Lipofibromatous hamartoma of median nerve and ulnar nerve: surgical treatment.

Seven cases of lipofibromatous hamartomas of the median and ulnar nerve wee seen. Three were treated conservatively, and four had radical surgical excision. The three conservatively treated patients, seen over 20 years ago, were lost to follow-up. Four hand centers stated that these masses do not regress on conservative treatment. Follow-up evaluation of 1, 4, 9, and 20 years of the patients treated by radical surgery indicated that all patients had a useful, functional hand. All had complete range of motion in flexion and extension. Moving two-point discrimination was normal in two and abnormal in the older patient and in the patient whose tumor was resected at the wrist. If surgical treatment is decided upon for the large tumor masses, it is recommended that it be done early, distal to the wrist, and at age 2. Electromyographic studies do not demonstrate sensory nerve regeneration. Compensatory sensibility results obtained must be due to the reeducational capability in children. Radical surgical excision without nerve grafting is not recommended in adults because the potential for reeducation is limited. Some surgeons recommend and do nerve grafting following resection of the tumor when there are no remaining identifiable nerve fibers.