Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery

Abstract

Background: Neuromas are caused by irregular and disorganized regeneration following nerve injury. Many surgical techniques have been described to address neuroma with varying success. The aim of this study was to evaluate predictive factors for secondary surgery after initial surgical intervention for symptomatic neuroma along with a description of the anatomical distribution of surgically treated symptomatic neuromas. Methods: Five hundred ninety-eight patients with 641 neuromas that underwent primary surgery for neuroma were identified retrospectively. The diagnosis of neuroma was based on physical examination and patient history in the medical charts. Neuromas were treated by excision, implantation in muscle or bone, excision with direct neurorrhaphy with or without nerve grafting, or other treatments. Results: The rate of secondary surgery for neuroma was 7.8 percent, and secondary operations were performed at a median of 16.1 months. Excision alone or excision with implantation into bone or muscle had higher rates of secondary surgery compared with excision and direct neurorrhaphy with or without nerve graft. Neuromas were located in the upper extremity (49.61 percent), lower extremity (46.65 percent), and the groin/trunk (3.74 percent). Conclusions: Symptomatic neuromas are located predominantly in the extremities, and surgery can improve pain, with low secondary surgery rates. Excision with direct neurorrhaphy with or without nerve grafting was associated with lower reoperation rates. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Outcomes of Surgical Treatment of Peripheral Neuromas of the Hand and Forearm

“…14 Also, Wolvetang et al found lower rates of secondary neuroma surgery in patients undergoing neurorrhaphy with or without nerve graft compared with those undergoing implantation techniques. 15 Although no specific technique proved to be clearly superior, our data demonstrated that surgical intervention should be considered in the treatment algorithm for patients suffering from painful neuroma refractory to conservative management.…”

A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits

“…30 Although these data are limited, symptomatic neuromas reduce patient quality of life, increase the risk of developing an opioid misuse disorder, may lead to multiple additional operations, and lead to donor-site allodynia and other complications such as infection. 59,[61][62][63][64][65][66][67] Finally, the procedure cost analysis demonstrated that overall allograft costs are 825e lower than autograft costs the inpatient setting and comparable in the outpatient setting. This suggests that allograft repair may achieve similar outcomes at similar or lower costs as compared with autograft repair.…”

<p>Peripheral Neuropathic Pain and Pain Related to Complex Regional Pain Syndrome with and without Fixed Dystonia – Efficient Therapeutic Approach with Local Anesthetics</p>

“…41 In accordance with other studies the surgical intervention remains recommended only for patients with painful neuromas who are not responsive to medical or other treatments. 42,43 It seems that the surgical procedure could at least partially dissolve the pain triggering mechanisms of the old scar neuromas, whereas the new scar neuromas created by this surgical procedure may follow new and different rules. This could support the suspicion that operating on a pain condition with a wrong assumption of its origin could still solve the pain problem at least partially.…”