Schnack Lauren L, Rodriguez-Collazo Edgardo R, Oexeman Stephanie A, Costa Andrew J
From the Department of Podiatric Medicine and Surgery, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Ill.
Ascension-Saint Joseph Chicago Podiatry Residency Program, Chicago, Ill.
Plast Reconstr Surg Glob Open. 2023 Oct 12;11(10):e5316. doi: 10.1097/GOX.0000000000005316. eCollection 2023 Oct.
Recent reconstructive approaches to peripheral nerve surgery have been directed toward active approaches; one such approach is nerve grafting the injured nerve segment. Addressing a nerve injury proximal to the zone of injury has demonstrated reproducible results in preventing symptomatic neuroma formation. A 53-year-old woman with a history of an ankle fracture presented with neuritic symptoms that interfered with her activities of daily living. Her intractable pain was significantly but temporarily relieved with in-office nerve blocks to the superficial peroneal nerve and sural nerve. There were no identifiable zones of injury in the nerve conduction study. Orthopedic etiology was ruled out. Nerve allografts, each 3 cm in length, were utilized with conduits and placed at the location proximal to the zone of maximum tenderness. Once the neurotomy was performed, the nerve allografts and conduits were coapted to each nerve. The patient's intractable neuritic pain was relieved even 15 months postoperatively. The visual analog scale went from eight of 10 preoperatively to two of 10 postoperatively. Additional nerve conduction studies were not needed, and the patient returned to daily activities once the skin incisions healed. The reset neurotomy is an option for the microsurgical surgeon to have for patients with a nonidentifiable zone of injury or no identifiable neuroma but presents with intractable nerve pain relieved by local anesthetic nerve blocks.
近期，周围神经外科的重建方法已转向积极的治疗方式；其中一种方法是对受损神经节段进行神经移植。在损伤区域近端处理神经损伤已被证明在预防症状性神经瘤形成方面能产生可重复的结果。一名有踝关节骨折病史的53岁女性出现了影响其日常生活活动的神经症状。她难以忍受的疼痛通过在门诊对腓浅神经和腓肠神经进行神经阻滞得到了显著但暂时的缓解。神经传导研究中未发现明确的损伤区域。排除了骨科病因。使用了长度均为3厘米的异体神经移植物，并搭配导管，放置在最压痛区域近端的位置。一旦进行了神经切断术，将异体神经移植物和导管与每条神经对接。即使在术后15个月，患者难以忍受的神经疼痛也得到了缓解。视觉模拟评分从术前的10分中的8分降至术后的10分中的2分。无需进行额外的神经传导研究，皮肤切口愈合后患者即可恢复日常活动。对于损伤区域不明确或未发现明确神经瘤但出现局部麻醉神经阻滞可缓解的难以忍受的神经疼痛的患者，重置神经切断术是显微外科医生的一种选择。
