Overview

About this study

Regenerating axons from a severed nerve forms a neuroma when it does not have the distal end to grow into.  The proximal end forms a thickening that contains myofibroblasts, inflammatory cells, disorganized regenerating axons with a larger proportion of small diameter, unmyelinated fibers, and an unrestrained growth of perineural cells. Not all neuromas are painful, but a symptomatic neuroma can cause significant physical and psychological disability.  Painful neuromas develop in 2% to 60% of patients with a nerve injury.  Numerous pharmacologic, physical, psychological, and surgical interventions have been described; but there is no consensus on the optimal treatment.  Meta-analyses on surgical treatment showed that surgical intervention significantly reduced pain in 70 to 77% of patients.  There were no significant differences between excision only, excision and transposition, excision and cap, excision and repair, or neurolysis and coverage.

Relocation nerve grafting is one technique of excision and transposition wherein the axons regenerating after excision of the neuroma are given a runway to a less stimulating destination.  This runway is provided by a nerve allograft microsurgically repaired to the proximal end of the cut nerve and its free terminal end is directed away from the painful area.  A nerve allograft aids in translocating neuromas growing near branch points where there is no more proximal length of nerve to redirect.  It also decreases the amount of nerve dissection necessary for translocation, decreasing the risk of injuring other cutaneous nerve branches and forming new neuromas. The terminal end of the allograft was shown in rats to have reduced axon numbers compared to an untreated injured nerve end.6  Relocation nerve grafting to interossei after excision of digital nerve neuromas in an amputated index finger resulted in complete pain resolution in one case report. 

The purpose of this study is to review the long-term results of relocation nerve grafting for management of painful neuromas.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

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