Treatment of the painful neuroma by neuroma resection and muscle implantation

A. Lee Dellon, Susan E. Mackinnon

Research output: Contribution to journalArticle

192 Scopus citations

Abstract

The successful treatment of the painful neuroma remains an elusive surgical goal. This report evaluates one approach to the management of this problem which entails neuroma excision and placement of the proximal end of the nerve away from denervated skin, away from tension, and into a well-vascularized environment: muscle. Seventy-eight neuromas in 60 patients with a mean follow-up of 31 months (range 18 to 43 months) were evaluated. Sixty-seven percent of these patients involved Workmen's Compensation and 57 percent had had at least one previous operation to treat their pain. The results demonstrated good to excellent results in 82 percent of the treated nerves in the entire group. Factors that were predictive of a poorer outcome were (1) digital neuroma (p < 0.0005), (2) Workmen's Compensation (p < 0.01), and (3) three or more previous operations for pain (p < 0.01). Transposition of nerves into small superficial muscles or muscles with significant excursion resulted in treatment failures. The etiology and histopathology of treatment failures are reviewed. Treatment of radial sensory neuromas by transposition of the radial sensory nerve into the brachioradialis muscle when any associated injury to the lateral antebrachial cutaneous nerve was also treated, gave good to excellent relief of pain, and improved hand function in 88 percent of the patients.

Original languageEnglish
Pages (from-to)427-436
Number of pages10
JournalPlastic and reconstructive surgery
Volume77
Issue number3
DOIs
StatePublished - Mar 1986
Externally publishedYes

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