five women and two men with intractable chronic pain despite wound reconstruction underwent surgery and were followed for a mean period of 27 months (range, 8 to 40 months). The involved sensory nerve was identified preoperatively by physical examination, confirmed by nerve block, and then surgically excised and implanted into adjacent muscle. Each patient's pain reduction, ambulation status, and quality-of-life improvement were evaluated.
RESULTS: The involved nerves included the ilioinguinal, lateral femoral cutaneous, sural, saphenous, superficial peroneal, and deep peroneal nerves, and the genital branch of the genitofemoral nerve. All seven patients reported significant pain reduction (p < 0.0001), improved ambulation (p < 0.0001), and improved quality of life (p < 0.0001), as evaluated at last follow-up (mean, 27 months).
CONCLUSIONS: This study suggests that an additional treatment modality in the management of chronic wounds can be considered for patients with disabling pain. As an adjunct to other interventions, this novel application of peripheral nerve surgery can critically improve symptoms in selected patients with intractable chronic wound pain.
Authors:
Ivica Ducic; Amir A Mafi; Christopher E Attinger; Kara Couch; Ali Al-Attar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  122     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-07-02     Completed Date:  2008-07-29     Revised Date:  2011-02-16    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  193-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC, USA. ducici@gunet.georgetown.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Chronic Disease
Female
Humans
Male
Middle Aged
Pain / etiology,  surgery*
Peripheral Nerves / surgery*
Wounds and Injuries / complications,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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