Surgical Algorithm for Neuroma Management: A Changing Treatment Paradigm.

Area of Science:

• Neurosurgery
• Regenerative Medicine
• Peripheral Nerve Surgery

Background:

• Painful neuromas present a significant challenge in nerve surgery.
• Historically, treatment involved passive excision and implantation, often neglecting nerve end repair.
• Recent advancements have shifted focus towards active nerve reconstruction techniques.

Purpose of the Study:

• To review contemporary surgical strategies for painful neuroma management.
• To detail diagnostic considerations and surgical technique selection.
• To categorize available reconstructive and ablative interventions.

Main Methods:

• Comprehensive literature review of surgical neuroma management techniques.
• Classification of techniques based on nerve end availability (intact vs. absent).
• Categorization into passive/ablative and active/reconstructive modalities.

Main Results:

• Techniques for intact nerve ends include hollow tube and nerve grafts.
• Methods for absent nerve ends encompass implantation, neurorrhaphy, nerve caps, regenerative interfaces, and targeted muscle reinnervation.
• A wide array of surgical options exists, tailored to nerve end condition.

Conclusions:

• Nerve surgeons must be aware of diverse treatment options for neuromas.
• Selection of the optimal intervention depends on individual patient factors and nerve end status.
• Further comparative studies are essential to evaluate the efficacy of different techniques.