Calcagni Maurizio, Zimmermann Simon, Scaglioni Mario F, Giesen Thomas, Giovanoli Pietro, Fakin Richard M
Division of Plastic and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
Microsurgery. 2018 Mar;38(3):264-269. doi: 10.1002/micr.30122. Epub 2016 Oct 12.
None of the existing treatments in the management of painful end-neuromas of the superficial branch of the radial nerve (SBRN) has been proven superior due to high levels of pain relapse. Fat grafts enriched with the stromal vascular fraction (SVF) could act as a mechanic barrier with biological effects decreasing the resorption rate and boosting the graft's regenerative potential. This study describes the novel surgical treatment technique of SVF-enriched fat grafting.
In this clinical study, five consecutive patients treated for painful end-neuromas of the SBRN between 2012 and 2013 were analyzed retrospectively. Microsurgical resection of end-neuromas followed by SVF-enriched fat grafting around the nerve stump was performed in all patients. Five different pain modalities and various predictors were compared pre- and up to 36 months postoperatively.
Pain reduction observed at 2 months after surgery was constant over time, though not statistically significant compared to preoperative levels. Spontaneous pain could be reduced from 1.6 ± 0.55 to 1.2 ± 1.1 (p = 0.414), spikes from 2.2 ± 1.3 to 1.4 ± 1.34 (p = 0.180), hyperaesthesia from 1.6 ± 1.14 to 1.2 ± 1.64 (p = 0.713), tap pain from 2.8 ± 0.45 to 1.8 ± 1.3 (p = 0.197) and motion pain from 2.8 ± 0.45 to 1.4 ± 1.34 (p = 0.066). An improvement in overall pain reduction could be observed from 2.2 ± 0.97 to 1.4 ± 1.26 3 years after the surgery (p = 0.104).
SVF-enriched fat grafting represents another alternative to numerous available treatments of painful end-neuromas of the SBRN. Our preliminary results could not show any significant difference in pain reduction following SVF-enriched fat grafting. Further larger trials are required in order to evaluate the therapeutic potential of SVF-enriched fat grafting.
由于疼痛复发率高，目前用于治疗桡神经浅支（SBRN）疼痛性终末神经瘤的现有治疗方法均未被证明具有优越性。富含基质血管成分（SVF）的脂肪移植可作为一种具有生物学效应的机械屏障，降低吸收率并提高移植组织的再生潜能。本研究描述了富含SVF的脂肪移植这种新型手术治疗技术。
在这项临床研究中，对2012年至2013年间连续治疗的5例SBRN疼痛性终末神经瘤患者进行回顾性分析。所有患者均先进行终末神经瘤的显微手术切除，然后在神经残端周围进行富含SVF的脂肪移植。比较了术前及术后长达36个月的5种不同疼痛形式和各种预测指标。
术后2个月观察到的疼痛减轻随时间持续存在，但与术前水平相比无统计学意义。自发痛可从1.6±0.55降至1.2±1.1（p = 0.414），刺痛从2.2±1.3降至1.4±1.34（p = 0.180），感觉过敏从1.6±1.14降至1.2±1.64（p = 0.713），轻叩痛从2.8±0.45降至1.8±1.3（p = 0.197），运动痛从2.8±0.45降至1.4±1.34（p = 0.066）。术后3年总体疼痛减轻情况从2.2±0.97改善至1.4±1.26（p = 0.104）。
富含SVF的脂肪移植是SBRN疼痛性终末神经瘤众多现有治疗方法的另一种选择。我们的初步结果未显示富含SVF的脂肪移植后疼痛减轻有任何显著差异。需要进一步开展更大规模的试验来评估富含SVF的脂肪移植的治疗潜力。
