Regenerative Peripheral Nerve Interfaces for the Management of Symptomatic Hand and Digital Neuromas

Rachel C Hooper, Paul S Cederna, David L Brown, Steven C Haase, Jennifer F Waljee, Brent M Egeland, Brian P Kelley, Theodore A Kung, Rachel C Hooper, Paul S Cederna, David L Brown, Steven C Haase, Jennifer F Waljee, Brent M Egeland, Brian P Kelley, Theodore A Kung

Abstract

Painful neuromas result from traumatic injuries of the hand and digits and cause substantial physical disability, psychological distress, and decreased quality of life among affected patients. The regenerative peripheral nerve interface (RPNI) is a novel surgical technique that involves implanting the divided end of a peripheral nerve into a free muscle graft for the purposes of mitigating neuroma formation and facilitating prosthetic limb control. The RPNI is effective in treating and preventing neuroma pain in major extremity amputations. The purpose of this study was to determine if RPNIs can be used to effectively treat neuroma pain following partial hand and digital amputations. We retrospectively reviewed the use of RPNI to treat symptomatic hand and digital neuromas at our institutions. Between November 2014 and July 2019, we performed 30 therapeutic RPNIs on 14 symptomatic neuroma patients. The average patient follow-up was 37 weeks (6-128 weeks); 85% of patients were pain-free or considerably improved at the last office visit. The RPNI can serve as a safe and effective surgical solution to treat symptomatic neuromas after hand trauma.

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.

Figures

Fig. 1.
Fig. 1.
Treatment of a symptomatic left small finger radial digital nerve neuroma with RPNI surgery. A, Radial digital nerve (DN) with symptomatic neuroma. B, Implantation of nerve into muscle graft. C, Nerve completely wrapped in muscle graft. D. Closure.

References

    1. Vlot MA, Wilkens SC, Chen NC, et al. Symptomatic neuroma following initial amputation for traumatic digital amputation. J Hand Surg Am. 2018;43:86.e1–86.e8.
    1. van der Avoort DJ, Hovius SE, Selles RW, et al. The incidence of symptomatic neuroma in amputation and neurorrhaphy patients. J Plast Reconstr Aesthet Surg. 2013;66:1330–1334.
    1. Wolvetang NHA, Lans J, Verhiel SHWL, et al. Surgery for symptomatic neuroma: anatomic distribution and predictors of secondary surgery. Plast Reconstr Surg. 2019;143:1762–1771.
    1. Woo SL, Kung TA, Brown DL, et al. Regenerative peripheral nerve interfaces for the treatment of postampuation neuroma pain: a pilot study. Plas Reconstr Surg Glob Open. 2016;4:e1038.
    1. Kumar N, Stevenson JH. Intractable digital neuroma pain; the ultimate solution? Br J Plast Surg. 1990;43:122–123.
    1. Yüksel F, Kişlaoğlu E, Durak N, et al. Prevention of painful neuromas by epineural ligatures, flaps and grafts. Br J Plast Surg. 1997;50:182–185.
    1. Dellon AL, Mackinnon SE. Treatment of the painful neuroma by neuroma resection and muscle implantation. Plast Reconstr Surg. 1986;77:427–438.
    1. Lewin-Kowalik J, Marcol W, Kotulska K, et al. Prevention and management of painful neuroma. Neurol Med Chir (Tokyo). 2006;46:62–67; discussion 67.
    1. Kung TA, Langhals NB, Martin DC, et al. Regenerative perihperal nerve interface viability and signal transduction with an implanted electrode. Plast Recontr Surg. 2014;133:1380–1394.
    1. Frost CM, Ursu DC, Flattery SM, et al. Regenerative peripheral nerve interfaces for real-time, proportional control of a neuroprosthetic hand. J Neuroeng Rehabil. 2018;15:108.
    1. Kubiak CA, Kemp SWP, Cederna PS. Regenerative peripheral nerve interface for management of postamputation neuroma. JAMA Surg. 2018;153:681–682.
    1. Kubiak CA, Kung TA, Brown DL, et al. State-of-the-art techniques in treating peripheral nerve injury. Plast Reconstr Surg. 2018;141:702–710.
    1. Watson J, Gonzalez M, Romero A, et al. Neuromas of the hand and upper extremity. J Hand Surg Am. 2010;35:499–510.
    1. Yao C, Zhou X, Zhao B, et al. Treatments of traumatic neuropathic pain: a systematic review. Oncotarget. 2017;8:57670–57679.
    1. Dellon AL. Surgical treatment of upper extremity pain. Hand Clin. 2016;32:71–80.
    1. Arnold DMJ, Wilkens SC, Coert JH, et al. Diagnostic criteria for symptomatic neuroma. Ann Plast Surg. 2019;82:420–427.
    1. Li QT, Zhang PX, Yin XF, et al. Functional recovery of denervated skeletal muscle with sensory or mixed nerve protection: a pilot study. PLoS One. 2013;8:e79746.
    1. Kozusko SD, Kaminsky AJ, Boyd LC, et al. Sensory neurotization of muscle: past, present, and future considerations. J Plast Hand Surg. 2018;53:31–36.
    1. Hynes NM, Bain JR, Thoma A, et al. Preservation of denervated muscle by sensory protection in rats. J Reconstr Microsurg. 1997;13:337–343.
    1. Bain JR, Veltri KL, Chamberlain D, et al. Improved functional recovery of denervated skeletal muscle after temporary sensory nerve innervation. Neuroscience. 2001;103:503–510.
    1. Placheta E, Wood MD, Lafontaine C, et al. Enhancement of facial nerve motor neuron regeneration through cross-face nerve grafts by adding end-to-side sensory axons. Plast Recontr Surg. 2015;135:460–468.
    1. Kuiken TA, Barlow AK, Hargrove L, et al. Targeted muscle reinnervation for the upper and lower extremity. Tech Orthop. 2017;32:109–116.

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren