Summary: Painful neuromas result from traumatic injuries of the hand and digits and cause substantial physical disability, psychological distress, and decreased quality of life among affected patients. The regenerative peripheral nerve interface (RPNI) is a novel surgical technique that involves implanting the divided end of a peripheral nerve into a free muscle graft for the purposes of mitigating neuroma formation and facilitating prosthetic limb control. The RPNI is effective in treating and preventing neuroma pain in major extremity amputations. The purpose of this study was to determine if RPNIs can be used to effectively treat neuroma pain following partial hand and digital amputations. We retrospectively reviewed the use of RPNI to treat symptomatic hand and digital neuromas at our institutions. Between November 2014 and July 2019, we performed 30 therapeutic RPNIs on 14 symptomatic neuroma patients. The average patient follow-up was 37 weeks (6–128 weeks); 85% of patients were pain-free or considerably improved at the last office visit. The RPNI can serve as a safe and effective surgical solution to treat symptomatic neuromas after hand trauma.

No abstract

No abstract

Background: Decisions made to undergo contralateral prophylactic mastectomy (CPM), in women at low risk for bilateral disease, are often attributed to a lack of knowledge. This study examines the role knowledge plays in determining surgical treatment for unilateral breast cancer made by laywomen and surgeons for themselves or loved ones. Methods: Our study cohort had three groups 1) laywomen in the general population 2) breast surgeons and 3) plastic surgeons. Laywomen were recruited using Amazon Mechanical Turk® Crowd Sourcing. Breast and plastic surgeons from 9 states were sent electronic surveys. Demographic and CPM specific information on decisions and knowledge were collected and analyzed. Results: Surveys from 1,333 laywomen, 198 plastic surgeons, and 142 breast surgeons were analyzed. A significantly greater proportion of laywomen in the general population favored CPM (67%) relative to plastic (50%) and breast surgeons (26%), p<0.0001. Breast surgeons who chose CPM were younger (p=0.044) and female (0.012). On assessment of knowledge, 78% of laywomen had a low-level breast cancer knowledge. Laywomen with higher levels of breast cancer knowledge had lower odds of choosing CPM (OR 0.37, 95% CI 0.28-0.49). Conclusion: Fewer women are likely to make decisions in favor of CPM with better breast cancer specific education. A knowledge gap likely explains the lower rates with which surgeons choose CPM for themselves or loved ones, however, some surgeons who were predominantly young and female, favor CPM. Improving patient education on surgical options for breast cancer treatment is critical, with well informed decisions as the goal.