Treatment of Neuroma Pain with Processed Nerve Allografts Via Translocation or Reconstruction.
Genevieve M Rambau, MD1, Christian Victoria, MPH1 and Steve K. Lee, MD2, (1)Hospital for Special Surgery, New York, NY, (2)Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
Introduction: Painful superficial neuromas remain a stymie for both patients and surgeons. Despite numerous described treatments, they are often unreliable with poor outcomes. This study hypothesized that the use of processed nerve allografts for nerve elongation and translocation into muscle or for the purpose of reconstruction would result in improved pain and functional outcomes.
Methods: Retrospective review of 12 patients treated by a single surgeon for painful lower extremity neuromas with the utilization of processed nerve allograft either with elongation of the residual nerve stump and translocation into muscle (n=7) or nerve reconstruction (n=5). Patient demographics, surgical details, and outcomes data were evaluated comparing preoperative and postoperative PROMIS (Patient Reported Outcomes Measurement Information System) scores. Patients underwent preoperative workup with imaging (US and/or MRI) and anesthetic injection, if indicated. Reconstruction was performed if a viable distal nerve end was identifiable, otherwise translocation to muscle was performed.
Results: Average follow-up was 15.2 mo (± 11.4). Neuroma locations included intermetatarsal (n=4), sural (n=1), deep peroneal (n=3), superficial peroneal (n=4), and medial plantar (n=1). Five patients failed a previous neuroma surgery, five patients had prior surgery in the zone of injury, one patient sustained a traumatic laceration, and one patient had an MVC with multiple previous surgeries. All but one patient had at least one prior surgery, with 7 patients (5 translocation, 2 reconstruction) having undergone a previous attempt to specifically address neuroma pain. Preoperative injection when administered was successful in 6/7 and 2/2 of the translocation and reconstruction groups, respectively. Preoperative ultrasound identified a neuroma in 4/7 translocation, and 4/4 reconstruction patients. Pathology confirmed a neuroma in all 12 patients. Outcomes data was available for 10 patients (6 translocation/4 reconstruction) which demonstrated a statistically significant improvement in PROMIS interference (p=0.006), intensity (p=0.011), pain behavior (p=0.016), and NRS (p=0.0004). Three patients underwent revision for recurrent neuroma: 1 translocation, 2 reconstruction.
Conclusions: Both translocation and reconstruction using processed nerve allografts offer improved pain and functional outcomes for the treatment of painful superficial neuromas. Preoperative anesthetic injection and ultrasound are excellent adjuncts to confirm diagnosis, however a negative finding on ultrasound should not preclude diagnosis or treatment. Three patients had neuroma occurrence at the proximal stump interface requiring revision surgery, prompting caution when counseling patients about recurrence and possible interventions to thwart these complications.
Back to 2021 ePosters