Reset Neurectomy for Cutaneous Nerve Injuries

Abstract

Summary Diffuse cutaneous nerve injuries, often caused by a crush mechanism, are challenging for the nerve surgeon. Discrete nerve transections and focal neuromas are easier to identify and have a more distinct treatment algorithm. Following crush injury to a noncritical sensory nerve, a successful local anesthetic block proximal to the injury may help determine the possibility of surgical intervention. In these cases, we describe a technique of “reset neurectomy” whereby a neurectomy is performed proximal to the zone of injury, and immediate repair or reconstruction (with or without a nerve graft) is performed. This technique may be useful in cases of diffuse, nontransection nerve injuries in which neuropathic pain is the primary symptom.

RPNI, TMR, and Reset Neurectomy/Relocation Nerve Grafting after Nerve Transection in Headache Surgery

“…However, there is no reason to suggest that the techniques that have been shown to improve/ prevent pain in sensory nerves of the extremities would be less efficacious in the region of the head and neck. 16,17,19,20,26,28 RPNI and TMR are both feasible options to address the GON/LON proximal nerve stump after transection. The semispinalis muscle is in close proximity to the nerve.…”

“…Advanced techniques to address the proximal nerve stump after nerve transection such as RPNI, TMR, relocation nerve grafting, and resect neurectomy have been shown to improve chronic pain and neuroma formation after transection of peripheral nerves. 16 , 17 , 19 , 20 , 26 , 28 These techniques have not been described in the head and neck region. In the context of headache surgery, GON transection is performed when the nerve appears severely damaged, if symptoms are recurrent or persistent, and when neuromas are excised.…”

“…However, there is no reason to suggest that the techniques that have been shown to improve/ prevent pain in sensory nerves of the extremities would be less efficacious in the region of the head and neck. 16 , 17 , 19 , 20 , 26 , 28 …”

“…2 ). 26 The nerve is transected proximal to the area of pain with immediate coaptation to the distal nerve end with or without nerve graft. This eliminates afferent nerve signals and allows the nerve to regenerate along the native nerve, which has become a “graft.” To our knowledge, the concept of reset neurectomy has not been combined with relocation nerve grafting.…”

Fluoroscopic-Guided Bilateral Superior Hypogastric Plexus Neurolysis in the Treatment of Intractable Neoplasm-Related Penile Pain

“…Neurolysis of the inferior hypogastric plexus has also been indicated in the treatment of pelvic and perineal pain caused by cancer [ 5 ]. A fluoroscopy-guided trans-sacral approach to the inferior hypogastric plexus showed a reduction in pain scores from a mean of 7.22 ± 1.31 to 4.06 ± 1.73 one week after the procedure [ 14 ]. Combinations of techniques, such as the neurolytic block of both the superior hypogastric plexus and the ganglion impar, have been shown to be an effective technique in cases of cancer-related lower abdominal and pelvic pain [ 15 - 17 ].…”