Clinical Outcomes of Symptomatic Neuroma Resection and Reconstruction with Processed Nerve Allograft

Abstract

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: 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: 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: Neuroma resection and nerve reconstruction using PNA can reduce or eliminate chronic peripheral nerve pain and provide meaningful sensory recovery.

Development of an acellular nerve cap xenograft for neuroma prevention

“…18 As an alternative, transposition of the nerve stump into muscle, bone, or a vein is often preferred. 19,20 This approach provides a dedicated space where nerve regeneration can occur; however, the lack of a directional structural template still exposes the nerve to the risk of disorganized axonal outgrowth or aberrant reinnervation. Additional, more complex surgical approaches have been used to create new functional interfaces between nerve and muscle tissue in amputees (e.g., targeted muscle reinnervation, regenerative peripheral nerve interface.…”

“…Yet, traction neurectomy is a mechanical rupture of normal or, worse, a sensitized nerve; this mechanism also occurs in traumatic injuries of nerves and is a known source for neuropathic pain 18 . As an alternative, transposition of the nerve stump into muscle, bone, or a vein is often preferred 19,20 . This approach provides a dedicated space where nerve regeneration can occur; however, the lack of a directional structural template still exposes the nerve to the risk of disorganized axonal outgrowth or aberrant reinnervation.…”

Use of Urinary Bladder Matrix Conduits in a Rat Model of Sciatic Nerve Regeneration after Nerve Transection Injury

“…This provides encouragement for the discovery of new techniques to bridge these gaps formed by nerve injury. Furthermore, autografts may produce undesirable symptoms in patients who undergo the procedure, including chronic pain and neuroma formation [15]. Despite these potential limitations, the autograft technique has been shown to produce the most promising and consistent healing and continues to remain at the forefront for nerve repair and regeneration.…”

Procedure Costs of Peripheral Nerve Graft Reconstruction

“…Surgical intervention is necessary to restore nerve function and includes primary repair of nerve transection, reconstruction of nerve gaps, management of painful nerve conditions, and neuromas that are associated with neuropathic pain. 11 , 12 Effective surgical treatment requires tension-free coaptation of healthy nerve tissue. Direct repair with suture of a transected nerve is common; however, tension-free technique is not always possible with direct repair.…”

“… 11 , 14 – 16 However, use of this surgical technique can result in complications/sequelae at the donor nerve site, including cold intolerance, dysesthesias, sensory loss, neuroma formation, chronic nerve pain, infection, and scarring, and can be constrained when repairing extensive injuries due to a limited supply of donor nerve. 5 , 11 , 12 , 14 , 15 , 17 , 18 …”