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Chirurgie 1. Dezember 2011

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

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 short-term 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 pain-related 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.

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