Martínez-Peniche J, Hernández-Méndez-Villamil E, Haquet-Guerrero P, Espinosa-Gutiérrez A

Language: Spanish
References: 14
Page: 314-317
PDF size: 183.03 Kb.

ABSTRACT

Introduction: nerve lesions are potentially catastrophic injuries. They can cause motor loss, severe pain and neuroma formation. The superficial branch of the radial nerve is at risk during first dorsal compartment release, its injury can cause neuroma formation. Autologous nerve reconstruction is the gold standard for treatment of small nerve gaps. Cases presentation: we present two cases of adult women (F/47 y F/51) with a prior history of first dorsal compartment release in another institution. Both patients developed debilitating neuropathic pain, as well as allodynia in the surgical site. They were diagnosed with superficial radial nerve neuroma. Oral medication and physical therapy was attempted without success. Surgical exploration and autologous nerve reconstruction was performed. Both patients had excellent relief of pain from visual analogue scale (VAS 9-10 to VAS 1-2). Postoperatively, both patients recovered partial sensitivity to pain in the zones distal to the repair. Conclusions: neuromas are feared complications that occur with unrecognized nerve lesions during surgery, they are difficult to treat and require multidisciplinary management. These two cases demonstrate that autologous nerve reconstruction is an excellent option for recovering function in small gaps of nerve tissue.

REFERENCES

1. Scadding JW. Development of ongoing activity, mechanosensitivity, and adrenaline sensitivity in severed peripheral nerve axons. Exp Neurol. 1981; 73(2): 345-64.

2. Spinazzi EF, Upadhyayula PS, Winfree CJ. Chapter 207: diagnosis and management of painful neuromas. In: Winn HR, editor. Youmans and Winn neurological surgery. 8th ed. Philadelphia, PA: Elsevier; 2023. pp. 1566-70.

3. Wood MD, Johnson PJ, Myckatyn TM. Anatomy and physiology for the peripheral nerve surgeon. In Mackinnon SE, editor. Nerve surgery. New York: Thieme Publishers; 2015.

4. Wall PD, Gutnick M. Properties of afferent nerve impulses originating from a neuroma. Nature. 1974; 248(5451): 740-3.

5. Eberlin KR, Ducic I. Surgical algorithm for neuroma management: a changing treatment paradigm. Plast Reconstr Surg Glob Open. 2018; 6(10): e1952. doi: 10.1097/GOX.0000000000001952.

6. Kalso E, Aldington DJ, Moore RA. Drugs for neuropathic pain. BMJ. 2013; 347: f7339.

7. Liu Y, Kao DS. Nonsurgical approaches to neuroma management. Hand Clin. 2021; 37(3): 323-33.

8. Starr BW, Chung KC. Traditional neuroma management. Hand Clin. 2021; 37(3): 335-44.

9. Souza JM, Purnell CA, Cheesborough JE, Kelikian AS, Dumanian GA. Treatment of foot and ankle neuroma pain with processed nerve allografts. Foot Ankle Int. 2016; 37(10): 1098-105.

10. Sears ED, Fujihara N, Chung KC. Release of De Quervain tenovaginitis. In: Chung KC, editor. Operative techniques: hand and wrist surgery. Philadelphia, PA.: Elsevier; 2018.

11. Radtke C, Kocsis JD, Reimers K, Allmeling C, Vogt PM. Sural nerve defects after nerve biopsy or nerve transfer as a sensory regeneration model for peripheral nerve conduit implantation. Med Hypotheses. 2013; 81(3): 500-2. doi: 10.1016/j.mehy.2013.06.020.

12. Ducic I, Yoon J, Buncke G. Chronic postoperative complications and donor site morbidity after sural nerve autograft harvest or biopsy. Microsurgery. 2020; 40(6): 710-6. doi: 10.1002/micr.30588.

13. Rinker B, Liau JY. A prospective randomized study comparing woven polyglycolic acid and autogenous vein conduits for reconstruction of digital nerve gaps. J Hand Surg Am. 2011; 36(5): 775-81.

14. Rbia N, Shin AY. The role of nerve graft substitutes in motor and mixed motor/sensory peripheral nerve injuries. J Hand Surg Am. 2017; 42(5): 367-77. doi: 10.1016/j.jhsa.2017.02.017.

EVIDENCE LEVEL

IV