Thomas Jefferson University, Philadelphia, PA.
Union Surgical, Doylestown, PA.
J Hand Surg Am. 2021 Jun;46(6):514.e1-514.e5. doi: 10.1016/j.jhsa.2020.10.027. Epub 2020 Dec 27.
The formation of a symptomatic neuroma after digital tip amputation presents a vexing problem. There is currently no procedure that completely and consistently prevents hypersensitive neuroma formation. This report presents the results of a technique designed to limit axon regeneration and mechanical irritation by neuroma excision, dorsal transposition, and coaptation with the corresponding digital nerve.
A retrospective chart review was conducted to assess the effectiveness of neuroma excision with dorsal transposition and epineurial coaptation for postamputation symptomatic digital neuromas. Neuromas were excised using a midlateral fish-mouth incision. Digital nerves were mobilized to the dorsum of the digital tip and coapted using 9-0 nylon epineurial suture. The procedure was modified to salvage viable fingernails or to avoid excessive tension. Mass et al's criteria system was used to evaluate effectiveness.
Twenty-four patients with painful neuromas of the radial and ulnar digital nerves after traumatic amputation were included. Thirty-two digits underwent dorsal coaptation. This procedure was associated with a result considered good or excellent in 28 of 32 digits. Twenty-seven of 32 digits registered no pain or stump anesthesia after dorsal coaptation. Twenty-five of 32 digits demonstrated no interference with activities of daily living. Twenty-one of 24 patients returned to work.
Neuroma excision with dorsal transposition and epineurial coaptation is an effective treatment for postamputation symptomatic digital neuroma.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
指尖截断后出现症状性神经瘤是一个令人困扰的问题。目前还没有一种方法能完全、一致地防止神经瘤形成。本报告介绍了一种旨在通过神经瘤切除、背侧转位和与相应的指神经吻合来限制轴突再生和机械性刺激的技术的结果。
回顾性图表分析评估了指尖截断后症状性指神经瘤的神经瘤切除伴背侧转位和神经外膜吻合的效果。采用中侧鱼口切口切除神经瘤。将指神经向指尖背侧移动，并使用 9-0 尼龙神经外膜缝线吻合。对该手术进行了改良，以挽救有活力的指甲或避免过度张力。采用 Mass 等人的标准系统评估效果。
24 例因创伤性截肢后出现桡侧和尺侧指神经痛性神经瘤的患者被纳入研究。32 个手指进行了背侧吻合。该手术在 32 个手指中有 28 个被认为效果良好或优秀。27 个手指在背侧吻合后没有疼痛或残端麻木。25 个手指的日常生活活动不受影响。21 例患者中有 21 例返回工作岗位。
神经瘤切除伴背侧转位和神经外膜吻合是治疗指尖截断后症状性神经瘤的有效方法。
研究类型/证据水平：治疗性 IV 级。
