Relief of the pain of neuromas-in-continuity and scarred median and ulnar nerves in the distal forearm and wrist by neurolysis, wrapping in vascularized forearm fascial flaps and adjunctive procedures

Abstract

This prospective study reports treatment by neurolysis then wrapping the nerves in vascularized forearm fascia and, when necessary, adjunctive procedures of twelve median and two ulnar nerves in continuity in the distal forearm with neurogenic pain. Preoperatively, all 14 patients had severe pain in at least one of the five modalities of pain analysed. There was complete resolution of all modalities of pain in eight of 14 patients following neurolysis and fascial nerve wrap surgery and two more patients had only mild pain in one or two modalities. After the addition of wrist pinning or arthrodesis alone or in conjunction with selective division of flexor tendons in four patients, there was complete resolution of all modalities of pain in nine of 14 patients. A further three patients had mild pain in three or less modalities and only one patient continued to have severe pain in one modality.

Skin, fascias, and scars: symptoms and systemic connections

“…When stimulated in this way, the sympathetic nervous system can produce a local vasoconstriction of the ankle, again disturbing the postural balance 56,57. Frequently, the patient experiences pain, even in the case of a small or aesthetically acceptable scar, because the adhesions trap the nerve (the peroneal nerve) 52,53,58. As a result of the constant stimulation of pain, the central and peripheral nervous systems adapt themselves and change their structure (allodynia and hyperalgesia), creating a vicious circle 59,60.…”

“…According to our clinical experience, there is often rigidity in the vertebral body corresponding to the output of the nerves 58. The arcade of Struthers, the Frohse’s arcade, and the sublime bridge are connective structures that correlate the brachial fascia anteriorly and posteriorly at the level of the elbow 95–97.…”

Functional recovery following peripheral nerve injury in the transgenic Thy1‐GFP rat

“…However, despite advancements in surgical techniques, functional recovery following nerve injury is often incomplete, leaving many patients with permanent debilitating sensory and motor impairments ( Brushart, 2011). Unfortunately, these injuries often require lifelong pain management, rehabilitation services, and even multiple surgical procedures ( Rosberg et al, 2005;Elliot et al, 2010;Lad et al, 2010).…”

Colgajo sinovial como tratamiento de neuromas del nervio mediano

“…Un pequeño porcentaje de los pacientes que presentan una lesión en un nervio periférico, tratada quirúrgicamente o no, desarrollan un neuroma doloroso que puede ser muy incapacitante 1 . Una de las causas parece ser la adherencia de la cicatriz nerviosa a los tejidos circundantes, que provocan la pérdida del deslizamiento normal del nervio 2 .…”