Schur Mathew D, Sochol Kristen M, Lefebvre Rachel, Stevanovic Milan
Keck School of Medicine of the University of Southern California, Los Angeles, Calif.
Plast Reconstr Surg Glob Open. 2021 Feb 15;9(2):e3403. doi: 10.1097/GOX.0000000000003403. eCollection 2021 Feb.
The treatment of postoperative, painful sensory neuromas is an ongoing challenge for surgeons. Here, we describe a technique for treatment with excision and allograft reconstruction and report on early results of its use in treating painful saphenous neuromas after knee arthroscopy.
A retrospective review of a single surgeon's peripheral nerve clinic from January 1, 2013, to December 31, 2019, was conducted to identify post-knee arthroscopy saphenous neuroma cases in which reconstruction with processed human nerve allograft distally implanted into healthy muscle belly was performed. We examined the outcomes for each patient, including subjective pain self-assessment and need for further surgical treatment.
In total, 9 cases were identified, with patient ages ranging from 21 to 74 years. The average time to referral to peripheral nerve clinic was 31 months (range: 4-143 months). Upon exploration, all nerves were found to have a neuroma in continuity. Six of the 9 patients reported subjective improvement through final follow-up. Three of the 9 patients reported initial improvement, with recurrence of pain at/near the site of the neuroma. The average follow-up time was 9 months (range: 1-21 months).
Here, we report on a novel technique of using a processed human nerve allograft after neuroma resection to provide an organized environment for bridging regenerated axons into muscle tissue. We also describe our early results using this technique to treat iatrogenic saphenous neuromas after knee arthroscopy. Results are encouraging, with 6 of the 9 patients experiencing subjective reduction in pain at final follow-up.
术后疼痛性感觉神经瘤的治疗对外科医生来说仍是一项持续的挑战。在此，我们描述一种切除和同种异体移植重建的治疗技术，并报告其用于治疗膝关节镜检查后疼痛性隐神经瘤的早期结果。
对一位外科医生2013年1月1日至2019年12月31日的周围神经诊所进行回顾性研究，以确定膝关节镜检查后隐神经瘤病例，其中对远端植入健康肌腹的经过处理的人神经同种异体移植进行了重建。我们检查了每位患者的结果，包括主观疼痛自我评估和进一步手术治疗的需求。
共确定9例，患者年龄在21至74岁之间。转诊至周围神经诊所的平均时间为31个月（范围：4 - 143个月）。经探查，所有神经均发现有连续性神经瘤。9例患者中有6例在最终随访时报告主观症状改善。9例患者中有3例报告最初有改善，但神经瘤部位或附近疼痛复发。平均随访时间为9个月（范围：1 - 21个月）。
在此，我们报告一种在神经瘤切除后使用经过处理的人神经同种异体移植的新技术，为再生轴突桥接进入肌肉组织提供一个有组织的环境。我们还描述了使用该技术治疗膝关节镜检查后医源性隐神经瘤的早期结果。结果令人鼓舞，9例患者中有6例在最终随访时主观疼痛减轻。
