Painful neuroma – mid-term results of resection and nerve stump transposition into veins*

Abstract

Background: Modification of the milieu around the nerve stump to prevent recurrent neuroma formation after resection of a painful neuroma is one of the treatment modalities for this condition. Good shortterm results have been reported for nerve stump transplantation into veins but long-term results for this method are lacking.Methods: Twenty-five patients were included in this retrospective study after neuroma resection and nerve stump transplantation into veins. In 17 cases, neuromas were treated on the upper extremity, in eight cases on the lower extremity. Pre-and postoperative subjective painrelated impairment in daily life was evaluated using a four-grade scale. Pain on percussion was assessed using a visual analogue scale (VAS, 10 grades). Subjective acceptance of the procedure was quantified with a four-grade scale. Average follow-up was 43.6 months.Results: A reduction of subjective pain-related impairment in daily life from 3.12 to 1.56 (average) was achieved, as was a significant decrease of pain on percussion. Subjective acceptance of surgery averaged 1.6.Conclusions: To date, there is a paucity of data on mid-and long-term results of surgical treatment of painful neuroma. Our mid-term results of neuroma resection and transposition of the nerve stump into veins are favourable and encouraging. Our data also indicate that the results do not deteriorate with time. Furthermore, our mid-term results compare favourably with the results of other treatment options. This treatment modality is relatively fast and easy to perform for experienced microsurgeons and gives good results in a difficult group of patients.

Predictive value of a diagnostic block in focal nerve injury with neuropathic pain when surgery is considered

“…Second, there is no consensus as to which envelopment of the proximal stump is optimal. ( Fig 4 ) The proximal stump can be buried in bone[ 10 , 14 – 16 , 33 , 43 , 48 , 51 ], muscle,[ 9 , 10 , 12 , 14 – 16 , 18 , 21 – 29 , 33 , 35 , 41 , 46 – 48 , 51 , 52 , 60 , 66 ] vein[ 12 , 32 , 36 – 38 ] or nerve. [ 13 , 57 , 59 ] Local factors in the area of the damaged nerve play a role in neuropathic pain[ 69 ] and provocation might not be entirely a mechanical problem.…”

Dessensibilização Química, Neurectomia Palmar E Complicações Pós-Cirurgicas Em Equino: Relato De Caso

“…Apesar da neurectomia digital palmar ser utilizada há décadas como forma de aliviar a dor presente em doenças degenerativas podais que não responderam às terapias conservativas (Dabareiner et al, 1997;Zhang et al, 2006;Nicoletti et al, 2007;Koch, 2011;Rezaie;Mousavi;Mohajeri, 2011), são poucas as citações de neurectomia palmar (NP), principalmente em relação ao pós-cirúrgico e complicações inerentes em equinos. No caso descrito, a NP foi sugerida como forma de alívio permanente da dor crônica, visto o cloreto de amônio não apresentar a longevidade no tempo de ação necessária para o caso clínico relatado.…”

“…Nos casos crônicos de equinos refratários às terapias convencionais, como na "dor crônica de talão" em equinos (associada às afecções degenerativas podais), pode-se optar de forma paliativa pela interrupção na transmissão nociceptiva, através da neurectomia digital palmar (NDP) ou utilização de fármacos neurolíticos, apresentando como principais complicações o surgimento de neuromas dolorosos, dessensibilização incompleta, tempo insuficiente de ação neurolítica química e reinervações (Dabareiner et al, 1997;Nicoletti et al, 2007;Koch, 2011;Rezaie et al, 2011).…”

Treatment of Postsurgical Neuroma in Foot and Ankle Surgery

“…Koch subsequently reported midterm results (range 19-64 months) from 8 patients with lower extremity and an additional 17 patients with upper extremity painful neuroma treated with neuroma resection and transposition into vein using microsurgical technique (Level IV evidence). 28 Although the 2 publications reported different outcome measures, they reported complete symptom resolution in 14 of 25 patients (56%). Mild symptoms recurred in 9 of 25 patients, while moderate to severe symptoms recurred in 2 of 25 patients at final follow-up.…”