Margot A Vlot1, Suzanne C Wilkens1, Neal C Chen1, Kyle R Eberlin2. 1. Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. 2. Division of Plastic and Reconstructive Surgery, Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: keberlin@mgh.harvard.edu.
Abstract
PURPOSE: We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation. METHODS: We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development. RESULTS: Of 1,083 patients, 71 (6.6%) developed a symptomatic neuroma. Mean time to diagnosis was 6.4 months. A total of 47 patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index finger injury and avulsion injury mechanism were significantly associated with a higher risk for symptomatic neuroma. CONCLUSIONS: Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation and more than half of these patients will undergo revision surgery for neuroma, with a mean time to operative intervention of 11 months. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
PURPOSE: We tested the null hypothesis that no factors are independently associated with the development of symptomatic neuroma after traumatic digital amputation. METHODS: We performed a retrospective review of 1,083 patients who underwent revision amputation for traumatic digital amputation; we excluded those undergoing replantation or revascularization. Patients who developed a painful neuroma during follow-up were identified with a minimum follow-up of 1 week and a median of 3.3 months. We calculated the rate of developing a painful neuroma as a proportion of the total number of patients and performed multivariable logistic regression analysis to identify factors independently associated with its development. RESULTS: Of 1,083 patients, 71 (6.6%) developed a symptomatic neuroma. Mean time to diagnosis was 6.4 months. A total of 47 patients (66%) underwent surgery for painful neuroma. Mean time to surgical intervention was 11 months. Index finger injury and avulsion injury mechanism were significantly associated with a higher risk for symptomatic neuroma. CONCLUSIONS: Approximately 1 in 15 patients will develop a symptomatic neuroma after traumatic digital amputation and more than half of these patients will undergo revision surgery for neuroma, with a mean time to operative intervention of 11 months. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
Authors: Deng Pan; Miles Bichanich; Ian S Wood; Daniel A Hunter; Scott M Tintle; Thomas A Davis; Matthew D Wood; Amy M Moore Journal: Plast Reconstr Surg Date: 2021-07-01 Impact factor: 5.169