Techniques to prevent symptomatic neuroma in digital amputations.

Area of Science:

• Hand Surgery
• Neurosurgery
• Regenerative Medicine

Background:

• Symptomatic neuromas are common after digital amputation, significantly impacting patient quality of life.
• Effective surgical nerve management is critical for preventing neuroma formation and associated pain.

Purpose of the Study:

• To analyze complications associated with various nerve management techniques in digital amputations.
• To compare the efficacy of different surgical nerve management strategies in preventing symptomatic neuroma occurrence.

Main Methods:

• Retrospective review of 105 patients undergoing digital amputation over a 5-year period.
• Clinical diagnosis of symptomatic neuroma-related pain using DN4 score and modified Tinel test.
• Comparison of neuroma incidence across different nerve management techniques: neglect, stripping, stripping with thermal ablation, bone burial, centrocentral union, and thermal ablation alone.

Main Results:

• 23 symptomatic neuromas were identified in 131 digital amputations.
• Neuroma rates varied significantly: 12/33 (neglect), 8/60 (stripping), 3/18 (stripping + thermal ablation).
• No neuromas were observed with bone burial (5/5), centrocentral union (5/5), or thermal ablation alone (9/9).

Conclusions:

• Nerve management is essential for preventing neuromas following digital amputation.
• Techniques such as bone burial and centrocentral union of digital nerve stumps demonstrate high efficacy in neuroma prevention.
• These advanced techniques offer promising solutions for improving outcomes and patient quality of life after digital amputation.