Clinical Outcome for Surgical Treatment of Traumatic neuroma with a Processed Nerve Allograft: Results of a Small Prospective Case Series
Anne Bolleboom, BSc; Godard De Ruiter, MD;
The Hague, Netherlands; Karin Boer, Hand & Pols Centrum Den haag, Den Haag, Netherlands
Purpose. Surgical treatment of traumatic neuromas remains an important clinical problem in peripheral nerve surgery. Surgical excision of the neuroma may provide pain relief, but symptoms often recur. The best surgical treatment is to reconnect the severed nerve ends after excision of the neuroma. In large motor nerves an autograft can be used for this purpose, but in small sensory nerves this would mean that one sensory nerve has to be sacrificed to reconstruct the other. An alternative is to use a processed nerve allograft. The goal of the present study was to evaluate the recovery of pain and sensation after surgical reconstruction of painful traumatic neuromas in the lower extremity using an allograft.
Patients and methods. Four patients with a traumatic painful neuroma of small sensory nerves in the lower extremity were surgically treated with a decellularized allograft (Axogen). Patients were followed prospectively for one year. Diagnosis of traumatic neuroma was confirmed with histopathologic analysis. Clinical outcome was assessed using the Likert scale. Recovery of sensation was tested using Semmes-Weinstein monofilaments.
Results. In all four cases an allograft of 3cms in lengths was used to reconstruct a defect in the superficial peroneal (3) or sural nerve (1) after excision of the traumatic neuroma. Complete relief of pain symptoms (Likert 1) was achieved in two patients: one case concerned the reconstruction of a neuroma-in-continuity and one case the reconstruction of a nerve lesion 6 months after injury. In the other two patients the interval between the injury and surgery was longer than one year (13 and 14 months). Recovery of normal sensation was only achieved in the two patients with good clinical outcome. No substantial sensory recovery was found in the other two patients.
Conclusions. This small prospective case series shows that processed nerve allografts can be successful for the reconstruction of small sensory nerves after excision of traumatic neuroma if the interval between injury and reconstruction is relatively short. For patients with an interval of more than one year no recovery of pain symptoms and sensation was found.
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