Autologous Fat Grafting for the Treatment of a Painful Neuroma of the Hand: A Case Report and Review of Literature

Abstract

Neuropathic pain caused by a neuroma can have a significant effect on daily life. Current surgical treatments include simple neuroma excision and proximal nerve stump relocation (into a muscle, vein, or bone). We describe a patient who presented with neuropathic pain, restricted to the dorsum of the right hand, and numbness of the dorsum of the radial half of the middle finger. The patient is a right-handed architect and due to the trauma could no longer shake hands for fear of pain. Her Tinel’s test was strongly positive. In 2015, she was diagnosed with a neuroma-in-continuity of the third digital nerve originating from the superficial branch of the radial nerve. At the time she was treated with an on-site Naropin injection and hand rehabilitation therapy, which ultimately alleviated the pain. Three years later she presented with pain progression whereupon we treated her exclusively with AFT. The patient was followed up for 12 weeks after the operation; the pain completely disappeared and the patient could shake hands again. After one year, she was still pain-free. AFT is a new technique for the treatment of persistent neuropathic pain and numbness in the hand caused by blunt-trauma neuroma. Autologous fat grafting is a safe, effective, minimally invasive, and innovative therapeutic approach for the management of painful neuromas.

Pharmacotherapy for Keloids and Hypertrophic Scars

“…Autologous fat grafts have many clinical applications in breast surgery, facial rejuvenation, buttock augmentation, and Romberg syndrome, as well as in the treatment of liposuction sequelae, indicating autologous fat grafting is a good method for the correction of scars on the face instead of traditional scar surgical excisions [362]. Adipose tissue can be safely grafted into scars to improve refractory neuropathic pain after severe scarring, such as via burn injury [364][365][366][367]. Based on these results, it was considered that the treatment of severe scars such as burn injuries with fat grafting can prevent the induction of KDs and/or HTSs at injury sites [368,369].…”

Pain-relieving Effects of Autologous Fat Grafting in Breast Cancer Surgery: A Scoping Review

“…42 Furthermore, there are reports suggesting that lipoaspirate, which is rich in mesenchymal stem cells, can attenuate pain responses 22,42,43 and prevent formation of neuromas. 44,45 Thus, although pharmacotherapy has been the mainstay of treatment, emerging evidence suggests that AFG is a promising adjunctive approach for management of PMPS.…”

Traumatic peripheral nerve injuries: diagnosis and management

“…Rehabilitation strategies and nonsurgical techniques are critically important to recovery following PNT. Even with optimal surgical management, recovery is typically incomplete and associated with significant ongoing physical dysfunction and pain [72]. These approaches are designed to reduce residual physical disability and enable compensatory functional adaptation.…”