Clinical Outcomes of Symptomatic Neuroma Resection and Reconstruction with Processed Nerve Allograft.
Journal
Plastic and reconstructive surgery. Global open
ISSN: 2169-7574
Titre abrégé: Plast Reconstr Surg Glob Open
Pays: United States
ID NLM: 101622231
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
29
01
2021
accepted:
22
07
2021
entrez:
7
10
2021
pubmed:
8
10
2021
medline:
8
10
2021
Statut:
epublish
Résumé
Neuromas causing sensory disturbance can substantially affect nerve function and quality of life. Historically, passive termination of the nerve end and proximal relocation to muscle or bone has been performed after neuroma resection, but this method does not allow for neurologic recovery or prevent recurrent neuromas. The use of processed nerve allografts (PNAs) for intercalary reconstruction of nerve defects following neuroma resection is reasonable for neuroma management, although reported outcomes are limited. The purpose of this study was to assess the outcomes of pain reduction and functional recovery following neuroma resection and intercalary nerve reconstruction using PNA. Data on outcomes of PNA use for peripheral nerve reconstruction were collected from a multicenter registry study. The registry database was queried for upper extremity nerve reconstruction with PNA after resection of symptomatic neuroma. Patients completing both pain and quantitative sensory assessments were included in the analysis. Improvement in pain-related symptoms was determined via patient self-reported outcomes and/or the visual analog scale. Meaningful sensory recovery was defined as a score of at least S3 on the Medical Research Council Classification scale. Twenty-five repairs involving 21 patients were included in this study. The median interval from injury to reconstruction was 386 days, and the average nerve defect length was 31 mm. Pain improved in 80% of repairs. Meaningful sensory recovery was achieved in 88% of repairs. Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.
Sections du résumé
BACKGROUND
BACKGROUND
Neuromas causing sensory disturbance can substantially affect nerve function and quality of life. Historically, passive termination of the nerve end and proximal relocation to muscle or bone has been performed after neuroma resection, but this method does not allow for neurologic recovery or prevent recurrent neuromas. The use of processed nerve allografts (PNAs) for intercalary reconstruction of nerve defects following neuroma resection is reasonable for neuroma management, although reported outcomes are limited. The purpose of this study was to assess the outcomes of pain reduction and functional recovery following neuroma resection and intercalary nerve reconstruction using PNA.
METHODS
METHODS
Data on outcomes of PNA use for peripheral nerve reconstruction were collected from a multicenter registry study. The registry database was queried for upper extremity nerve reconstruction with PNA after resection of symptomatic neuroma. Patients completing both pain and quantitative sensory assessments were included in the analysis. Improvement in pain-related symptoms was determined via patient self-reported outcomes and/or the visual analog scale. Meaningful sensory recovery was defined as a score of at least S3 on the Medical Research Council Classification scale.
RESULTS
RESULTS
Twenty-five repairs involving 21 patients were included in this study. The median interval from injury to reconstruction was 386 days, and the average nerve defect length was 31 mm. Pain improved in 80% of repairs. Meaningful sensory recovery was achieved in 88% of repairs.
CONCLUSION
CONCLUSIONS
Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.
Identifiants
pubmed: 34616638
doi: 10.1097/GOX.0000000000003832
pmc: PMC8489892
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e3832Informations de copyright
Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.
Déclaration de conflit d'intérêts
Disclosure:The authors have no financial interest to declare in relation to the content of this article. This study was supported by Axogen (Alachua, Fla.).
Références
J Reconstr Microsurg. 2015 Jun;31(5):384-90
pubmed: 25893633
Pain. 2010 Dec;151(3):862-869
pubmed: 20974520
Microsurgery. 2013 Sep;33(6):460-7
pubmed: 23861174
Ann Plast Surg. 2019 Apr;82(4):420-427
pubmed: 30855369
J Neurosurg. 2018 Apr;128(4):1235-1240
pubmed: 28621630
Brain Res. 1991 Sep 20;559(2):315-21
pubmed: 1794104
Exp Neurol. 2007 Jan;203(1):185-95
pubmed: 16970940
Plast Reconstr Surg. 2020 Feb;145(2):368e-381e
pubmed: 31985643
Hand (N Y). 2016 Jun;11(2):144-51
pubmed: 27390554
Rev Neurosci. 2018 Jul 26;29(5):557-566
pubmed: 29306933
Ann Plast Surg. 2015 Apr;74(4):454-61
pubmed: 25003441
J Reconstr Microsurg. 2005 Jan;21(1):29-33; discussion 34
pubmed: 15672316
Ann Surg. 2019 Aug;270(2):238-246
pubmed: 30371518
Clin Orthop Relat Res. 2020 Sep;478(9):2161-2167
pubmed: 32452928
Hand (N Y). 2017 Jan;12(1):55-59
pubmed: 28082844
J Hand Surg Am. 1992 Jul;17(4):677-87
pubmed: 1629548
Neurosurgery. 2018 Sep 1;83(3):354-364
pubmed: 29053875
J Hand Surg Am. 2013 Oct;38(10):1965-71
pubmed: 23998191
J Hand Surg Am. 2012 Nov;37(11):2340-9
pubmed: 23101532
Ann Plast Surg. 2013 Dec;71(6):654-8
pubmed: 22868319
Ann Plast Surg. 2017 Jun;78(6S Suppl 5):S292-S295
pubmed: 28328632
Plast Reconstr Surg Glob Open. 2018 Mar 6;6(3):e1670
pubmed: 29707445
J Craniofac Surg. 2017 Mar;28(2):496-500
pubmed: 28045824
Foot Ankle Int. 2016 Oct;37(10):1098-1105
pubmed: 27340257
Microsurgery. 2020 Jul;40(5):527-537
pubmed: 32101338
Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2163
pubmed: 31044125
Orthop Clin North Am. 2000 Jul;31(3):485-98
pubmed: 10882473
Plast Reconstr Surg. 2021 Jan 1;147(1):101-111
pubmed: 33002982
J Bone Joint Surg Br. 1973 May;55(2):390-401
pubmed: 4707307
Neuroreport. 2010 Oct 6;21(14):958-62
pubmed: 20729767
Orthop Traumatol Surg Res. 2020 Feb;106(1S):S13-S18
pubmed: 31843513
J Trauma. 2004 Mar;56(3):571-84
pubmed: 15128129
Microsurgery. 2009;29(7):568-72
pubmed: 19693931
Microsurgery. 2012 Jan;32(1):1-14
pubmed: 22121093
Mil Med. 2018 Sep 1;183(9-10):e434-e441
pubmed: 29590419
Exp Neurol. 2007 Sep;207(1):163-70
pubmed: 17669401
Pain Res Manag. 2019 Jul 10;2019:7490801
pubmed: 31360271
Microsurgery. 2020 Sep;40(6):710-716
pubmed: 32277511
Ann Plast Surg. 1999 Dec;43(6):661-7
pubmed: 10597831
Plast Reconstr Surg Glob Open. 2019 Dec 19;7(12):e2467
pubmed: 32537284
Ann Plast Surg. 2019 Apr;82(4S Suppl 3):S247-S255
pubmed: 30855395
Plast Reconstr Surg Glob Open. 2018 Oct 16;6(10):e1952
pubmed: 30534497
Muscle Nerve. 2009 Jun;39(6):787-99
pubmed: 19291791