Kadota Hideki, Ishida Kunihiro
Department of Plastic Surgery, Kyushu University Hospital, Fukuoka, Japan.
Department of Plastic and Reconstructive Surgery, Okinawa Chubu Hospital, Okinawa, Japan.
Strategies Trauma Limb Reconstr. 2020 Jan-Apr;15(1):50-53. doi: 10.5005/jp-journals-10080-1442.
Various surgical treatments have been advocated for stump pain and phantom limb pain after limb amputation but the most effective is unknown. We report a case of intractable stump pain and phantom limb pain of the upper limb, which was successfully treated by end-to-end coaptation of the cutaneous nerves after multimodal treatment failures.
A 39-year-old man was referred to our department with a history of severe stump neuroma-related pain and phantom limb pain of his right upper limb. He had undergone multiple treatments over 26 years including medication, nerve blocks, and repeated surgeries. None had been successful for relief of pain. The clinical assessment showed a point of marked tenderness around the medial stump of the upper arm. Ultrasound-guided peripheral infiltration of local anaesthetic around the medial stump produced significant relief of his pain. Exploration around the medial limb stump revealed two stump neuromas of the medial cutaneous nerves of the forearm. Both stump neuromas were resected, and their stumps were coapted to each other. After 4 years, he was completely relieved of his pain and without any sensory deficit.
Successful nerve coaptations for painful stump neuromas of the upper limb are reported rarely. This case suggests this method can be helpful. The patient burden was minimal because it involved the resection and coaptation of the two neuromas. This method should be encouraged for cases of intractable stump-related pain in the upper limb.
Kadota H, Ishida K. Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation. Strategies Trauma Limb Reconstr 2020;15(1):50-53.
对于肢体截肢术后的残端痛和幻肢痛，已有多种外科治疗方法被提倡，但最有效的方法尚不清楚。我们报告一例上肢顽固性残端痛和幻肢痛病例，在多模式治疗失败后，通过皮神经端端吻合成功治愈。
一名39岁男性因右上肢严重残端神经瘤相关疼痛和幻肢痛被转诊至我科。他在26年里接受了多种治疗，包括药物治疗、神经阻滞和多次手术，但均未能成功缓解疼痛。临床评估显示上臂内侧残端周围有一个明显压痛点。超声引导下在残端内侧周围进行局部麻醉药外周浸润，可显著缓解其疼痛。探查上肢内侧残端发现两个前臂内侧皮神经残端神经瘤。切除两个残端神经瘤，并将其残端相互吻合。4年后，他的疼痛完全缓解，且无任何感觉障碍。
上肢疼痛性残端神经瘤成功进行神经吻合的报道很少。本病例表明这种方法可能有帮助。由于该方法仅涉及两个神经瘤的切除和吻合，患者负担最小。对于上肢顽固性残端相关疼痛的病例，应鼓励采用这种方法。
Kadota H, Ishida K. Coaptation of Cutaneous Nerves for Intractable Stump Pain and Phantom Limb Pain after Upper Limb Amputation. Strategies Trauma Limb Reconstr 2020;15(1):50-53.
