Novel Use of Dermal Regenerative Peripheral Nerve Interfaces for Neuroma Prevention in Digit Amputation
Laura Bashour, MS1, Helen Schafer, BS1, Cole Holan, MS1, Brent M Egeland, MD2, Steven Haase, MD3, Theodore A Kung, MD4, Steven L Henry, MD, FACS, FAAP5 and Brian P Kelley, MD1, (1)Dell Medical School at the University of Texas, Austin, TX, (2)Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, (3)University of Michigan Health System, Ann Arbor, MI, (4)Section of Plastic & Reconstructive Surgery, University of Michigan, Ann Arbor, MI, (5)Dell Medical School at University of Texas, Austin, TX
Background: Symptomatic neuromas are a significant cause of morbidity in post-amputation patients, typically occurring within two to four months after the initial amputation, and often require surgical revision. Numerous surgical treatment options exist to address symptomatic neuromas without a definitive gold standard. These include regenerative peripheral nerve interfaces (RPNI), neurorrhaphy, transposition, nerve graft or transfer, and excision and covering with epineurium or silicon caps, or simple neurectomy. RPNIs provide targets for nerve reinnervation and can be placed at the site of amputations or symptomatic neuromas anywhere in the body without a donor nerve or foreign body implant. Previously, skeletal muscle RPNI has been shown to be effective in symptomatic neuroma prevention in below knee amputations for both neuroma formation and phantom pain mitigation. Also, skeletal muscle RPNIs have also been shown to be effective in the treatment of symptomatic neuromas in the upper extremity. Laboratory studies also demonstrate effective of dermal RPNIs. Here we demonstrate our series of prophylactive dermal graft RPNIs for prophylactic treatment of digital neuromas in patients undergoing digital amputation.
Methods: We retrospectively reviewed all cases of digit amputation by a single surgeon from March 1st, 2018 to March 1st, 2020 who received prophylactic treatment with RPNI. Indications precipitating amputation included traumatic injury, dry gangrene, or infection. We compared prophylactic RPNI in digit amputation to digit amputation patients with traditional traction neurectomy as a control. We analysed the outcomes including painful neuroma formation, phantom pain, and postoperative infection.
Results: We identified 14 digits in 10 patients who received radial and ulnar nerve dermal RPNIs (n = 28 nerves) during this time period and 19 digits in 17 patients in the control group (n = 36 nerves). Of 28 nerves treated with dermal RPNIs, no nerves (0%) developed a symptomatic neuroma versus 2 nerves (5.6%) in the control group (p>0.05). Infection rates were similar (p>0.05). All patients went on to heal without further operative intervention. No extrusions of the graft used in the RPNI were noted.
Conclusions: Prophylactic use of RPNI in digit amputations resulted in no symptomatic neuromas in this short series compared with a rate of 5.6% with traditional traction neurectomy. There was no difference in complications between RPNI and control patients, including no change in infection rates. Therefore, the use of dermal RPNIs may be an effective surgical intervention for patients undergoing digit amputation to prevent neuroma formation without increased risk to the patient.
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