PURPOSE: We report the treatment of 9 patients with 9 painful neuromas at the tips of the digits using reverse pedicled island flaps containing subcutaneous nerves that were connected to the digital nerve stumps after removal of the neuromas. METHODS: There were 9 patients (7 men and 2 women) with painful cutaneous neuromas at the tips of the digits. The ages of the patients at time of surgery were 21 to 66 years (mean, 46 y). All neuromas were formed in the palmar digital nerves in the hand. Preoperative and postoperative status of the patients with neuromas were assessed and graded using a system modified from previously described grading systems for patients with neuromas. Recovery of sensation in the transplanted skin islands was assessed using the Semmes-Weinstein monofilament test. RESULTS: In the preoperative assessment of patients using the grading system for neuromas, 3 patients were assessed as grade 4 (severe), 5 patients as grade 3 (moderate), and the remaining patient as grade 2 (mild). After surgery, Tinel sign disappeared completely in 6 of 9 patients. According to the grading system for neuromas, 6 patients were assessed as grade 1 (normal), and the other 3 patients were assessed as grade 2 (mild) postoperatively. Using the Semmes-Weinstein monofilament test for assessing recovery of sensation of the skin islands, 3 patients recognized the 2.83 monofilament (normal), 2 patients recognized the 3.22 monofilament (loss of tactile sense), and the remaining 4 patients recognized the 3.66 monofilament applied (loss of tactile sense). CONCLUSIONS: This skin island approach provided us with good pain control and recovery of hand function after painful neuromas. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: We report the treatment of 9 patients with 9 painful neuromas at the tips of the digits using reverse pedicled island flaps containing subcutaneous nerves that were connected to the digital nerve stumps after removal of the neuromas. METHODS: There were 9 patients (7 men and 2 women) with painful cutaneous neuromas at the tips of the digits. The ages of the patients at time of surgery were 21 to 66 years (mean, 46 y). All neuromas were formed in the palmar digital nerves in the hand. Preoperative and postoperative status of the patients with neuromas were assessed and graded using a system modified from previously described grading systems for patients with neuromas. Recovery of sensation in the transplanted skin islands was assessed using the Semmes-Weinstein monofilament test. RESULTS: In the preoperative assessment of patients using the grading system for neuromas, 3 patients were assessed as grade 4 (severe), 5 patients as grade 3 (moderate), and the remaining patient as grade 2 (mild). After surgery, Tinel sign disappeared completely in 6 of 9 patients. According to the grading system for neuromas, 6 patients were assessed as grade 1 (normal), and the other 3 patients were assessed as grade 2 (mild) postoperatively. Using the Semmes-Weinstein monofilament test for assessing recovery of sensation of the skin islands, 3 patients recognized the 2.83 monofilament (normal), 2 patients recognized the 3.22 monofilament (loss of tactile sense), and the remaining 4 patients recognized the 3.66 monofilament applied (loss of tactile sense). CONCLUSIONS: This skin island approach provided us with good pain control and recovery of hand function after painful neuromas. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Authors: Louis H Poppler; Rajiv P Parikh; Miles J Bichanich; Kelsey Rebehn; Carrie R Bettlach; Susan E Mackinnon; Amy M Moore Journal: Pain Date: 2018-02 Impact factor: 7.926