Ferrin Peter C, Hathaway Brynn, Russo Stephanie A, Peters Blair R
From Department of Surgery, Oregon Health and Science University, Portland, Oreg.
Division of Plastic & Reconstructive Surgery, Oregon Health and Science University, Portland, Oreg.
Plast Reconstr Surg Glob Open. 2024 Jan 10;12(1):e5512. doi: 10.1097/GOX.0000000000005512. eCollection 2024 Jan.
Symptomatic neuromas of the superficial radial nerve (SRN) can cause debilitating pain. Traditional surgical management options have demonstrated inconsistent outcomes prompting a search for alternatives. Recent reports have emerged on the use of targeted muscle reinnervation (TMR) for neuromas of the SRN using donors that are well established in hand surgery, such as the brachioradialis (BR) or extensor capri radialis longus or brevis. Use of the brachioradialis or extensor capri radialis longus motor targets can require surgery at or above the level of the antecubital fossa, and denervation of these muscle groups may be undesirable in cases of complex upper extremity injury where these donors may be needed for tendon or nerve transfer. The supinator is an expendable and often overlooked donor nerve that has not been assessed as a target for TMR of the SRN. In this case series, three patients with SRN neuromas whose conservative management failed and who did not have an SRN lesion amenable to reconstruction were managed with TMR to the nerves to supinator. At latest follow-up (9-22 months), no patients had deficits in supination or evident donor site morbidity. Two patients reported complete resolution of their SRN neuroma pain, and one patient reported partial improvement. This case series reports early results of TMR of the SRN using nerves to supinator in cases of SRN neuromas not amenable to reconstruction, demonstrating technical feasibility, improvements in neuroma pain, and no discernible donor morbidity.
桡神经浅支（SRN）的症状性神经瘤可导致使人衰弱的疼痛。传统的手术治疗方案效果不一，促使人们寻找替代方法。最近有报告称，对于SRN神经瘤，可使用在手外科中已广泛应用的供体进行靶向肌肉再支配（TMR），如肱桡肌（BR）或桡侧腕长伸肌或桡侧腕短伸肌。使用肱桡肌或桡侧腕长伸肌作为运动靶点可能需要在前臂肘窝或其上方进行手术，而在复杂上肢损伤的情况下，若可能需要这些供体进行肌腱或神经转移，则对这些肌肉群进行去神经支配可能并不理想。旋后肌是一条可牺牲且常被忽视的供体神经，尚未被评估作为SRN进行TMR的靶点。在本病例系列中，3例SRN神经瘤患者保守治疗失败且不存在适合重建的SRN病变，采用了对旋后肌神经进行TMR的治疗方法。在最新随访（9 - 22个月）时，没有患者出现旋后功能障碍或明显的供体部位并发症。2例患者报告SRN神经瘤疼痛完全缓解，1例患者报告部分改善。本病例系列报告了在SRN神经瘤不适合重建的情况下，使用旋后肌神经对SRN进行TMR的早期结果，证明了技术可行性、神经瘤疼痛得到改善且无明显的供体并发症。
