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Perineural fat grafting in end-neuroma pain treatment: long-term outcomes

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European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Peripheral painful end-neuromas decrease quality of life significantly. Drug-resistant painful neuromas often require surgical treatment, nevertheless there is no actual gold standard.

Methods

We retrospectively analyzed 26 patients suffering from painful end-neuromas treated with neuroma excision followed by the perineural fat grafting (PFG). We evaluated the improvement in pain, disability, and quality of life on the long term.All patients were referred to our department between 2009 and 2017. “Visual analogue scale (VAS)”; “disability of the arm, shoulder, and hand (DASH)”; and “World Health Organization Quality of Life (WHOQOL) index” were systematically scored before each surgical intervention and re-evaluated after 24 months.

Results

The majority of neuromas were traumatic (n. 16; 62%) and involved the upper extremity (n. 21; 81%). Eight patients (31%) had already received a previous neuroma excision. After the neuroma excision followed by the PFG, pain decreased 4 points in the VAS scale on average (p < 0.001); disability improved 15 points in the DASH questionnaire (p < 0.001); the quality of life significantly improved in every WHOQOL index domain. Neuroma excision with PFG appeared equally effective both on patients with a primary or a relapsing neuroma.

Conclusions

Neuromectomy with perineural fat grafting is a simple, accessible, and effective technique in end-neuroma pain treatment, owning a low surgical risk and minimal donor site morbidity.

Level of evidence: Level III, therapeutic Study.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, I.R.C.C.S. Policlinico San Donato, San Donato Milanese, Italy

    Luca Vaienti, Francesco Amendola, Francesco Borelli & Giuseppe Cottone

  2. Department of Plastic, Reconstructive and Aesthetic Surgery, University of Milan, Milan, Italy

    Luca Vaienti, Francesco Amendola, Francesco Borelli & Giuseppe Cottone

  3. Department of Plastic and Reconstructive Surgery, Policlinico di Modena Azienda Ospedaliero-Universitaria di Modena, Modena, Italy

    Giovanna Zaccaria

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  1. Luca Vaienti
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  2. Francesco Amendola
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Correspondence to Giuseppe Cottone.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of I.R.C.C.S. Policlinico San Donato, Milan. However, for this kind of retrospective study a formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. Data were treated anonymously.

Conflict of interest

L. Vaienti, F. Amendola, F. Borelli, G. Zaccaria, and G. Cottone declare that they have no conflict of interest.

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Vaienti, L., Amendola, F., Borelli, F. et al. Perineural fat grafting in end-neuroma pain treatment: long-term outcomes. Eur J Plast Surg 44, 249–254 (2021). https://doi.org/10.1007/s00238-020-01664-6

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  • DOI: https://doi.org/10.1007/s00238-020-01664-6

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