Artikel
Coverage of painful peripheral nerve neuromas with vascularized soft tissue: Method and results
Die Behandlung schmerzhafter peripherer Nervenneurome mittels vaskularisierten Weichteilläppchen: Methode und Ergebnisse
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Our aim is to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in eight patients and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients and medications before and after surgery is presented.
Methods
Eight patients (mean age: 45.1 years; all males) with post traumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity and who had unsuccessfully undergone several treatment procedures, were selected for the surgery described here. Surgery included resection of the stump neuroma (4 patients) or neurolysis of the neuroma-in-continuity (4 cases) and coverage of the nerve with a vascularized fascial or fasciocutaneous or perforator flap (4 pedicled regional flaps; 4 free flaps). A modified quadruple visual analogue scale (QVAS) was used to quantify pain before and after surgical treatment. The mean follow-up was 20.6 months.
Results
The mean values of the QVAS (pain now/ typically/ at its best/ at its worst) before surgery were 6.5/6.5/4.7/7.9. These values changed to 0.3/0.4/0/0.9 at a mean follow-up of 20.6 months after surgery. Six patients returned to their original profession, one receives a pension and one took-up a less demanding job after surgery. 6/8 patients received opioids before surgery (one of them had a spinal cord stimulator). After surgery, all patients stopped taking regular pain killers, the SCS was deactivated in one, and two patients still occasionally take NSAID’s, but not on a regular basis.
Conclusions
Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective, attractive and, at the same time, complex method of treatment. This option may be considered and reserved for patients, who have already undergone several pain treatment modalities without success.