gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Painful end-neuromas of the upper limb treatment with fat graft. Evidences from an Italian multicentric study

Meeting Abstract

  • presenting/speaker Michele Colonna - Dept Human Pathology, University of Messina, Messina, Italy
  • Franco Bassetto - Plastic Surgery University of Padua, Padua, Italy
  • Giorgio Pajardi - Hand Surgery, Multimedica, University of Milan, Milan, Italy
  • Bruno Battiston - Citta della Salute, Depatment of Traumatology, Turin, Italy
  • Luca Vaienti - Policlinico San Donato, University of Milan, San Donato Milanese (MI), Italy
  • Michele Riccio - Chirurgia Arto Superiore, Ospedali Riuniti Ancona, Torrette, Ancona, Italy
  • Giovanni Risitano - Private practice, Hand Surgery, Sperone, Messina, Italy
  • Rosario Emanuele Perrotta - Plastic Surgery, University of Catania, Catania, Italy
  • Adriana Cordova - Plastic Surgery, University of Palermo, Palermo, Italy
  • Giorgio De Santis - Plastic Surgery, University of Modena, Modena, Italy

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1702

doi: 10.3205/19ifssh0749, urn:nbn:de:0183-19ifssh07491

Veröffentlicht: 6. Februar 2020

© 2020 Colonna et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Objectives/Interrogation: A number of techniques have been proposed for treatment of painful neuromas, but the results still remain poor in up to 67-75 percent of cases.

Fat grafting has proven to effectively contrast post-traumatic adherences and painful scars.

In this multicentric Italian study, the efficacy of fat grafting in treatment of painful upper limb neuromas is presented.

Methods: Since 2012 to 2018, 37 (20 female and 17 male, mean age 49 y) patients were treated in Messina, Milan, Ancona, Turin, Modena, Padua, Palermo and Catania.

The affected nerves were 6 sensate radial, 1 medial antebrachial cutaneous, 6 median, 5 ulnar, 2 digital common trunks, 18 digital collateral nerves.

Terminal neuromas or neuromas in continuity causing persistent pain, unresponsive to conservative and surgical treatments, were ruled in. Before surgery, the nerve was assessed by clinical examination. Preoperatively, the patient gave an evaluation of pain at rest about the neuroma with a visual acuity scale. Limb functionality was evaluated with the "Disabilities of the Arm, Shoulder, and Hand" score. The same variables were collected at day 30, 60, 90; 1, 2 and 6 years after surgery.

At surgery, proper skin incisions were placed to minimize adherences and scar tissue near the nerve. Both neuroma and nerve trunk were exposed, with a complete visualization of neuroma and an accurate proximal dissection, to find healthy proximal nerve.

The neuroma was resected and the adipose tissue harvested from the abdominal region with tumescent technique. The adipose tissue was injected with fine-gauge cannulas around the proximal nerve stump. Depending on the involved segment, an early gentle range of motion was allowed.

Results and Conclusions: DASH score recorded a mean decrease of 10.7 points, from 48.3 to 37.6 (22.2% of the initial value), whereas VAS decreased from 7.6 to 5.2 (31,5%). Analgesic medications were stopped.

The positive effect of fat on painful neuromas can be explained as a gliding soft fat envelope isolating the stump, allowing a normal excursion and modulating inflammatory response, creating neoangiogenesis and paracrine production of signals, interrupting local triggering for pain [1].

Fat grafting is easy to perform, does not require infusion of local anesthetic nor immobilization, is repeatable without reduction of effectiveness. and can be applied virtually for every nerve. The Authors recommend its use to treat painful neuromas of the upper limb, even if further biological and instrumental/functional studies are needed.


Vaienti L, Merle M, Battiston B, Villani F, Gazzola R. Perineural fat grafting in the treatment of painful end-neuromas of the upper limb: a pilot study. J Hand Surg Eur Vol. 2013 Jan;38(1):36-42.