Abstract
The choice of a specific technique for surgical treatment of neuromas remains a problem.
The purpose of this study is to determine the overall effectiveness of surgery as
well as to find out whether certain surgical procedures are more effective than others.
Twenty-nine patients operated between 1998 and 2018 and followed for at least 12 months
were reviewed. Clinical assessment included the identification of a pre- and postoperative
Tinel sign, pain visual analog score, two-point discrimination (2PD), and grip strength.
Mechanisms of injury included clean lacerations (11), crush injuries (11), and other
trauma or surgery (7). Mean time from presentation to surgery was 9 months. Seven
surgical procedures involving excision in 10 patients and excision and nerve repair
in 19 patients were performed. Pain score improved from an average of 7.1 ± 2.3 to
1.8 ± 1.7 with 27 patients (93%) reporting mild or no postoperative pain. Nine patients
complained of residual scar hypersensitivity and six patients had residual positive
Tinel. No patient required an additional surgical procedure. 2PD improved from an
average of 9.6 ± 4.0 to 6.8 ± 1.0. The improvement of pain score and 2PD was statistically
significant. Nerve repair resulted in marginally better outcomes, in terms of 2PD
and grip strength recovery, than excision alone. The mechanism of injury, zone of
involvement, time to intervention, or length of follow-up did not have an impact on
the outcomes. Although patient numbers in this study are large in comparison to previous
studies, larger patient numbers will allow for a multivariate analysis, which can
be possible with a prospective multicenter trial.
Keywords
neuroma - resection - reconstruction
