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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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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Data availability

No datasets were generated or analysed during the current study.

Abbreviations

NRS:

numerical rating scale

PLP:

phantom limb pain

PROMIS:

patient-reported outcome measurement information system

TMR:

targeted muscle reinnervation

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Authors and Affiliations

  1. Department of Orthopedic, Trauma and Reconstructive Surgery, Percy Military Hospital, 101 Avenue Henri Barbusse, Clamart, 92140, France

    Aurore Lemaire-Petit, Alexia Milaire, Claire Redais, Anaïs Chataigneau & Laurent Mathieu

  2. Department of Orthopedic and Trauma Surgery, Bégin Military Hospital, 69 Avenue de Paris, Saint-Mandé, 94160, France

    Sarah Amar

  3. Department of Lower Extremity Surgery, Edouard Herriot Hospital, 5 Place d’Arsonval, Lyon, 69003, France

    Jean-Noël Bernard

  4. Brachial Plexus and Peripheral Nerve Surgery Unit, Mont-Louis Private Hospital, 8 rue de la Folie-Regnault, Paris, 75011, France

    Zoubir Belkheyar

  5. Department of Hand and Upper Extremity Surgery, Edouard Herriot Hospital, 5 Place d’Arsonval, Lyon, 69003, France

    Laurent Mathieu

  6. Department of Surgery, French Military Health Service Academy, Ecole du Val-de-Grâce, 1 Place Alphonse Laveran, Paris, 75005, France

    Laurent Mathieu

  7. Military Biomedical Research Institute (IRBA), 1 Place Général Valérie André, Brétigny-sur-Orge, 91220, France

    Laurent Mathieu

Authors
  1. Aurore Lemaire-Petit
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  2. Alexia Milaire
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  7. Zoubir Belkheyar
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  8. Laurent Mathieu
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Contributions

A.C., J.N.B., L.M. and Z.B. operated the patients. A.L.P., A.M., C.R., and S.A. collected the data. L.M. supervised the study and analyzed the data. A.L.P. and L.M. and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Laurent Mathieu.

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Ethics approval

This study was approved by our review board (Protocol No 42-2019 HIA-CS).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no competing interests.

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Lemaire-Petit, A., Milaire, A., Amar, S. et al. Surgical treatment of painful neuroma in amputated and non-amputated patients: does the level of neurotomy affect clinical outcomes?. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02529-4

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  • DOI: https://doi.org/10.1007/s00068-024-02529-4

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