Digital Nerve Management and Neuroma Prevention in Hand Amputations.

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Hand Surgery

Background:

• Digital nerve injury is common in hand amputations.
• Neuroma formation can cause significant disability and necessitate revision surgery.
• Interdigital end-to-end nerve coaptation is a technique to prevent neuroma formation.

Purpose of the Study:

• To evaluate the efficacy of digital nerve end-to-end neurorrhaphy in preventing neuroma formation.
• To assess the impact of this technique on patient pain, complications, and need for revision surgery.

Main Methods:

• Retrospective review of patients with digital nerve amputations from 2010-2020.
• Nerves were managed with traction neurectomy or end-to-end neurorrhaphy.
• Primary outcome: neuroma development; Secondary outcomes: revision surgery, complications, pain scores.

Main Results:

• End-to-end coaptation was performed on 78 nerves (27%), with a 12.8% neuroma incidence versus 22.7% without coaptation.
• Patients undergoing coaptation reported significantly less persistent pain (0% vs. 11.8%).
• Symptomatic neuromas were associated with higher rates of depression and workers' compensation claims.

Conclusions:

• Digital nerve end-to-end neurorrhaphy is effective for neuroma prevention in partial hand amputations.
• This technique reduces residual hand pain without increasing complications.
• Symptomatic neuroma formation is linked to psychological and socioeconomic factors.