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Regenerative Peripheral Nerve Interface: Surgical Protocol for a Randomized Controlled Trial in Postamputation Pain
Published on: March 15, 2024
The Incidence and aetiology of symptomatic neuroma development following digital amputation; a single centre
Raveenjot Nagra1, Sunil Parthiban1, Toby Austin1
1Department of Hand and Peripheral Nerve Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom.
Background:
Symptomatic neuromas are an uncommon but disabling consequence of digital amputation. Reported incidence varies widely, and there is limited evidence regarding the influence of amputation aetiology, level and intraoperative nerve management technique on subsequence neuroma formation. The aim of this study was to assess the incidence of symptomatic digital neuromas and to determine whether aetiology, amputation levels, or nerve management technique influenced their development.
Methods:
A single-centre retrospective cross-sectional cohort study was conducted of all patients undergoing digital amputation between 2014 and 2021 at a tertiary trauma centre. Patient records were reviewed for demographics, amputation aetiology, anatomical level, intraoperative nerve management technique, and clinical follow-up for evidence of symptomatic neuroma development.
Results:
A total of 815 digital amputations were performed amongst 689 patients. The total incidence of digital neuroma was 6.26%. Trauma was the lead indication for amputation (86.3%). There was no statistically significant association between developing neuroma and amputation aetiology or anatomical level. The most commonly employed nerve management techniques were traction neurectomy (231/815; 28.3%) and bipolar cautery (238/815; 29.2%). Neuroma incidence was higher following traction neurectomy compared with bipolar cautery (9.96% (23/231) vs 5.04% (12/238). Traction neurectomy was associated with a statistically increased risk of symptomatic neuroma formation compared with bipolar cautery (unadjusted odds ratio (OR) 2.08; 95% CI 1.01-4.29, P<0.046).
Conclusion:
This study provides contemporary incidence data on symptomatic digital neuromas following amputation. Traction neurectomy at the time of digital amputation is associated with an increased likelihood of subsequent neuroma development compared with bipolar cautery, highlighting the importance of nerve management technique in surgical planning.
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