gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

Recalcitrant painful peripheral nerve neuromas : a treatment algorithm including vascularised soft tissue coverage

Therapieresistente Schmerzen bei traumatischen peripheren Neuromen: ein Behandlungsalgorithmus mit vaskularisierter Lappendeckung

Meeting Abstract

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  • corresponding author K. G. Krishnan - Neurochirurgische Klinik, Universitätsklinikum Dresden
  • T. Pinzer - Neurochirurgische Klinik, Universitätsklinikum Dresden
  • G. Schackert - Neurochirurgische Klinik, Universitätsklinikum Dresden

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc09.05.-09.02

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Veröffentlicht: 4. Mai 2005

© 2005 Krishnan et al.
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Our aim is to describe a method of treating painful peripheral nerve neuromas by means of vascularised tissue coverage, report the results in twelve 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.


Twelve patients (mean age: 45.1 yrs; 8 males, 4 females) with post traumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity, who had unsuccessfully underwent several treatment procedures, were selected for surgery described here. Surgery included resection of the stump neuroma (5 patients) or neurolysis of the neuroma-in-continuity (7 cases) and coverage of the nerve with a vascularised fascial or fasciocutaneous or perforator flap (5 pedicled regional flaps; 7 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.


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. 8 patients returned to their original profession, 3 receive pension and one took-up a less demanding job after surgery. 9/12 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.


Vascularised 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 had already underwent several pain treatment modalities without success.