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25-04-2024 | Neurotomy | Original Article

Surgical treatment of painful neuroma in amputated and non-amputated patients: does the level of neurotomy affect clinical outcomes?

Authors: Aurore Lemaire-Petit, Alexia Milaire, Sarah Amar, Claire Redais, Anaïs Chataigneau, Jean-Noël Bernard, Zoubir Belkheyar, Laurent Mathieu

Published in: European Journal of Trauma and Emergency Surgery

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Abstract

Purpose

To compare the outcomes of distal neurotomy (DN) versus proximal neurotomy (PN) for the surgical management of painful neuromas in amputees and non-amputees, whether used in passive or active treatment.

Methods

A retrospective study was conducted on patients who underwent surgery for painful traumatic neuromas between 2019 and 2022. DN with neuroma excision was performed at the level of the injury or amputation. PN was performed using a separate proximal approach without neuroma excision. Outcomes included a Numerical Rating Scale (NRS) score and Patient-Reported Outcomes Measurement Information System (PROMIS) scores, as well as patients’ subjective assessments.

Results

A total of 33 patients were included: 17 amputees and 16 non-amputees. They totalized 43 neuromas treated by DN in 21 cases and PN in 22 cases. At the median follow-up time of 13 months, there were significant decreases in all NRS and PROMIS scores in the whole series. The decrease in limb pain scores was not significantly different between groups, except for the decrease in pain interference and patient satisfaction which were higher in the DN group. Sub-group analyses found the same significant differences in amputees. Targeted muscle reinnervation (TMR) was associated with a higher decrease in PROMIS scores.

Conclusion

DN seemed to give better results in amputees but there were confusing factors related to associated lesions. In other situations, the non-inferiority of PN was demonstrated. PN could be of interest for treating neuromas of superficial sensory nerves, for avoiding direct revision of a well-fitted stump and in conjunction with TMR.
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Metadata
Title
Surgical treatment of painful neuroma in amputated and non-amputated patients: does the level of neurotomy affect clinical outcomes?
Authors
Aurore Lemaire-Petit
Alexia Milaire
Sarah Amar
Claire Redais
Anaïs Chataigneau
Jean-Noël Bernard
Zoubir Belkheyar
Laurent Mathieu
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Keyword
Neurotomy
Published in
European Journal of Trauma and Emergency Surgery
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-024-02529-4