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Surgery for Symptomatic Neuroma: Anatomic Distribution and Predictors of Secondary Surgery

Wolvetang, Nicolaas H. A. M.D.; Lans, Jonathan M.D.; Verhiel, Svenna H. W. L. M.D.; Notermans, Bo J. W. M.D.; Chen, Neal C. M.D.; Eberlin, Kyle R. M.D.

Plastic and Reconstructive Surgery: June 2019 - Volume 143 - Issue 6 - p 1762-1771
doi: 10.1097/PRS.0000000000005664
Reconstructive: Trunk: Original Article
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Background: Neuromas are caused by irregular and disorganized regeneration following nerve injury. Many surgical techniques have been described to address neuroma with varying success. The aim of this study was to evaluate predictive factors for secondary surgery after initial surgical intervention for symptomatic neuroma along with a description of the anatomical distribution of surgically treated symptomatic neuromas.

Methods: Five hundred ninety-eight patients with 641 neuromas that underwent primary surgery for neuroma were identified retrospectively. The diagnosis of neuroma was based on physical examination and patient history in the medical charts. Neuromas were treated by excision, implantation in muscle or bone, excision with direct neurorrhaphy with or without nerve grafting, or other treatments.

Results: The rate of secondary surgery for neuroma was 7.8 percent, and secondary operations were performed at a median of 16.1 months. Excision alone or excision with implantation into bone or muscle had higher rates of secondary surgery compared with excision and direct neurorrhaphy with or without nerve graft. Neuromas were located in the upper extremity (49.61 percent), lower extremity (46.65 percent), and the groin/trunk (3.74 percent).

Conclusions: Symptomatic neuromas are located predominantly in the extremities, and surgery can improve pain, with low secondary surgery rates. Excision with direct neurorrhaphy with or without nerve grafting was associated with lower reoperation rates.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Boston, Mass.

From the Department of Orthopaedic Surgery, Hand and Upper Extremity Service, and the Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School.

Received for publication April 16, 2018; accepted December 10, 2018.

Disclosure:Dr. Eberlin is a consultant for AxoGen. The remaining authors have no financial interest to report. No funding was received for this article.

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Kyle R. Eberlin, M.D., Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 15 Parkman Street, Wang 435, Boston, Mass. 02114, keberlin@mgh.harvard.edu

Copyright © 2019 by the American Society of Plastic Surgeons