Fracol Megan E, Dumanian Gregory A, Janes Lindsay E, Bai Jennifer, Ko Jason H
Division of Plastic Surgery, Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2020 Jan 17;8(1):e2545. doi: 10.1097/GOX.0000000000002545. eCollection 2020 Jan.
Neuromas are a debilitating peripheral nerve problem due to aberrant axon sprouting and inflammation after nerve injury. The surgical management of neuromas has for a long time been up for debate, largely due to lack of consistent, reliable outcomes with any one technique. We have found success utilizing targeted muscle reinnervation, a technique originally described in amputees that re-routes the proximal ends of cut sensory nerve stumps into the distal ends of motor nerves to nearby muscles. In doing so, the sensory nerve ending can regenerate along the length of the motor nerve, giving it a place to go and something to do. In this report, we describe our technique specifically for targeted muscle reinnervation of sural nerve neuromas that is applicable to both amputees and to patients with intact limbs. Sural nerve neuromas can occur after sural nerve harvest for reconstructive procedures and particularly after lateral malleolar incisions for orthopedic access to the calcaneus. By re-routing the sural nerve into a motor nerve of the lateral gastrocnemius muscle, we are able to manage a variety of sural nerve neuromas presenting anywhere along the course of the sural nerve and in a variety of clinical settings.
神经瘤是一种因神经损伤后轴突异常萌发和炎症导致的使人衰弱的周围神经问题。长期以来，神经瘤的外科治疗一直存在争议，主要原因是任何一种技术都缺乏一致、可靠的治疗效果。我们利用靶向肌肉再支配技术取得了成功，该技术最初是在截肢患者中描述的，即将切断的感觉神经残端的近端重新路由到附近肌肉的运动神经远端。这样一来，感觉神经末梢可以沿着运动神经的长度再生，为其提供了去处和功能。在本报告中，我们详细描述了针对腓肠神经瘤的靶向肌肉再支配技术，该技术适用于截肢患者和肢体完整的患者。腓肠神经瘤可发生在为重建手术而采集腓肠神经后，尤其是在为骨科手术进入跟骨而进行外踝切口后。通过将腓肠神经重新路由到腓肠肌外侧头的运动神经，我们能够处理出现在腓肠神经走行任何部位、各种临床情况下的多种腓肠神经瘤。
