Digital Nerve Management and Neuroma Prevention in Hand Amputations

Abstract

Background: Hand and digit amputations represent a relatively common injury affecting an active patient population. Neuroma formation following amputation at the level of the digital nerve can cause significant disability and lead to revision surgery. One method for managing digital nerves in primary and revision partial hand amputations is to perform interdigital end-to-end nerve coaptations to prevent neuroma formation. Methods: All patients with an amputation at the level of the common or proper digital nerves that had appropriate follow-up at our institution from 2010 to 2020 were included. Common or proper digital nerves were managed with either traction neurectomy or digital end-to-end neurorrhaphy. The primary outcome was the development of a neuroma. Secondary outcomes included revision surgery, complications, and visual analog pain scores. Results: A total of 289 nerves in 54 patients underwent hand or digital amputation in the study period. Thirteen hands with 78 nerves (27%) underwent direct end-to-end coaptation with a postoperative neuroma incidence of 12.8% compared with 22.7% in the 211 nerves that did not have a coaptation performed. Significantly fewer patients reported persistent pain if an end-to-end coaptation was performed (0% vs. 11.8%, P < .01). The prevalence of depression and workers compensation status was significantly higher in in patients with symptomatic neuromas than in patients without symptomatic neuromas ( P < .01). Conclusions: Digital nerve end-to-end neurorrhaphy is a method for neuroma prevention in partial hand amputations that results in decreased residual hand pain without increase complications. Depression and worker’s compensations status were significantly associated with symptomatic neuroma formation.

Dorsal‐to‐palmar branch neuroanastomosis in horses undergoing palmar digital neurectomy does not reduce neuroma formation or improve outcome

“…Direct end-to-end neuroanastomosis is technically simpler and clinical studies support its use in human and equine medicine. 17,20,22,23 Despite reported clinical outcomes, histological evaluation has suggested that direct end-to-end anastomosis can increase neuroma formation due to lack of interposition of axon sprouting from each terminal stump. 20,21 In comparison, centrocentral or group fascicular anastomoses have similarly been shown to be both functional and effective at reducing neuroma formation but are both more technically demanding and require significant more dissection when compared to the simpler technique of direct end-to-end anastomosis.…”

“…Neuroanastomoses have been described in the human literature as a means to both treat neuroma formation as well as prevent formation thereby improving long-term comfort in patients with digit amputation. 15,17,18 A recent study found that neuroma occurred in 12.8% (10/78 nerves) of cases with end-to-end anastomosis performed compared with 22.7% (48/211 nerves) of cases in which no anastomosis was performed. 17 The main objective of this study was to evaluate the outcome of horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN, including success of the neurectomy as determined by resolution of lameness, postoperative complications, and owner satisfaction.…”

“…15,17,18 A recent study found that neuroma occurred in 12.8% (10/78 nerves) of cases with end-to-end anastomosis performed compared with 22.7% (48/211 nerves) of cases in which no anastomosis was performed. 17 The main objective of this study was to evaluate the outcome of horses undergoing dorsal-to-palmar branch neuroanastomosis following PDN, including success of the neurectomy as determined by resolution of lameness, postoperative complications, and owner satisfaction. We also aimed to identify potential factors associated with outcome including horse age, sex, breed, and athletic use, preoperative diagnostic imaging modalities used, preoperative diagnosis, and surgical center.…”

Nerve Capping Techniques for Neuroma Management

“…Conservative management has proven to be successful in reducing symptoms; however, it is not always sufficient 1,2 . Clinicians should consider surgical intervention in certain situations that are resistant to medicinal treatment 3–5 …”

“…1,2 Clinicians should consider surgical intervention in certain situations that are resistant to medicinal treatment. [3][4][5] Unlike the central nervous system, the peripheral nerve system (PNS) demonstrates a remarkable capacity to regenerate. 6 It is not clear if cranial nerves follow the PNS model, the central nervous system model, or a different regenerative pathway.…”