J Korean Soc Surg Hand.  2014 Dec;19(4):209-220. 10.12790/jkssh.2014.19.4.209.

Treatment of the Traumatic Neuroma

• Roh YT
• Park IJ

• KMID: 1896912
• DOI: http://doi.org/10.12790/jkssh.2014.19.4.209

Abstract

Formation of the traumatic neuroma results from abnormal nerve regeneration following a peripheral nerve injury. Numerous treatment options have been described. However, there is no one way that is completely effective in the management of these peripheral neuromas. Prevention is best. It is important to maximize nonsurgical management, including pain management and physiotherapy. At the time of surgery, definitive neuroma resection and tension-free repair or coverage will provide the least amount of subsequent nerve irritation.

Keyword

Traumatic neuroma; Nerve; Regeneration

MeSH Terms

Nerve Regeneration
Neuroma*
Pain Management
Peripheral Nerve Injuries
Regeneration

Figure

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  Fig. 1. Three types of neuroma. (A) A neuroma (asterisk) originated from completely severed median nerve. (B) Neuromas-in-continuity of the median (black arrow) and ulnar nerve (white arrow). (C) Neuromas of the digital nerve in amputation stump.

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  Fig. 2. (A) A neuroma (asterisk) originated from completely severed median nerve. Because distal part of severed nerve was available (black arrows), (B, C) the gap was repaired with a sural nerve cable graft.

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  Fig. 3. (A) Amputation stump neuroma formation to the ulnar digital nerve of the thumb. Restoration of function was so critical, but a distal nerve was not available. (B) Modified neurovascular island flap from the middle finger was performed.

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  Fig. 4. (A) Hypertrophic neuroma-in-continuity of the digital nerve (black arrow) was observed. (B) After excision of the neuroma, 5 mm sized nerve defect was noted. (C) Autologus vein was harvested and (D) digital nerve repair using the vein conduit was performed.

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  Fig. 5. (A, B) After traumatic forearm amputation, hypertrophic neuromas of the median (asterisk) and ulnar nerve (double asterisk) were developed. (C, D) Excision of the neuromas were performed and the nerve were placed in unscarred muscle. Unfortunately, new neuromas of the both nerves were developed after the operation. N, nerve.

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  Fig. 6. Division of the hand and wrist into zones for planning of neuroma relocation.

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  Fig. 7. (A, B) Neuromas of the ulnar and radial digital nerve (empty arrows) were observed. (C) After excision of the neuromas, relocation of the nerve ends into the mid and proximal phalanx (black arrow) was performed, respectively. (D) Excised digital nerves including the neuromas.

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  Fig. 8. Translocation of the neuroma into the muscle. (A) A neuroma arising from palmar cutaneous branch of the median nerve. After resection of the neuroma proximally, the nerve was implanted into the pronator quadratus muscle. The pronator quadratus muscle was one of the most commonly used muscles for transposition. (B) A neuroma arising from the superficial radial nerve. The neuroma was resected and then the nerve was implanted within the brachioradialis muscle.

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  Fig. 9. Centra-centralization. (A) Centra-central nerve repair involved the coaptation of 2 nerve cords of central origin. (B) This technique could also be applied for 1 nerve if it was split into 2 fascicles of equal size. The 2 nerves or fascicles had simple end-to-end repair.

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  Fig. 10. (A) After traumatic forearm amputation, hypertrophic neuromas of the median and ulnar nerve were redeveloped. (B) After resecting the neuromas, normal nerve fascicles were observed. (C) Microscopic end to end neurorrhaphy of the median and ulnar nerve was performed. (D) Repaired nerve was underneath the deep forearm muscles. N, nerve.

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  Fig. 11. Coverage with flap. (A) A neuroma-in-continuity of the ulnar nerve was developed after sural nerve graft. (B, C) The abductor digiti minimi (empty arrow) was mobilized to cover the neuroma-in-continuity. (D) The flap coverage with vascularized muscle mass (black star) might provide a vascularized and nourished milieu and protect the nerve from the mechanical irritability.

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