Case Report

Treatment of Painful Neuroma of Amputated Phalanx with Distal Toe Transfer: A Case Report

Authors: Feng Zhang, MD, PHD, Eric C. Hu, MD, Weijia Chen, MD, PHD, William C. Lineaweaver, MD

Abstract

Abstract:A painful neuroma in the amputation stump of a finger can be psychologically and physically disabling. Numerous surgical procedures have been attempted to prevent and treat amputation neuromas of the finger, but the results are inconsistent. Microsurgical transfer of the distal second toe to the amputated stump of the finger can provide a pathway and target for the regenerating axons and avoid recurrence of neuromas. In this article, we present the experience of successful treatment of amputation neuromas of an index finger with microsurgical distal toe transfer.

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References

1.Laborde KJ, Kalisman M, Tsai TM. Results of surgical treatment of painful neuromas of the hand. J Hand Surg 1982;7A:190–193.
 
2.Battista AF, Cravioto HM, Budzilovich GN. Painful neuroma: changes produced in peripheral nerve after fascicle ligation. Neurosurgery 1981;9:589–600.
 
3.Yuksel F, Kislaoglu E, Durak N, et al. Prevention of painful neuromas by epineural ligatures, flaps and grafts. Br J Plast Surg 1997;50:182–185.
 
4.Swanson AB, Boeve NR, Lumsden RM. The prevention and treatment of amputation neuromata by silicone capping. J Hand Surg 1977;2A:70–78.
 
5.Gorkisch K, Boese-Landgraf J, Vaubel E. Treatment and prevention of amputation neuromas in hand surgery. Plast Reconstr Surg 1984;73:293–299.
 
6.Mass DP, Ciano MC, Tortosa R, et al. Treatment of painful hand neuromas by their transfer into bone.Plast Reconstr Surg 1984;74:182–185.
 
7.Herndon JH, Eaton RG, Littler JW. Management of painful neuromas in the hand. J Bone Joint Surg1976;58A:369–373.
 
8.Aszmann OC, Korak KJ, Rab M, et al. Neuroma prevention by end-to-side neurorraphy: an experimental study in rats. J Hand Surg 2003;28A:1022–1028.
 
9.Al-Qattan MM. Prevention and treatment of painful neuromas of the superficial radial nerve by the end-to-side nerve repair concept: an experimental study and preliminary clinical experience. Microsurgery2000;20:99–104.
 
10.Ashley L, Stallings JO. End-to-side nerve flap for treatment of painful neuroma: a 15-year follow-up. J Am Osteopath Assoc 1988;88:621–624.
 
11.Low CK, Chew SH, Song IC, et al. End-to-side anastomosis of transected nerves to prevent neuroma formation. Clin Orthop 1999;369:327–332.
 
12.Chiu DT, Wu J. Treatment of painful neuromas: a case report. Ann Plast Surg 2000;44:340–342.
 
13.Low CK, Chew SH, Song IC, et al. Implantation of a nerve ending into a vein. Clin Orthop2000;379:242–246.
 
14.Whipple RR, Unsell RS. Treatment of painful neuromas. Orthop Clin North Am 1988;19:175–185.
 
15.Omer GE, Spinner M, Van Beek AL. Management of peripheral nerve problems. Philadephia, W.B. Sauners, 1998.
 
16.Tupper JW, Booth DM. Treatment of painful neuromas of sensory nerves in the hand: a comparison of traditional and newer methods. J Hand Surg 1976;1A:144–151.
 
17.Fisher GT, Boswick JA Jr. Neuroma formation following digital amputations. J Trauma 1983;23:136–142.
 
18.Robbins TH. Nerve capping in the treatment of troublesome terminal neuromata. Br J Plast Surg1986;39:239–240.
 
19.Rahimi F, Muehleman C. Epineurial capping via Surgitron and the reduction of stump neuromas in the rat. J Foot Surg 1992;31:124–128.
 
20.Goldstein SA, Sturim HS. Intraosseous nerve transposition for treatment of painful neuromas. J Hand Surg 1985;10A:270–274.
 
21.Masquelet AC, Bellivet C, Nordin JY. Treatment of painful neuromas of the hand by intra-osseous implantation. Ann Chir Main 1987;6:64–66.
 
22.Belcher HJ, Pandya AN. Centro-central union for the prevention of neuroma formation after finger amputation. J Hand Surg 2000;25B:154–159.
 
23.Barbera J, Albert-Pamplo R. Centrocentral anastomosis of the proximal nerve stump in the treatment of painful amputation neuromas of major nerves. J Neurosurg 1993;79:331–334.
 
24.Lidor C, Hall RL, Nunley JA. Centrocentral anastomosis with autologous nerve graft treatment of foot and ankle neuromas. Foot Ankle Int 1996;17:85–88.
 
25.Buncke HJ. Toe digital transfer. Clin Plast Surg 1976;3:49–57.
 
26.O’Brien B, MacLeod AM, Sykes PJ, et al. Microvascular second toe transfer for digital reconstruction. J Hand Surg 1978;3A:123–133.
 
27.Wei FC, el-Gammal TA. Toe-to-hand transfer. Current concepts, techniques, and research. Clin Plast Surg 1996;23:103–116.
 
28.Buncke HJ, Rose EH. Free toe-to-fingertip neurovascular flaps. Plast Reconstr Surg 1979;63:607–612.
 
29.Koshima I, Inagawa K, Urushibara K, et al. Fingertip reconstructions using partial-toe transfers. Plast Reconstr Surg 2000;105:1666–1674.
 
30.Hirase Y, Kojima T, Matsui M. Aesthetic fingertip reconstruction with a free vascularized nail graft: a review of 60 flaps involving partial toe transfers. Plast Reconstr Surg 1997;99:774–784.