Scott Benjamin B, Winograd Jonathan M, Redmond Robert W
Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Front Surg. 2022 Jun 27;9:819608. doi: 10.3389/fsurg.2022.819608. eCollection 2022.
Painful neuroma is a frequent sequela of peripheral nerve injury which can result in pain and decreased quality of life for the patient, often necessitating surgical intervention. End neuromas are benign neural tumors that commonly form after nerve transection, when axons from the proximal nerve stump regenerate in a disorganized manner in an attempt to recreate nerve continuity. Inflammation and collagen remodeling leads to a bulbous end neuroma which can become symptomatic and result in decreased quality of life. This review covers surgical prophylaxis of end neuroma formation at time of injury, rather than treatment of existing neuroma and prevention of recurrence. The current accepted methods to prevent end neuroma formation at time of injury include different mechanisms to inhibit the regenerative response or provide a conduit for organized regrowth, with mixed results. Approaches include proximal nerve stump capping, nerve implantation into bone, muscle and vein, various pharmacologic methods to inhibit axonal growth, and mechanisms to guide axonal growth after injury. This article reviews historical treatments that aimed to prevent end neuroma formation as well as current and experimental treatments, and seeks to provide a concise, comprehensive resource for current and future therapies aimed at preventing neuroma formation.
疼痛性神经瘤是周围神经损伤常见的后遗症，可导致患者疼痛并降低生活质量，常需手术干预。终末神经瘤是一种良性神经肿瘤，通常在神经横断后形成，此时近端神经残端的轴突会无序再生，试图重建神经连续性。炎症和胶原重塑会导致形成球状终末神经瘤，可出现症状并导致生活质量下降。本综述涵盖损伤时终末神经瘤形成的手术预防，而非现有神经瘤的治疗和复发预防。目前公认的损伤时预防终末神经瘤形成的方法包括不同的抑制再生反应或为有序再生提供管道的机制，但结果不一。方法包括近端神经残端封闭、将神经植入骨、肌肉和静脉、各种抑制轴突生长的药理学方法以及损伤后引导轴突生长的机制。本文回顾了旨在预防终末神经瘤形成的既往治疗方法以及当前和实验性治疗方法，并试图为当前和未来旨在预防神经瘤形成的治疗提供一份简洁、全面的资源。
